hollis day, md, ms susan meyer, phd. four domains for effective practice outlined in the...
TRANSCRIPT
Four domains for effective practice outlined in the Interprofessional Education Collaborative’s “Core Competencies for Interprofessional Collaborative Practice:”
1. values/ethics 2. roles/responsibilities 3. communication4. teams/teamwork
Background
Most health professions have interprofessional education as expectations in their accreditation standards
There is a need to evaluate a learner’s ability to work and communicate effectively in teams
To date, few validated tools for assessment of interprofessional competency attainment have been identified
Background
Identify tools used in healthcare settings to assess the performance of teams
Propose how these tools might be translated into the medical education environment
Authors chose the one domain of “Teams/Teamwork” to determine if there was a tool or tools that evaluated each of the 11 individual competencies
Objectives
Competency (TT)
1 Describe the process of team development and the roles and practices of effective teams
2 Develop consensus on the ethical principles to guide all aspects of patient care and team work
3 Engage other health professionals - appropriate to the specific care situation-in shared patient-centered problem-solving
4 Integrate the knowledge and experience of other professions-appropriate to the specific care situation-to inform care decisions while respecting patient and community values and priorities/preferences for care.
5 Apply leadership practices that support collaborative practice and team effectiveness.
6 Engage self and others to constructively manage disagreements about values, roles, goals and actions that arise among healthcare professionals and with patients and families.
7 Share accountability with other professions, patients, and communities for outcomes relevant to prevention and healthcare.
8 Reflect on individual and team performance for individual as well as team performance improvement
9 Use process improvement strategies to increase the effectiveness of interprofessional teamwork and team-based care
10 Use available evidence to inform effective teamwork and team-based practices.
11 Perform effectively on teams and in different team roles in a variety of settings.
Teams/Teamwork Competencies
Teamwork, teamwork assessment and valid Databases included: PubMed, HaPI, ERIC,
PsychInfo, Cochrane Library Bibliographies of articles were hand searched
as well Tools assessed measured performance of
teams of two or more healthcare providers, including a physician and at least one other health professional
Methods
Included articles reported measures of reliability and validity
Only articles published in English were reviewed
Methods: Inclusion criteria of articles
Conference abstracts and articles that focused on patient care outcomes
Attitudinal questionnaires as we were seeking instruments that assessed specific behaviors
Methods: Exclusion criteria
Authors independently reviewed each of the tools and mapped individual elements of the tools to one of the Teams/Teamwork competencies
Discrepancies were discussed and mutually resolved
Methods
TT3 and 4 (Engaging other healthcare professionals and integrating the knowledge and experience of other health professionals in shared decision making) were collapsed into one item for the purposes of tool development as it was difficult to identify differences between the two competencies when looking at existing tools
Methods
2281 references were identified From these references, 68 unique tools with
reported validity and reliability or use in multiple settings were chosen
No one tool evaluated all of the Team/Teamwork competencies
There were no tools that assessed TT2 and few tools outlined behaviors for TT1 or TT11
Results
CompetencyInstrument Item wording
Number of items addressing competency Unique statements SM tool wording
HD tool wording
1. Describe the process of team development and the roles and practices of effective teams 10Establishes a leader
The team establishes a leader.
The team establishes a leader
24
The group is spending its time planning how it will get its work done
Assigns roles and responsibilities
Team members assume specific roles and responsibilities.
The team assigns roles and responsibilities
31Establish the leader, form the team, set team goals Establishes a work process
The team follows a clear work process.
The team establishes a work process
31Assign roles and responsibilities to team members
36
Leaders and helpers were identified among the team members (roles can change)
42 AOTPLeader identified
42 AOTP
Roles and responsibilities of team members clear; quickly establish roles
42
Leader identified and encourages participation and identifies opportunities for improvement
64Team follows a clear structure and time format
64Team is prepared with respect to materials and information
64Team avoids distraction/focuses on the task at hand
Sample Mapping Strategy
SM tool wording HD tool wording Our Tool
The team establishes a leader. The team establishes a leader The team establishes a leaderTeam members assume specific roles and responsibilities.
The team assigns roles and responsibilities
The team assigns roles and responsibilities
The team follows a clear work process. The team establishes a work process
Sample Mapping Strategy
Competency Our Tool Items1. Describe the process of team development and the roles and practices of effective teams
The team establishes a leaderThe team assigns roles and responsibilitiesTeam members execute roles in integrated manner.
2. Develop consensus on the ethical principles to guide all aspects of patient care and team work3. Engage other health professionals - appropriate to the specific care situation-in shared patient-centered problem-solving 4. Integrate the knowledge and experience of other professions-appropriate to the specific care situation-to inform care decisions while respecting patient and community values and priorities/preferences for care.
The team engages all relevant team members in decision making, integrating individual assessments of patient needs
5. Apply leadership practices that support collaborative practice and team effectiveness. The team leader varies depending upon the
situationThe team leader showed an appropriate balance between authority and openness to suggestionsThe team leader recognizes contributions of team members
Mapping to Our Tool
Competency Our Tool6. Engage self and others to constructively manage disagreements about values, roles, goals and actions that arise among healthcare professionals and with patients and families.
The team agrees upon and uses a process to resolve conflicts to determine not who is right but what is right for the situation
7. Share accountability with other professions, patients, and communities for outcomes relevant to prevention and healthcare.
Team members mutually agree upon goals.Team members seek assistance when needed.Team members provide assistance when needed.Team members respectfully correct each other's mistakes to ensure that procedures are followed properly
8. Reflect on individual and team performance for individual as well as team performance improvement
Team members openly talk about what is and isn't working
9. Use process improvement strategies to increase the effectiveness of interprofessional teamwork and team-based care
The team gets, gives, and uses feedback about its effectiveness and productivity
10. Use available evidence to inform effective teamwork and team-based practices.
Team members refer to established protocols/ checklists for the procedure/intervention
11. Perform effectively on teams and in different team roles in a variety of settings.
Team member skills overlap sufficiently for work to be shared when necessaryWhen appropriate, roles are shifted to address changing situations
Mapping to Our Tool
1. The team establishes a leader. 2. The team assigns roles and responsibilities.3. The team engages all relevant team members in decision
making, integrating individual assessments of patient needs.
4. The team leader varies depending upon the situation.5. The team leader showed an appropriate balance between
authority and openness to suggestions.6. The team leader recognizes contributions of team
members.7. The team agrees upon and uses a process to resolve
conflicts to determine not who is right but what is right for the situation.
8. Team members mutually agree upon goals.
Final Tool Items
9. Team members seek assistance when needed.10. Team members provide assistance when needed.11. Team members respectfully correct each other's
mistakes to ensure that procedures are followed properly.12. Team members openly talk about what is and isn't
working.13. The team gets, gives, and uses feedback about its
effectiveness and productivity.14. Team members refer to established protocols/checklists
for the procedure/intervention.15. Team member skills overlap sufficiently for work to be
shared when necessary.16. When appropriate, roles are shifted to address changing
situations.
Final Tool Items Con’t
TT Competency Behavioral Expectation Level 1 Level 2 Level 3
1 The team establishes a leader.
No leader established. Leader emerges de facto rather than through explicit process.
Leader explicitly established.
1 The team assigns roles and responsibilities.
Team members unsure of roles and responsibilities.
Team members have roles that may be duplicative or inappropriate, or needed roles are unfilled.
Team members have explicit, complementary tasks and assignments.
3-4 The team engages all relevant team members in decision making, integrating individual assessments of patient needs.
Team members work individually, without input from others.
Minimal interaction among team members for decision making.
Team members execute roles in integrated manner.
Translating to Educational Setting
Articles only in English We did not explicate TT2 on our tool All tools created for physician engagement Tools are often context specific so taking
them out of context may change their designated purpose
Limitations
While there are multiple tools addressing teamwork in healthcare, no one tool addresses all of the competencies in the teamwork domain
It is possible through an iterative process to
develop a tool that can be applied to the educational setting
Conclusions
Further refine and validate the tool Informed item development for TT2 Identify ways in which this tool may assist
residency and health science schools in meeting accreditation standards
Future Directions
Presented at All Together Better Health Interest in participating in validation
Future Directions: Immediate