Develop Coalitions – Applying teamwork to develop patient centred coalitions Authors: G. Dickson, D. Dath, D. Blumenthal, J. Adolphe, J. Van Aerde, S. Tsuei, J. Pickard, D. Koff , L. Loh Advisory Panel: J Tepper, J Karpinski, K Stobart

BACKGROUND Coalition • A group of people or organizations outside of the direct

care team that share a common goal and pool theircapabilities to achieve that goal.

• Coalitions are built on relationships.Applying teamwork to coalition building � Integrated with competency of listening to patient voice.� Coalitions must be deliberately constructed to ensure all

providers involved in patient’s care create a seamlesspathway so that quality improvement informs practice.

INSTRUCTIONAL METHODS � Case and situation (i.e., real) based learning� Interactive workshop� Self-study—readings, assignments, portfolio� Online learning—chat groups, online assignments� On-site learning (e.g., hospital rounds, teaching sessions

by staff physicians, and/or peer teaching).� Program that integrates above methods

ASSESSMENT METHODS � Emphasis on formative vs summative

assessment� Applied assignments instructor reviewed—

think pieces re case; application of content toreal scenarios

� Observation—discussion participation; 360;online chats; peer /colleague interactions, Peerassessments—feedback on situations in whichresident demonstrates evidence of learning

� Self assessment—reflection on experiences,and plans to improve subsequent situations

INTENDED LEARNING OUTCOMES Beginning - The resident will: • Develop an awareness of the need to build coalitions to

maximize the quality of individual patient care.• Know the importance of understanding and clarifying

roles, responsibilities of various coalition partners.• Seek to engender and maintain trust in coalitions.• Demonstrate trust-building factors in classroom activities,

on the job, or while interacting with individuals frompotential coalitions.

Advanced - The senior resident will demonstrate: • The knowledge to build coalitions to maximize the quality

of population-based patient care.• The skills to seek out such knowledge; and the ability to

utilize it as appropriate for collective patient care.• The ability to explain and demonstrate factors that

engender and maintain trust in patient-centeredcoalitions.

TEACHER’S GUIDE • Beginning and advanced learning outcomes for

progression of learning.• Face-to-face, self study and online methods.• Teaching at point-of-care is vitally important;

can be augmented with small groupdiscussions, didactic sessions and onlinemodules.

• Link teaching to assessment for feedback andto summative assessments in the program.

• Share content re roles and responsibilities forbuilding coalitions and how to build trust.

• Story-telling : examples of coalitions built.• Description of workshops, activities, and

methods to apply and practice knowledge andskills of coalition building in case and real-lifescenarios experienced in the clinic/hospital/organization.

OTHER RESOURCES • Lawrence, P. R., Lynch, R. P. (2011)

Leadership and the Structure of Trust.• Coalitions work. Coalitions Work Tools.

http://coalitionswork.com/resources/tools/

CASE

Questions for Discussion

Questions for discussion: 1. What elements of this case suggest that the

coalitions that should exist between providers didnot--or if they did, were not working well?

2. What are the appropriate roles/ responsibilities ofdifferent partners (e.g. surgeon, ER doctor, nurse,staff, patient) in:

(a) the design of a well-understood patient pathway for recovery; (b) when unanticipated consequences are

experienced by the patient? 3. What factors would build trust amongst providers

and Frank to facilitate better communication,information sharing, and Frank’s confidence infollowing an appropriate recovery process?

OBJECTIVES � To show how the discipline of developing coalitions is

key to seamless patient care and quality improvement.� To outline how important defining roles &

responsibilities a creating trust are to an effectivecoalition.

Frank is a 38 year old, healthy man who underwent surgery for obstructive sleep apnea; he was discharged the next day. Over the next 3 weeks, Frank visited the ER 4 times and a community clinic once, each time with a high fever spike, general malaise and rigors. The acuity of symptoms had mostly disappeared by the time he arrived at the ER and was seen, each time 4-6 hours after the onset of the symptoms. After 5 such episodes, he wasadmitted and treated with IV antibiotics.

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