Action 5.5

The health service organisation has processes to:

a. Support multidisciplinary collaboration and teamwork

b. Define the roles and responsibilities of each clinician working in a team

Intent

Clinicians are supported to work in collaborative multidisciplinary teams, and they understand their own roles and responsibilities, and those of other team members.

Reflective questions

How do multidisciplinary collaboration and teamwork operate in the health service organisation?

How are the roles and responsibilities of each clinician working in a team defined? How is this communicated to team members and the patient?

Key task

Develop structured processes to support multidisciplinary teamwork and collaboration.

Strategies for improvement

Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Given the complexity of health care, teams and clinicians may change regularly or over time, depending on the needs of the patient.6,7 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Some Australian programs targeting improvements in multidisciplinary teamwork include:

  • In Safe Hands (NSW Clinical Excellence Commission)
  • TeamSTEPPS® – Team Strategies and Tools to Enhance Performance and Patient Safety (SA Health).

Although interventions to improve multidisciplinary teamwork and collaboration vary, there are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11,12,13 

Work with local clinical teams to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Day Procedure Services

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced risk of complications of medical care and reduced risk of surgical complications or death.9,10 To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

Examples of tools and processes that can help to structure and facilitate effective teamwork are:

  • Structured opportunities for multidisciplinary team communication
  • The surgical safety checklist
  • Evidence-based scoring systems, such as the Aldrete or PADDS score
  • Structured communication tools such as ISBAR (see Action 6.7).

In a day procedure service, the multidisciplinary team may include the referring clinician, anaesthetist and nurse involved in delivering care for the patient.

Consider providing formal training in teamwork and communication.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Examples of evidence

Select only examples currently in use:

  • Policy documents or by-laws that outline structured communication processes that are used to ensure that members of the workforce understand their delegated roles and responsibilities when working as a multidisciplinary team
  • Audits on clinical handover
  • Employment documents that describe the roles, responsibilities and accountabilities of the workforce
  • Organisational chart and delegations policy that show clinical governance reporting lines and relationships.
MPS & Small Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. MPSs and small hospitals will need to develop structured processes to support multidisciplinary teamwork and collaboration. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Teams and clinicians in MPSs and small hospitals are likely to change regularly as agency or locum clinicians come and go. This poses a challenge to effective teamwork. There are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11,12,13

Examples of tools and processes that can help to structure and encourage effective teamwork include:

Work with clinicians to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Action 5.6

Clinicians work collaboratively to plan and deliver comprehensive care

Intent

Clinicians work together to plan and deliver comprehensive care in partnership with patients, carers and families.

Reflective question

How are clinicians supported to collaborate with each other, patients, carers and families in planning and delivering comprehensive care?

Key task

Ensure that clinicians use organisational processes and collaborate with each other, and with patients, carers and families, to plan and deliver comprehensive care.

Strategies for improvement

Hospitals

Use the Partnering with Consumers Standard to guide the development of processes for comprehensive care.

Collaborate with patients, carers and families

Collaborating with patients, carers and family members can ensure that essential baseline information about a patient’s condition is established so that deterioration, improvement and strategies for ongoing care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.16

As well as being experts in care needs, information providers and part of shared decision making, carers and other family members may also choose to be actively involved in a person’s care.17Health service organisations can support carers in this role through policies and programs that enable practical strategies such as providing beds or chairs for overnight stays, refreshments, discounted parking and flexible visiting hours. An example is the 40 unique carer zones [video] that were commissioned in single rooms across the new clinical services building at Blacktown Hospital, Sydney. Formal, agreed procedures governing the program were created in partnership with consumers.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families. Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.18 Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, interventions and care.19

One model for shared decision making describes five questions that clinicians can use to guide the process19,20:

1. What will happen if the patient waits and watches?

2. What are the test or treatment options?

3. What are the benefits and harms of each option?

4. How do the benefits and harms weigh up for the patient?

5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

The Commission has also developed a Question Builder tool to help patients, carers and families consider questions to ask their doctor and prepare for a clinical consultation.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.21 Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.22

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard) to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

Interventions to improve teamwork vary, but broadly include23:

  • Training to increase individual competence of team members and offer the opportunity to practise skills (for example, in simulation or role play)
  • Structured communication protocols to increase reliability of communication
  • Clear articulation of the roles, responsibilities and accountabilities of different team members
  • Work and process redesign to provide structured opportunities for effective team communication.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.22 These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.22,24 Set up processes to support clinicians to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.25 Strategies may include:

  • Using structured handover and communication tools26
  • Using checklists to prompt discussion of patient, family and clinical concerns during bedside rounds27
  • Using tools to prompt participation from different professional groups at critical moments – for example
  • Identifying roles and responsibilities relating to comprehensive care in position descriptions and scope of clinical practice documentation
  • Identifying accountabilities relating to collaboration, teamwork, shared decision making and other key skills, attitudes and behaviours required for comprehensive care in performance review processes
  • Identifying clinical and executive leaders to lead collaborative practice and act as role models
  • Developing processes to manage issues and feedback relating to multidisciplinary collaboration.

Work with clinical leaders to directly and specifically deal with the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be especially apparent in the relationships between clinicians, and between clinicians and other professional groups.13,28-29 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.22 Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.30-31

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.

Day Procedure Services

Use the Partnering with Consumers Standard to guide the development of processes for comprehensive care.

Collaborate with patients, carers and families

Pre-admission screening and assessment processes require collaboration with patients, carers and family members to ensure that essential baseline information about a patient’s condition is established. This is so that deterioration, improvement and strategies for comprehensive care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.16

Carers may be able to assist in providing strategies for managing a patient’s care during a procedure, and may wish to be actively involved in the provision of care.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families during pre-admission assessment and comprehensive care planning. Shared decision making may occur between the referring clinician and the patient before admission to the day procedure service. However, do not assume that this has happened: include requirements relating to shared decision making in by-laws and screening processes, and provide information about shared decision making to all clinicians, including referring clinicians.

Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.17 Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, procedures and care.18

One model for shared decision making describes five questions that clinicians can use to guide the process18,19:

1. What will happen if the patient waits and watches?

2. What are the test or treatment options?

3. What are the benefits and harms of each option?

4. How do the benefits and harms weigh up for the patient?

5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.20 Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.213

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard) to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.21 These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.21,22 Set up processes to support clinicians (including credentialed medical and other practitioners) to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.23

By-laws should address the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be particularly apparent in the relationships between clinicians, and between clinicians and other professional groups.24-27 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.28 Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.29-31

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.

Examples of evidence

Select only examples currently in use:

  • Resources and tools, including decision aids or pathways, that outline accountabilities of clinicians and promote collaborative practice (for example, whiteboards, electronic journey boards)
  • Examples of activities that have been implemented and evaluated to improve organisation of care delivery routines and workflow
  • Observation of collaborative work to plan and deliver care
  • Feedback from consumers about how clinicians worked together to deliver care
  • Data from patient and carer experience surveys about collaboration and teamwork among clinicians.
MPS & Small Hospitals

Collaborate with patients, carers and families

Collaborating with patients, carers and family members can ensure that essential baseline information about a patient’s condition is established so that deterioration, improvement and strategies for ongoing care can be identified. For example, the carer of a person with advanced dementia is likely to be the most accurate source of information about that patient’s usual capabilities, behaviours, preferences and medical history.16

As well as being experts in care needs, information providers and part of shared decision making, carers and other family members may also choose to be actively involved in a person’s care.17Health service organisations can support carers in this role through policies and programs that enable practical strategies such as providing beds or chairs for overnight stays, refreshments, discounted parking and flexible visiting hours.

Implement shared decision making

Shared decision making is a critical strategy for effectively collaborating with patients, carers and families. Shared decision making is a process of incorporating the best available clinical evidence into a discussion about a patient’s values and preferences to make decisions about care.18 Shared decision making offers a framework for working jointly with patients (and carers and families, if the patient chooses to have them involved) to make decisions about the comprehensive care plan that are based on a shared understanding of the patient’s goals of care, and the risks and benefits of clinically appropriate options for diagnostic tests, treatments, interventions and care.19

One model for shared decision making describes five questions that clinicians can use to guide the process19,20:

1. What will happen if the patient waits and watches?

2. What are the test or treatment options?

3. What are the benefits and harms of each option?

4. How do the benefits and harms weigh up for the patient?

5. Does the patient have enough information to make a choice?

Another model, framed from the patient perspective, is Ask Share Know, which encourages patients to ask three questions about their care.

The Commission has also developed a Question Builder tool to help patients, carers and families consider questions to ask their doctor and prepare for a clinical consultation.

Use decision support tools

Decision aids are a type of decision support tool that clinicians, patients, carers and families can work through together. Specific decision aids have been developed for some health topics, and an online inventory of existing tools is available.

generic decision aid tool has also been developed to help clinicians, patients, carers and families work together to make decisions if no specific decision aid is available.

Strengthen teamwork processes

No single clinician can deliver all aspects of the care that a patient needs.21 Different clinician groups bring specific expertise and need to work together to provide the complete health care that a patient requires. Effective teamwork and collaboration rely on establishing and communicating clear and shared goals. These goals should have meaning for each team member who contributes to the effort to achieve them.22

Use processes for clinical handover, communicating critical information and documenting information (described in the Communicating for Safety Standard), to ensure that clinicians collaborate effectively to plan and deliver comprehensive care.

Interventions to improve teamwork vary, but broadly include23:

  • Training to increase individual competency of team members and offer the opportunity to practise skills (for example, in simulation or role play)
  • Structured communication protocols to increase reliability of communication
  • Clear articulation of the roles, responsibilities and accountabilities of different team members
  • Work and process redesign to provide structured opportunities for effective team communication.

The professional cultures associated with different disciplines and specialty groups can strongly influence the way that clinicians approach goal-setting and decision-making.22 These cultures contribute to differing degrees of engagement in working collaboratively with other disciplines and professions.22,24 Set up processes to support clinicians to understand their own accountabilities in relation to planning and delivering comprehensive care, and those of other members of the team.25 Strategies may include:

  • Using structured handover and communication tools26
  • Using checklists to prompt discussion of patient, family and clinical concerns during bedside rounds27
  • Using tools to prompt participation from different professional groups at critical moments – for example
  • Identifying roles and responsibilities relating to comprehensive care in position descriptions and scope of clinical practice documentation
  • Identifying accountabilities relating to collaboration, teamwork, shared decision making and other key skills, attitudes and behaviours required for comprehensive care in performance review processes
  • Identifying clinical and executive leaders to lead collaborative practice and act as role models
  • Developing processes to manage issues and feedback relating to multidisciplinary collaboration.

Work with clinical leaders to directly and specifically deal with the expectations for clinicians’ participation in teamwork for comprehensive care. Suboptimal collaboration and communication can be especially apparent in the relationships between clinicians, and between clinicians and other professional groups.28,29-31 Such problems have been attributed to issues arising from traditional professional hierarchies and cultures, and the relative seniority of the clinicians involved.22 Improving the organisation of care delivery routines (such as structured multidisciplinary bedside rounds) within the workflow can help provide opportunities for more effective communication and collaboration between clinicians and other professional groups.32-34

Monitor, analyse and report on system effectiveness

Develop systems consistent with the requirements of the Clinical Governance Standard for reporting and analysing adverse events relating to failures of teamwork and communication, and for ensuring that clinicians are professionally accountable for working collaboratively with patients, carers, families and each other in the planning and delivery of comprehensive care.

Last updated 4th July, 2018 at 11:56pm
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