Hollis Day, MD, MS Susan Meyer, PhD. Four domains for effective practice outlined in the Interprofessional Education Collaborative’s “Core Competencies.

Assessment of Teams/Teamwork: A

Critical SynthesisHollis Day, MD, MSSusan Meyer, PhD

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

SDRME for funding this project Maria Magone for outstanding research

assistance

Thanks