Building the Multidisciplinary Team

1. Building the Multidisciplinary Team AACN Nurse Manager Priorities Thursday September 19, 2013 Julie Lindeman Read, RN, M.S. Area Quality Leader Kaiser Foundation Hospitals Fremont Medical Center Fremont, CA Chapter President, South Bay AACN

2. Learning Objectives • Identify various stages of team development • Describe methods to build a highly effective multidisciplinary team • Discuss strategies to improve multidisciplinary collaboration

3. Together Everyone Achieves More • Theory • How teams work • Stages of Team Development • Application • Building a collaborative multidisciplinary leadership team in the Critical Care Unit • Building your unit-based multi-disciplinary care team

4. What is a team? A small number of people with complementary skills who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable -Katzenbach and Smith

5. Multidisciplinary Team Math “2+2 =8” Kohn and O’Connell, 2007 The 6 Habits of Highly Effective Teams

6. What are your teams? • Hospital Executive Leadership • Nursing Leadership (Hospital) • Critical Care Division • Nursing Leadership (ICU) • Unit Leadership Team (Multi-disciplinary) • Staff committees • Multi-disciplinary care team on your unit

7. Essentials for a team • Common commitment and purpose • Performance Goals • Complimentary Skills • Mutual Accountability

8. Common commitment and purpose • Purpose is distinctive • Purpose specific to the group • Promote member buy-in • Whole becomes greater than the individual contributions

9. Performance Goals • Compelling - Develop shared purpose • Often are developed outside the team • Specific and measurable • Well communicated and understood

10. Complimentary Skills • Technical or functional expertise • Problem-solving skills • Decision making skills • Interpersonal skills

11. Mutual Accountability • Built-in accountability • Seek to achieve milestones in a coordinated way • Responsibilities clear • Every individual is responsible for success or failure in achieve shared goals

12. Stages of Team Formation • Forming • Storming • Norming • Performing Theory developed by Bruce Tuckerman, 1965

13. Forming • High dependency on leader • Guidance and direction • Clarification of purpose and objectives • Little agreement on team goals • Individual roles and responsibilities unclear • Processes unclear or ignored • Members test tolerance of system and leader Kohn and O’Connell 6 Habits of Highly Effective Teams pp 56-63

14. Storming • Clarity of purpose increases but uncertainty persists • Decisions difficult • Team members vie for position • Team members may challenge leader • Cliques, factions, power struggles • Compromises may be required • Need to focus on goals

15. Norming • Agreement and consensus • Commitment and unity strong • Leader plays a facilitating and enabling role • Roles and responsibilities are clear and accepted • Big decisions made by group agreement; small decisions delegated to individuals or small teams within the group • Team may engage in fun and social activities • Team discusses and develops processes and working style • Respect for the leader • Some leadership is shared by team

16. Performing • Clarity on purpose and processes • Shared vision • Focus on over-achieving goals • Shared decision making with leader • Team has a high degree of autonomy • Team works toward achieving the goal and also attended to relationship, style, and process • Little direction is needed from the leader; may ask leader for assistance with personal and interpersonal development

17. Drexler/Sibbet Team Performance Model • Stage 1: Orientation • Stage 2: Trust building • Stage 3: Goal Clarification • Stage 4: Commitment • Stage 5: Implementation • Stage 6: High Performance • Stage 7: Renewal

18. 6 Habits of Highly Effective Teams • Entrusting Team Members with Appropriate Roles • Establishing and Regulating Team Norms • Thinking Laterally • Strengthening Emotional Capacity to Improve Team Relationships • Expanding Team Self-Awareness • Practicing Empathy and Respectfulness

19. Establishing a Multidisciplinary Leadership Team in the Critical Care Unit • Why bother? • Where should you start? • What are the rewards? • What are the potential barriers?

20. AACN Standards for Establishing and Sustaining a Healthy Work Environment Skilled Communication Meaningful Recognition True Collaboration Appropriate Staffing Authentic Leader- ship Effective Decision Making

21. “True Collaboration” • Partnership • Power of both sides valued by both • Recognition and acceptance of separate and combined practice spheres • Mutual safe-guarding of the interest of each party • Commonality of goals recognized by each party Amer Nurses’ Assoc 1980. Nursing :A Social Statement. Kansas City, Mo.

22. Why collaborate? • To establish an effective multidisciplinary team all participants must be involved in problem-identification and resolution • Improves cooperation across disciplines • Creates an environment that encourages high quality care *

23. Literature Supporting Collaboration “Collaboration between surgeons, anesthesiologists and nurses decreased risk- adjusted morbidity and mortality.” -Young et al. (1997). Health Care Management Review “Collaboration between physicians and nurses was related to better patient outcomes in ICUs” -Baggs et al. (1992). Heart and Lung “Job satisfaction and workplace empowerment positively related to collaboration” -Laschinger et al. (2003). J NursAdm

24. CASE STUDY • A real life experience with developing a collaborative ICU Leadership Team • The Team: Medical Director, ICU Manager, Critical Care Clinical Nurse Specialist, Respiratory Therapy Manager • 22 bed combined Medical-Surgical-Cardiac ICU in a Community Hospital within a large Managed Care Organization

25. Create your Vision • Excellence in patient care • Continuous staff development • To make the ICU the “Best in the Bay Area”

26. Establish Goals • Evidence-based practice • Multidisciplinary care • Advanced education • Organized systems • Standardized workflow • Staff participation

27. Assess your current teamwork climate • Barriers • No established process to support collaborative model • Daily unit operations • Capacity/census growth • Nursing shortage • High staff vacancy • High use of registry, • Environmental challenges • Unit culture • Ingrained patient care practice • Exclusive focus on direct patient care • Individual based approach to problem solving • Lack of objective information on current performance

28. Insufficient Data for Change • Lack of demographic, quality and outcome data • Inaccurate quality data collection and analysis • Outcome data not linked to clinical practice

29. Potential for Fostering Collaboration • People • Collaborative practice promoted by ICU leadership • Dedicated CNS • 24 hravailability of intensivists and manager • Unit structure • Combined ICU • 1:2 ratio • Multi-hospital system • Regional forum • Focused training program • Technology *

30. Organizing Collaborative Improvement • Define responsibilities and assignments • Strategic planning • Communicate with staff • Actively engage staff

31. Role definition • Defining Roles • Unit operations • Decision-making • Challenges • Breaking down the traditional roles • Respecting each other’s turf • Communication (within the team and with staff)

32. Strategic planning • Determine areas of focus • Development of timelines • Identify key personnel *

33. Communication of Vision/Goals to Staff • Being cognizant of previous leadership vision, direction, style • Understanding interpersonal relationships • Identifying staff motivation • Communication • Unified message • Staff input • Meeting logistics

34. Out with the OLD Individual rounding Fragmented leadership communication Reactive problem solving Short-term goals Ad-hoc meetings In with the NEW Multidisciplinary rounding Joint leadership meetings Strategic planning Goals: immediate, future Timelines Interdisciplinary team meetings Changing the system

35. Tools for achieving successful outcomes • Constant communication • Regular leadership team meetings • Jointly led staff meetings • Unit Advisory Council • Timelines • Practice Protocols • Data collection tools • Standardized Report to Leadership • Strategic Timeline with short and long term goals

36. Measuring Success • Determine desired outcomes of collaboration • Assess baseline status • Establish timeframes for measurement • Course correct based on achievement of outcomes *

37. Avoiding the Perils • Explain rationale for collaboration • Take into account the current unit culture • Set realistic goals • Communicate constantly • Communicate widely • Share your turf • Expect occasional setbacks • Have a plan for leadership transitions *

38. Reaping the Rewards • Improved patient outcomes • Streamlined workflow • Knowledge exchange between disciplines • Shared successes • Increased job satisfaction • Ongoing professional collaboration

39. Suggested Outcome Measures • Timely achievement of established goals • Improvement in clinical outcomes • Increased operational efficiency • Improvement in patient satisfaction scores • Improvement in staff perception of safety climate • Feedback from staff

40. The Multidisciplinary Care Team • Value • Function • Members • Outcomes • Communication • Workflow

41. Multidisciplinary Care Team Members • Intensivist • Primary Nurse • Respiratory Therapist • Charge Nurse or Asst Nurse Manager • Critical Care Pharmacist • Physical Therapist • Clinical Dietician • Social Work or Patient Care Coordinator • Infection Preventionist • Palliative Care Coordinator • Spiritual Care

42. Tools for success • Determine Goals • Defined roles • Understand individual roles, expectation, and limitations • Implement Rounds • Participation • Scripts • Agreed upon outcomes • Time limits • Outcome measures • Share performance to goals frequently • Develop communication strategies

43. Building your team • Assess your current environment • Identify team members • Create your vision • Set performance targets (goals) • Communicate the vision and goals to the team • Develop team • Individual skills • Relationships • Trust • Adjust leadership style to stage of team development • Continue to nurture and develop team members

44. Bibliography and References • American Association of Critical Care Nurses. AACN standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care. 2005;14:187-197. • Baggs JG, Schmidt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991-1998 • Boyle DK, Kochinda C. Enhancing collaborative communication of nurse and physician leadership in two intensive care units. J Nurs Adm. 2004;2:60-70. • Brilli RJ, Spevetz A, Branson RD et al. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model.CritCare Med. 2001;29:2007-2019 • Disch J, Beilman G, Ingbar D. Medical directors as partners in creating healthy work environments. AACN Clin Issues. 2001;12:366-377 • Halm MA, Gagner S, Goering M, et al. Interdisciplinary Rounds: Impact on Patients, Families, and Staff. ClinNurs Spec. 2003;17:133-142. • KatzenbachJR, Smith DK. Best of HBR 1993: The Discipline of Teams . HBR. July-August 2005 • Katzenbach JR, Smith DK. The Wisdom of Teams. New York: Harper Collins, 2003. • Kohn SE and O’Connell VD. The 6 Habits of Highly Effective Teams. Pomptom Plains, NJ: Career Press; 2007. • LencioniP. The Five Dysfunctions of a Team. Jossey-Bass: San Francisco; 2002 • Patterson K, Grenny J, McMillan R, and SwitzlerA. Crucial Conversations, 2nd ed. New York: McGraw-Hill; 2012.