Communication in Teams: Facilitating Interprofessional Learning SGIM Annual Meeting 2015, Toronto April 24, 2015, 1:15 PM William Weppner, Maria Wamsley, Rebecca Brienza, Karen McDonough, Carole Warde, Shakaib Rehman, Elizabeth Eckstrom As you wait, think of who is on your clinical team?

Goals for this Workshop: 1.To enhance how you teach interprofessional (IP) team communication and collaboration 2.To practice using a framework for learning team communication 3.To share useful tools and references

Session Agenda Overview – Communication in IP Teams –Models of IP Education –Sharing Challenges –Team Function and Trigger tape #1 Trigger tape #2 Trigger tape #3 Wrap-up and Reflection

Who is on the Team?

"Interprofessional Education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care” UK Centre for Advancement of Interprofessional Education, 2002

How we learned in clinical settings Explicit teaching about: –Medical knowledge –Patient management Implicit learning about: –Team hierarchy –Team work and team communication –Other professions’ goals, roles, skills, perspectives

Unique Characteristics of IP Learning Each profession brings different: –Knowledge about the patient –Professional identity and culture –Perspective Effective IPE must recognize, incorporate, and encourage REFLECTION on these differences

But HOW can we ‘do IPE’ in the course of a busy day in the clinic or on the wards?

Faculty Development Framework Focus on collaborative practice settings Provide opportunities to specifically discuss IPE: Didactics - IP role modelling IP Faculty development – small group exercises Trigger tapes - reflection Tools for evaluation – experiential learning Structural changes – IP evaluation, presentation Feedback to other professions? Hall & Zierler, Journal of Interprofessional Care, published online, 14 July 2014 Steinert, Journal of Interprofessional Care, May 2005; supplement 1:60-75

Sharing Challenges “Generalists in Teams” –Generalists in Canada (forefront of IPE) –Leaders/models for IP teams –Know when things go wrong, i.e. “teachable moments” (vs. “horrible morasses”) –Need to be able to remediate (often in real time) –Frameworks to evaluate communication breakdown? –Methods of dealing with it in real time?

Examples of common problems?

–Role delineation (unknown skills, unknown level) –Expectations (different between professions) –Trust (lack of socialization) –Power & conflict –Knowledge deficit (how to evaluate/remediate between professions) –Confidence gap (how to balance with skill/supervision/knowledge) –Decisions (dictator vs. consensus) –Dealing with conflict (emotional dysregulation) –Feedback (giving/receiving/feeling safe to do so?) –Time pressure (differential in professions) –Punitive/cynical vs. optimistic/normalizing/self-deprecating. –Listening (situational or personality) –Communication

Goals of IP Learning Collaborate to improve each other’s education –Not learn with each, or near each other –Learn from & about each other (1) Collaborate to improve care of patient –Better quality (2) –More efficient (cost, utilization, length of stay) (2) –Fewer medical errors (2) 1.Hammick et al, Med Teach. 2007:209(8): IOM Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality; National Academy Press, 2003

A Model of Team Function A Model of Team Function TASK WORK Roles and Responsibilities Roles and Responsibilities Continuous Learning and Improvement TEAM WORK Build Trusted Relationships Communicate Respectfully TEAM PROCESSES Teamlet Meetings Teamlet Meetings Daily Huddles Daily Huddles Warde and Pearson 2015 TASK WORK Roles and Responsibilities Roles and Responsibilities Continuous Learning and Improvement TEAM WORK Build Trusted Relationships Communicate Respectfully TEAM PROCESSES Teamlet Meetings Teamlet Meetings Daily Huddles Daily Huddles Warde and Pearson 2015

Cohesive Teams: Communication is Key Engage in healthy conflict around ideas Accountability Trust Commitment Focus on Collective Results Inattention to Results Avoidance of Accountability Lack of Commitment Fear of Conflict Absence of Trust Willingness to be vulnerable, admit mistakes and weaknesses Adapted from Patrick Lencioni. The Five Dysfunctions of a Team Jossey Bass 2002

Vision and Values: –Every teamlet member is essential to Patient-centered Care –PCC is complex, changing and requires ongoing learning Teamlet Member Actions: –Speak-up, collaborate, experiment, reflect, admit vulnerabilities, and learn from failure –Communicate to improve teamlet coordination –Support others positively through change is essential Trust, Accountability and Change –Disagreement as an opportunity to improve team function –Boundary setting and holding others accountable create a safe practice environment What does it take to be a TEAM PLAYER?

A Team’s Interpersonal Climate 17 Psychological Safety: A climate in which people feel free to express feelings, ask questions, admit mistakes, and ask for help Accountability: the degree to which people are expected to adhere to high standards and pursue challenging goals Apathy Comfort Anxiety Learning

Team Communication Coaching Principles 1.Role Model Team Communication Behaviors –Self-awareness –Active listening –Appreciate Differences –Address Emotions –Disciplined Conversations 2.Build Commitment for Collaboration

Team Communication Coaching Principles 3.Foster a Safe Learning Environment –Withhold your opinions –Value each teamlet member –Convey your own fallibility 4.Provide Feedback 5.Frame failures for learning 6.Facilitate Discussion and Authentic Interactions 7.Foster Continuous Reflection (appreciative)

Summary Importance of explicit teaching about teamwork Faculty development strategies for enhancing explicit teaching about IP collaboration Challenges to IP collaboration Team communication coaching principles Framework for assessing team communication

Slides Communication in Teams Tool Trigger tapes development-interprofessional-education/ Transdisciplinary Work: Achieving More Than the Sum of the Parts Transdisciplinary work

UW Interprofessional Rounds Slides Communication in Teams Tool Trigger tapes development-interprofessional-education/ Interprofessional Rounds

Quality Improvement That Needs Improvement Slides Communication in Teams Tool Trigger tapes development-interprofessional-education/ Quality Improvement That Needs Improvement

Resources Slides Communication in Teams Tool Trigger tapes development-interprofessional-education/

References Warde C, Pearson M. An Interprofessional Education Program to Improve VA PCMH Team Function. (in preparation) Edmondson, A. Teaming. Jossey Bass. San Francisco 2012 Lencioni, P. The Five Dysfunctions of a Team: A Leadership Fable. Jossey Bass ( Suchman AL, Sluyter DJ, Williamson PR. Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology and Relationship-centered Care. Radcliffe Publishing. New York 2011.

Thank you!

DentistryMedicineNursingPharmacySW Team Communication xxxxx Roles & Responsibilities xxx Team work xxxx Practice with other professions xxx IPE Accreditation Requirements IPE Accreditation Requirements