Collaborative Caring: Stories and Reflections on Teamwork in Health Care

[Excerpt] There are many theoretical and conceptual books and countless articles that have explored issues of teamwork in general and teamwork in health care in particular. The editors, and many of the authors in this book, have read most, and have even written some of them. To tackle the issue of teamwork, we have, however, taken a different approach. Rather than write a theoretical book about what teamwork is, what it is not, where it exists in health care, what barriers prevent its implementation and how they can be removed, we have chosen instead to address these questions through narratives and reflections that vividly describe good teamwork as well as problems in creating, leading, and working on genuine teams. What we believe is too often lacking in the literature is a clear and compelling picture of what teamwork looks like on the ground, in the institutions where health care work is delivered and where teams play well, or don\u27t play well, on a daily basis. The question we ask here is thus: What is the state of play in most health care institutions? To describe the state of play, we have asked clinicians to write what we think of as where the rubber hits the road stories or reflections about the nature of teamwork in their own particular work setting. To gather these stories, we talked to many people in different health care disciplines. In the invitation for submissions we wrote the following: We are seeking short, concise narratives that describe a concrete example in which you personally have been involved. The idea here is not to focus so much on the individual doctor-patient, nurse-patient, therapist-patient communication but the teamwork that was involved in ensuring that the standard of care was met or exceeded. If the patient or family was involved, so much the better. Stories can deal with interprofessional or intraprofessional teamwork. On balance, we would prefer to have more stories about interprofessional or occupational teamwork. Nonetheless, we recognize that interprofessional work depends on the ability to create teamwork within an occupation or profession. Stories involving support staff, such as housekeepers who spoke up about a patient safety issue, are definitely within the purview of this book. We would also welcome personal reflections that would enhance our understanding of either how to produce genuine teamwork or the obstacles that stand in its way

To Fib or Not to Fib: Misdiagnosis of Atrial Fibrillation on Telemetry Case Presentation and Root Cause Analysis

Case presentation, current practices of telemetry management, root cause analysis, goals for improvement, proposed intervention and next steps

Shared Decision Making: Where Evidence Based Medicine Meets Patient-Centered Care

Shared Decision Making bridges patient-centered care with evidence based medicine, while at the same time highlighting the tensions between them. Shared decision making, a structured form of patient-centered communication, includes information exchange, deliberation and consensus building and is advocated in clinical situations where the evidence leaves room for more than one medically reasonable choice. Based on the ethical principal of patient autonomy, the central tenants of shared decision making are: understanding the patient from a bio-psychosocial perspective, empowering the patient to be an active participant in the decision making process, and incorporating patients’ values and preferences into the decision. In the context of chronic disease care the provider patient relationship becomes a paramount. Shared decision making has been shown to increase patient knowledge, decrease consultation time, improve patient satisfaction, and reduce decisional conflict. However translating shared decision making into clinical practice remains difficult. A complex intervention, implementation requires provider behavior change as well as skills training for the competencies of shared decision making which includes patient-centered communication and conveyance of risk. Decision support interventions, especially through the use of decision aids, assist the process of shared decision making. Assessing quality in patient-centered decision making remains a challenging task. Quality monitoring programs using current performance measures fail to account for patient-centered care and are even at odds with it. Clear definitions of high quality decision making and patient-centered measures need to be developed and operationalized for use in quality monitoring in clinical practice in order to including patient centered decision making in measurement of quality care. Financial incentives such as pay for performance need to be realigned to support patient-centered care and to encourage patient-centered decision making. Practice guidelines need to be made more patient-centered by making preference sensitive decision points explicit and including tools of shared decision making, such as decision aids, directly into their content. Broader systemic changes are needed to create a system that values and rewards patient-centered care and shared decision making.Master of Public Healt