In 1987 when the late President Ronald Reagan famously urged Soviet leader Mikhail Gorbachev to “tear down this wall,” Reagan was referring to the heavily fortified barricade dividing East and West Berlin.
That same call to action can be heard in health profession training programs across the United States, but this time the plea has to do with the figurative wall separating doctors, nurses, dentists, biomedical scientists, health informaticians and public health officers.
“Everyone has typically worked independently making his or her own unique contribution,” says Patricia L. Starck, Ph.D., R.N., senior vice president of interprofessional education at The University of Texas Health Science Center at Houston (UTHealth). “That’s no longer good enough.”
Today’s caregivers are being challenged to do more with less and will have to work much more closely with their counterparts to accomplish this, Starck adds.
“Interprofessional education is central to preparing the modern health care workforce, and is an essential part of UTHealth’s ongoing commitment to providing our students with the best possible training,” says Giuseppe N. Colasurdo, M.D., president and Alkek-Williams Distinguished Chair at UTHealth.
To do that, UTHealth and other academic health centers across the country are bringing together students studying in all the health professions for teamwork training.
“It is no longer enough for health workers to be professional. In the current global climate, health workers also need to be interprofessional.”
— World Health Organization
“There is compelling evidence that health care quality is enhanced when those delivering care work well in teams,” says Raymond S. Greenberg, M.D., Ph.D., executive vice chancellor for health affairs for The University of Texas System.
“It is imperative, therefore, that we teach future health care providers across all disciplines how to perform as effective team members,” Greenberg adds. “UTHealth, with a wide range of educational programs across the clinical spectrum, is well positioned to be a leader in this effort.”
These initiatives are referred to as interprofessional collaboration, and there is a National Center for Interprofessional Practice and Education directed by Barbara Brandt, Ph.D.
“Driven by a number of factors, health care is changing rapidly, and the focus is now on the Triple Aim of improving patient experience of care, improving the health of populations and reducing the per capita cost of health care,” says Brandt, who also is the associate vice president for education at the University of Minnesota Academic Health Center Office of Education.
“Health care is redesigning around new workforce models requiring interprofessional collaboration and better preparation around teamwork,” Brandt says.
Teamwork training is now offered on an elective basis at UTHealth. The goal is for all students at the university’s six schools to receive interprofessional education throughout their preparation, Starck says.
Students at UTHealth are taught a teamwork model called the TeamSTEPPS system used by the Agency for Healthcare Research and Quality.
Before joining the faculty of UTHealth School of Biomedical Informatics, Angela Ross, D.N.P., M.P.H., was a TeamSTEPPS instructor and traveled across the country providing teamwork training in clinical areas such as surgical services with the Department of Defense Patient Safety Program.
Team-based Care: A World of Difference
This short video shows a patient care scenario before and after team training.
“The goal is to build cohesion in the team,” Ross says. “We would pull together the whole team to share patient information and improve accuracy, which may lead to better patient outcomes.”
Trust is also an important part of team building. “If a team member discovers a vital piece of information that may affect the outcome for the patient, he or she is empowered to quickly inform the rest of the team,” she adds. “We are all interested in what’s best for the patient.”
Teamwork is particularly important in an emergency department when a critically injured patient arrives at the hospital.
“We use the personal strengths of each member of the team to provide the best care possible,” says Richard Bradley, M.D., professor and chief of emergency medical services at John P. and Kathrine G. McGovern Medical School at UTHealth. “The members of the team complement each other.”
Not limited to clinicians, the care team also includes the security officers who stand ready to assist the family members of patients and the housekeepers who ready the rooms, says Bradley, who sees patients at Memorial Hermann-Texas Medical Center.
‘Communicating… is not enough…’
UTHealth launched its Center for Interprofessional Collaboration in 2013 and offers teamwork training through a program called the Dean’s Honors Colloquium in Interprofessional Collaboration.
“Our plan is to embed this training in the curriculum of each of the university’s six schools,” Starck says. “If we can get them working together as students, they will be more effective practitioners when they graduate.”
Those completing the training include Amelia Bush, a 27-year-old student at McGovern Medical School, and her twin sister, Alicia Bush, who is enrolled at UTHealth School of Dentistry. Both are scheduled to graduate in May.
“It was the first time I had been with a number of students from the other schools,” says Amelia. “It gave me a better appreciation of the contributions and roles of other caregivers.”
“I didn’t realize how large some of these collaborative efforts are,” Alicia says. “One of the examples involved an intensive care unit, and there may have been 15 members on that team.”
The big takeaway for Amelia was the importance of accurately relaying patient information to other team members. “Communicating the information is not enough. It also has to be understood,” she says.
Juliana Brixey, Ph.D., R.N., M.P.H., program director for interprofessional collaboration at UTHealth, says the five principles of the TeamSTEPPS system include identifying the members of the team, ensuring communication is clear, speaking up when necessary, monitoring the situation and supporting each other.
“Studies show that this system has been associated with improved patient outcomes,” says Brixey, noting that the training includes role playing sessions and simulations with case studies emphasizing patient safety.
Others taking the training include Olusegun “Olu” Popoola, M.D., who is pursuing a master’s degree at UTHealth School of Public Health after moving to the United States in 2011 from Lagos, Nigeria, where he worked as a family physician.
A new approach for a new year, breaking the silos
Students at The University of Texas Health Science Center at Houston (UTHealth) are invited to free teamwork training this spring.
Offered by the UTHealth Center for Interprofessional Collaboration, students will be introduced to the basics of collaborative health care through team-based health scenarios.
For information, call 713-500-3579 or visit the center’s website atwww.uth.edu/ipc.
“Knowing the responsibilities of the other team members is important when handing off assignments or passing the baton,” he says.
Popoola says there may also be circumstances in which a written note is not sufficient and that meeting face-to-face is most effective. “You have to be open to input from all members of the team,” he says. “And you need to feel a responsibility to speak up when necessary.”
He recalled an experience while he was volunteering as a physician in a remote village in Northern Nigeria with no access to laboratories. Popoola cites the care of a disoriented patient who had fever and a constellation of other nonspecific symptoms. With a limited medical toolbox, treating this patient was difficult.
“It turned out that one of the nurses was from the same part of Nigeria and was familiar with the cultural background of the patient. She gave an insight into their diet which included a lot of raw food and unpasteurized milk from cows,” Popoola says. “With helpful information from a member of the team, it was relatively easy to diagnose the cause of the problem and rule out other problems that are endemic in the community.”
Popoola adds, “This would be good training for residents, too.”
Interprofessional education applies to basic scientists involved in collaborative research teams. “Students at The University of Texas Graduate School of Biomedical Sciences at Houston also need team training,” Brixey says.
Brixey also is an associate professor with UTHealth School of Biomedical Informatics, where researchers are working to make electronic health records more user friendly.
“When you are designing software programs, you have to ensure they meet the needs of caregivers. If not, the programs won’t be used. The health information professionals work with frontline caregivers,” she says.
Bela Patel, M.D., division director of critical care medicine at McGovern Medical School and assistant chief medical officer at Memorial Hermann-TMC, says, “Caregivers early on used to work in silos. Doctors with doctors. Nurses with nurses. Greater teamwork among caregivers improves quality and lowers costs.”