Transcript Assessment of Teams/Teamwork: A Critical Synthesis
Hollis Day, MD, MS Susan Meyer, PhD
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Four domains for effective practice outlined in the Interprofessional Education Collaborative’s “Core Competencies for Interprofessional Collaborative Practice:” values/ethics roles/responsibilities communication teams/teamwork
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
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
Competency (TT) 1 2 3 4 5 6 7 8 9 10 11 Describe the process of team development and the roles and practices of effective teams Develop consensus on the ethical principles to guide all aspects of patient care and team work Engage other health professionals - appropriate to the specific care situation-in shared patient-centered problem-solving 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.
Apply leadership practices that support collaborative practice and team effectiveness.
Engage self and others to constructively manage disagreements about values, roles, goals and actions that arise among healthcare professionals and with patients and families.
Share accountability with other professions, patients, and communities for outcomes relevant to prevention and healthcare.
Reflect on individual and team performance for individual as well as team performance improvement Use process improvement strategies to increase the effectiveness of interprofessional teamwork and team-based care Use available evidence to inform effective teamwork and team-based practices.
Perform effectively on teams and in different team roles in a variety of settings.
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
Included articles reported measures of reliability and validity Only articles published in English were reviewed
Conference abstracts and articles that focused on patient care outcomes Attitudinal questionnaires as we were seeking instruments that assessed specific behaviors
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
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
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
Competency 1. Describe the process of team development and the roles and practices of effective teams Instrume nt Item wording 24 The group is spending its time planning how it will get its work done 31 Establish the leader, form the team, set team goals 31 Assign roles and responsibilities to team members 36 Leaders and helpers were identified among the team members (roles can change) 42 AOTPLeader identified 42 AOTP 42 Roles and responsibilities of team members clear; quickly establish roles Leader identified and encourages participation and identifies opportunities for improvement 64 Team follows a clear structure and time format 64 Team is prepared with respect to materials and information 64 Team avoids distraction/focuses on the task at hand Number of items addressing competency Unique statements SM tool wording HD tool wording 10Establishes a leader Assigns roles and responsibilities Establishes a work process The team establishes a leader.
Team members assume specific roles and responsibilities.
The team follows a clear work process.
The team establishes a leader The team assigns roles and responsibilitie s The team establishes a work process
SM tool wording The team establishes a leader.
Team members assume specific roles and responsibilities.
The team follows a clear work process.
HD tool wording The team establishes a leader The team assigns roles and responsibilities The team establishes a work process Our Tool The team establishes a leader The team assigns roles and responsibilities
Competency 1. Describe the process of team development and the roles and practices of effective teams Our Tool Items The team establishes a leader The team assigns roles and responsibilities Team members execute roles in integrated manner.
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.
The team engages all relevant team members in decision making, integrating individual assessments of patient needs The team leader varies depending upon the situation The team leader showed an appropriate balance between authority and openness to suggestions The team leader recognizes contributions of team members
Competency Our Tool 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.
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 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.
Team members openly talk about what is and isn't working The team gets, gives, and uses feedback about its effectiveness and productivity Team members refer to established protocols/ checklists for the procedure/intervention Team member skills overlap sufficiently for work to be shared when necessary When appropriate, roles are shifted to address changing situations
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The team establishes a leader.
The team assigns roles and responsibilities.
The team engages all relevant team members in decision making, integrating individual assessments of patient needs.
The team leader varies depending upon the situation.
The team leader showed an appropriate balance between authority and openness to suggestions.
The team leader recognizes contributions of team members.
The team agrees upon and uses a process to resolve conflicts to determine not who is right but what is right for the situation.
Team members mutually agree upon goals.
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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.
Team members openly talk about what is and isn't working.
The team gets, gives, and uses feedback about its effectiveness and productivity.
Team members refer to established protocols/checklists for the procedure/intervention.
Team member skills overlap sufficiently for work to be shared when necessary.
When appropriate, roles are shifted to address changing situations.
TT Competency
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Behavioral Expectation Level 1 Level 2 Level 3
The team establishes a leader.
The team assigns roles and responsibilities.
No leader established.
Team members unsure of roles and responsibilities.
The team engages all relevant team members in decision making, integrating individual assessments of patient needs.
Team members work individually, without input from others.
Leader emerges de facto rather than through explicit process.
Team members have roles that may be duplicative or inappropriate, or needed roles are unfilled.
Minimal interaction among team members for decision making.
Leader explicitly established.
Team members have explicit, complementary tasks and assignments.
Team members execute roles in integrated manner.
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
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
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
Presented at All Together Better Health Interest in participating in validation
SDRME for funding this project Maria Magone for outstanding research assistance