UW-BOISE INTERNAL MEDICINE RESIDENCY FACULTY DEVELOPMENT FEBRUARY 26, 2015 AMBER FISHER, PHARMD ELENA SPEROFF, NP BILL WEPPNER, MD MPH JANET WILLIS, RN Lost in Translation – Faculty Development for Facilitating Team Communication

What is an team?

Examples in Health Care? Clinic (Teamlet, PCMH/PACT) Ward team Emergency department Rapid response team Rehabilitation Palliative Care team PACT ICU These tend to be interprofessional

Definition of a interprofessional team “An interprofessional team is composed of members from different health professions who have specialized knowledge, skills and abilities” (IOM 2003)

Why do teams work well?

Characteristics of a high functioning interprofessional academic team Common goal (patient-centered) Members synthesize observations from their profession-specific expertise Collaborative work  In concern to achieve patient centered goal  Joint decision making is valued  Team members empowered to assume leadership in certain areas/times (with varying levels of supervision) Communicate well!

Why do we care about interprofessional communication? Well, we pretty much all work in teams There evidence improved outcomes and safety (Cochrane Rev 2009:CD000072)  Quality of care, lower costs, decreased LOS, reduced errors  Improved trainee satisfaction Increasing graduate school education There is increased interest on teaching trainees how to work in and lead interprofessional teams.

ACGME/ABIM Milestone Project

Parallel play to Collaboration One way to think of this (credit to Carole Warde, VA SAIL):  Task work (individual roles & responsibilities)  Team work (understanding, trust, communication)  Team processes (daily huddles/rounds, consults, meetings) Progression of:  Multidisciplinary teams  Interdisciplinary teams  Transdisciplinary teams

(and, yes we are doing a workshop at SGIM on it, too...) Faculty development – “train the trainer” Trigger tapes of team interactions The good, the bad, the ugly Structured evaluation tool from VA SAIL

Goals Measurable Learning Objectives: 1. Demonstrate strategies to effectively facilitate communication in interprofessional teams. 2. Apply an evaluation tool that has been used successfully for communication in interprofessional teams. 3. Practice skills in celebrating successes and addressing challenging situations in interprofessional education. Optional Objectives 4. Review key models of effective interprofessional team education. 5. Apply communication strategies to enhance interprofessional team function.

Evaluation tool Active listening People interrupt; do not encourage speaker’s story; are impatient to speak; judge responses; Two conversations frequently occur at once People listen without interruption or judgment; elicit other’s perspective; reflect back understanding; one person speaks at a time Trust Building People don’t share their feelings, thoughts or weaknesses with honesty People disclose feelings, weaknesses and relevant experiences appropriately Hold team members accountable for their behaviors People ignore misunderstandings and inappropriate behaviors; follow-up items aren’t done, nor discussed; there are negative response to being held accountable to tasks and behaviors People respond to others’ inappropriate remarks; address misunderstanding; follow up on the “to do” list; remind each other of agreed upon duties. Make decisions by consensus Poor participation in discussions; different opinions/solutions are discounted/judged; confusion about decisions, or they are not made; some members compromise their position Everyone participates openly in discussions; different opinions are encouraged; everyone suggests solutions, understands the decision and can explain it; final decisions are a synthesis of ideas, not a compromise Conflict Conflict is avoided and discouraged; disagreements are left unresolved before moving to another subject Teamlets learn from disagreement; members challenge each other about conclusions and opinions

Evaluation tool Give Constructive Feedback Giving feedback is avoided; occurs at an inappropriate time; when given, it criticizes, embarrasses or blames; behavior and effect on others is not described; alternative action is not suggested; responses of recipient are not heard; ends on a negative note Giving feedback is expected; behaviors and effect of actions on others are described; constructive changes are suggested; recipient response is encouraged and heard; negative feelings in recipient are avoided; ends on a positive note Receive Constructive Feedback Feedback is viewed as criticism; when received, recipient is defensive, angry or avoidant; lack of learning or change Feedback is appreciated; recipients feel safe and supported; it is used as an opportunity to learn or improve Emotional Management People disregard or are insensitive to emotional cues or others’ emotions. Negative emotions are avoided. People elicit, respond, name, understand and support other’s emotions. Support Change in Others People are surprised that change could ever occur in others; they are cynical and make discouraging remarks that incite defensiveness in others or tear down confidence People help others to see change positively; motivation and confidence for new behaviors are encouraged with discussion of barriers and positive remarks.

Workshop process Scenario #1 – all discuss evaluation tool TOGETHER  (don’t write anything) Scenario #2 – use evaluation tool INDIVIDUALLY  (write scenario # on top & hand in at end) Scenario #3 – use evaluation tool INDIVIDUALLY  (write scenario # on top & hand in at end)  Give feedback in comments