What barriers may prevent practitioners from effectively practicing team-based care?
What benefits could patients and physicians see with the team-based care model?
How can TeamSTEPPS be used to establish effective team-based care?
The practice of medicine often conjures up the image of talented, intelligent, hardworking doctors making life-or-death decisions about patients, with hardly a consideration for the execution of those decisions. In popular culture, the predominant images are of the cantankerous but brilliant doctor who connects the dots to solve an otherwise inscrutable mystery (à la House), or unflappable surgeons removing bullets from brains, unaffected by any chaos surrounding them (as in ER or Code Black). These images push aside the reality that doctors today are not silos of knowledge and experience; rather, they are members of an increasingly intricate medical system—a system that requires coordination, communication, and teamwork.1
It is an understatement to say that medicine has become more complex. Since the day when antibiotics were first added to the physicians tool-belt. With over 25,000 articles published on the PubMed site,2 over 1000 medications in use, and countless medication interactions,3 it is difficult for one physician to understand the state of medicine as it currently stands, let alone keep up with the pool of knowledge that is exponentially expanding.4
As a result of the increasing complexity of healthcare delivery, more and more errors are occurring in patient care. This is not because of gaps in knowledge by their providers or the inefficacy of procedures, but rather due to the intricacy of delivering the care needed in a multifaceted medical system. While it may have been possible in the past for a patient to be treated by one family physician, one recent study showed that today, a patient over the age of 65 has seen, on average, more than 28 physicians during their lifetime.5 Another study estimated that up to 400,000 deaths occurring in the hospital were related to errors, making this the third-leading cause of death in the United States.6
One approach to handling this staggering amount of information, dynamics, and complexity is to disperse the responsibility among several members of a care team. However, this cannot be done without significant foresight and training. Unfortunately, training in shared responsibility and high-quality teamwork is frequently lacking for many physicians, resulting in a significant number of medical errors pertaining to that lack of training.4
In an effort to improve not just outcomes for patients, but value in medicine and physician satisfaction, significant thought has been given to how team-based care can help. We will explore in this chapter the reasons behind team-based care, the principles underlying it, how it may be implemented, and examples where it has been employed successfully in the hospital to improve clinical outcomes.
WHY THE NEED FOR TEAM-BASED CARE