Manthous, Constantine; Nembhard, Ingrid M; Hollingshead, Andrea B
Critical care is formulated and delivered by a team. Accordingly, behavioral scientific principles relevant to teams, namely psychological safety, transactive memory and leadership, apply to critical care teams. Two experts in behavioral sciences review the impact of psychological safety, transactive memory and leadership on medical team outcomes. A clinician then applies those principles to two routine critical care paradigms: daily rounds and resuscitations. Since critical care is a team en...
Manthous, Constantine; Nembhard, Ingrid M; Hollingshead, Andrea B
Critical care is formulated and delivered by a team. Accordingly, behavioral scientific principles relevant to teams, namely psychological safety, transactive memory and leadership, apply to critical care teams. Two experts in behavioral sciences review the impact of psychological safety, transactive memory and leadership on medical team outcomes. A clinician then applies those principles to two routine critical care paradigms: daily rounds and resuscitations. Since critical care is a team endeavor, methods to maximize teamwork should be learned and mastered by critical care team members, and especially leaders. PMID:21884639
Manthous, Constantine A; Hollingshead, Andrea B
Because critical care is administered by multidisciplinary teams, it is plausible that behavioral methods to enhance team performance may impact the quality and outcomes of care. This review highlights the social and behavioral scientific principles of team building and briefly reviews four features of teams--leadership, psychological safety, transactive memory, and accountability--that are germane to critical care teams. The article highlights how team principles might be used to improve patient care and navigate hospital hierarchies, and concludes with implications for future educational and scientific efforts. PMID:21471081
Thomas, George B.; Jones, James M.
This examination of the operation of teams in the Pilot Communities Program is chiefly historical in character. Based on intensive examination of proposals, evaluation studies, reports, memoranda, and interviews with personnel involved in the program, it was written by two university professors who had not been involved in the actual program. The…
Thulasiraj Ravilla; Gnanasekaran Chinnathambi
Eye care services are people intensive. They require the right people (competence), in the right numbers (capacity), in the right mix (team) with the right resources and processes (enabling conditions) to ensure effective and sustainable delivery of patient care.
Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila
Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." PMID:25794871
"If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members. PMID:21811361
Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.
... of these areas: Surgery Internal medicine Pediatrics Anesthesiology Critical care nurse: A highly skilled nurse who provides all aspects ... and can often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with ...
Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.
"If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges f...
Momsen, Anne-Mette; Rasmussen, Jens Ole; Nielsen, Claus Vinther;
people with hip fracture, homeless people with mental illness, adults with multiple sclerosis, stroke, aquired brain injury, chronic arthropathy, chronic pain, low back pain, and fibromyalgia. Whereas evidence was not found for adults with amyetrophic lateral schlerosis, and neck and shoulder pain...... from existing systematic reviews was critically appraised and summarized. Study selection: Using the search terms "rehabilitation", "multidisciplinary teams" or "team care", references were identified for existing studies published after 2000 that examined multidisciplinary rehabilitation team care for......Objectives: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems. Data sources: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research...
Klarare, Anna; Hagelin, Carina Lundh; Fürst, Carl Johan; Fossum, Bjoorn
Background: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned. Aim: The aim was to explore team interaction among team members in special...
... Selecting a Team Now that you understand how team care works and have seen the approved listing of teams ... so make sure you are comfortable communicating and working with the members of the team. Treatment recommendations should be communicated to you in ...
Havig, Anders Kvale; SKOGSTAD, Anders; Veenstra, Marijke; Romøren, Tor Inge
Background: Use of teams has shown to be an important factor for organizational performance. However, research has shown that a team has to meet certain criteria and operate in a certain way to realize the potential benefits of team organizing. There are few studies that have examined how teams operate in the nursing home sector and their effect on quality of care. This study investigates the relationship between teams that meet an academic definition of the team concept and quality of care i...
Carter, M W; Hans, E.W.; Kolisch, R.
Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management.
Stahelski, Anthony J.; Tsukuda, Ruth Ann
Investigated assumption that positive group process results from cooperation among group members by analyzing specific components of cooperation involved in teamwork and relating them to group input variables in interdisciplinary health care team members (N=72). Found cooperation was significantly related to size of team and whether an individual…
This study explored members' perceptions of teamwork in two primary health care teams (PHCTs). It also examined the effect of a team-building intervention on members' perceptions centred around five topics: the PHCT, role perception, communication, leadership and conflict. The study used a qualitative approach with semistructured interviews before and after the intervention. It was found that members perceived each other's roles only in the light of their interactions with each other. Issues of hierarchy in leadership and interpersonal conflicts were raised. It is concluded that the team-building intervention had some positive effects on team members' perceptions and behaviour. However, further research is needed into management structures and conflict resolution in the PHCT. PMID:8732520
Janney, Rob; Sabatier, Veronica
This slide presentation reviews the role of the biomedical flight controllers (BMEs), and BME Operations Team Leads (OTLs) in providing medical support for personnel on the International Space Station. This presentation will concentrate on role of the BME OTLs, who provide the integration function across the integration function across all Crew Health Care System (CHeCS) disciplines for operational products and medical procedures.
Hermsen, M.A.; Have, H.A.M.J. ten
Working as a multidisciplinary or interdisciplinary team is an essential condition to provide good palliative care. This widespread assumption is based on the idea that teamwork makes it possible to address the various needs of the patient and family more effectively. This article is about teamwork
Brodsky, Dara; Gupta, Munish; Quinn, Mary; Smallcomb, Jane; Mao, Wenyang; Koyama, Nina; May, Virginia; Waldo, Karen; Young, Susan; Pursley, DeWayne M
The complex multidisciplinary nature of neonatal intensive care combined with the numerous hand-offs occurring in this shift-based environment, requires efficient and clear communication and collaboration among staff to provide optimal care. However, the skills required to function as a team are not typically assessed, discussed, or even taught on a regular basis among neonatal personnel. We developed a multidisciplinary, small group, interactive workshop based on Team STEPPS to provide staff with formal teamwork skills, and to introduce new team-based practices; 129 (95%) of the eligible 136 staff were trained. We then compared the results of the pretraining survey (completed by 114 (84%) of staff) with the post-training survey (completed by 104 (81%) of participants) 2 years later. We found an improvement in the overall teamwork score from 7.37 to 8.08 (p=job fulfilment (p=<0.0001), believed that their abilities were being utilised properly (p=0.003), and felt more respected (p=0.0037). 90% of staff found the new practice of team meetings to help increase awareness of unit acuity, and 77% of staff noted that they had asked for help or offered assistance because of information shared during these meetings. In addition to summarising the results of our training programme, this paper also provides practical tools that may be of use in developing team training programmes in other neonatal units. PMID:23396854
Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise
This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families. PMID:25397338
In my diploma thesis special attention is given to care workers that work with a group of youth in extrafamilial residential institutions. They are defined as a team or work group, depending on the work structure. I am aware of the difficulty of educational team work and that is why I want to define and research their experiencing team or group work. At the beginning of the theoretical part I define educational work in educational institutions and youth homes, then continue with the definitio...
Fiscella, Kevin; Fogarty, Colleen; Salas, Eduardo
Teams are familiar to sports but relatively new to primary care. In this perspective, we use sports teams to illustrate key principles from team science and extract practical lessons for primary care teams. The most notable lessons include the need for continuous team learning based on presession planning and postsession debriefing, real-world team training focused on identified teamwork needs, and on-site team coaching. Implementation of these principles requires organizational commitment coupled with alignment of continuing medical education and recertification requirements with primary care teamwork competencies. PMID:27232689
In 1982, the IAEA set up the Operational Safety Review Team (OSART) programme, under which international expert teams make in-depth three week reviews of operational safety practices at nuclear power plants (NPPs). The OSART reviews offer excellent opportunities for the exchange of experience between expert team members and operating organization staff on how to improve safety performance. The missions deal with important areas of operational safety, including plant management, personnel training, operation, technical support, radiation protection and emergency planning. OSART does not advocate a single proven approach, but supports alternative approaches that can contribute to a plant's drive for enhanced operational safety. An OSART mission comprises 10 to 12 experts, external consultants recruited from NPPs, utilities and regulatory authorities for reactor specific expertise, and IAEA staff to ensure consistency between reviews. OSART Guidelines have been developed, based on IAEA Safety Series publications, applicable national rules and experience from OSARTs. A technical document on the major results of the first 18 OSART reviews (1983-1987) has been published. As of April 1988, a total of 25 OSART missions had been carried out. All NPPs visited were being operated without causing undue risk to the health and safety of plant personnel or the general public. However, room for further improvements was discovered, particularly in those areas where human factors play a major role. The most important recommendations made concerned advanced management methods, preparedness to cope with emergencies and the comprehensive feedback of operating experience. All plants visited were responsive to the teams' proposals and actions were often initiated while the teams were still present at the site. (author). 3 refs, 3 tabs
In order to work effectively, control room crews need to possess well-developed team skills. Extensive research supports the notion that improved quality and effectiveness are possible when a group works together, rather than as individuals. The Nuclear Regulatory Commission (NRC) has recognized the role of team performance in plant safety and has attempted to evaluate licensee performance as part of audits, inspections, and reviews. However, reliable and valid criteria for team performance have not yet been adequately developed. The purpose of the present research was to develop such reliable and valid measures of team skills. Seven dimensions of team skill performance were developed on the basis of input from NRC operator licensing examiners and from the results of previous research and experience in the area. These dimensions included two-way communications, resource management, inquiry, advocacy, conflict resolution/decision-making, stress management, and team spirit. Several different types of rating formats were developed for use with these dimensions, including a modified Behaviorally Anchored Rating Scale (BARS) format and a Behavioral Frequency format. Following pilot-testing and revision, observer and control room crew ratings of team performance were obtained using 14 control room crews responding to simulator scenarios at a BWR and a PWR reactor. It is concluded, overall, that the Behavioral Frequency ratings appeared quite promising as a measure of team skills but that additional statistical analyses and other follow-up research are needed to refine several of the team skills dimensions and to make the scales fully functional in an applied setting
Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit;
. Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance......BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced by...
Gilmore, John F.; Garbarino, Joseph E.
The Behavior Enhanced Heterogeneous Autonomous Vehicle Environment (BEHAVE) is a distributed system for the command and control of multiple Unmanned Vehicle Systems (UVS) with various sensor payloads (EO, infrared and radar) and mission roles (combat, reconnaissance, penetrator, relay) working in cooperation to fulfill mission goals in light of encountered threats, vehicle damage, and mission redirects. In its current form, BEHAVE provides UVS dynamic route planning/replanning, autonomous vehicle control, platform self-awareness, autonomous threat response, and muti-vehicle cooperation. This paper focuses on BEHAVE's heterogeneous autonomous UVS team cooperation achieved through the transformation of UVS operational doctrine into UVS team behaviors. This level of tactics provides the initial high-level cooperative control guidance and plans for multiple UVSs operating to achieve specific mission goal. BEHAVE's heterogeneous UVS behaviors include inter-vehicle cueing capability on coupled missions based on new threats, targets, and foreshadowing changes in environments, optimizing individual UVS mission roles, enhanced reassignment of mission goals based upon resources consumed and threats encountered, and multi UVS team threat behavior. Threat behaviors include logic incorporated for team scenarios such as drawing out or confusing threats.
Taplin, Stephen H.; Foster, Mary K.; Shortell, Stephen M.
The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they al...
Prashant Garg; Snigdha Reddy; Chaitanya Nelluri
One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. Bu...
Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse\\'s experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse\\'s roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.
Kennedy, Norelee; Armstrong, Claire; Woodward, Oonagh; Cullen, Walter
Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams. PMID:25429985
Dimas, Isabel Dórdio; Renato Lourenço, Paulo; Rebelo, Teresa
The purpose of this study was to examine the effects of coaching behaviours provided by peers and by the leader on the emotions experienced by interprofessional health and social care teams and on members' satisfaction with the team, as well as on team performance. Data were obtained from a survey among 344 employees working in 52 interprofessional health and social care teams from nine Portuguese organizations. The results show that leader coaching and peer coaching have a positive effect on the level of team members' satisfaction with the team and on positive emotions, and a negative effect on negative emotions. Furthermore, coaching provided by peers presents a positive effect on team performance as assessed by the leader of the team. Our findings put forward the importance of engaging in coaching behaviours to promote quality of the team experience, as well as the achievement of team performance objectives. Further studies should explore how coaching behaviours impact the patient, whose well-being is the ultimate objective of a team in the health and social care system, namely in terms of the patient's perception of quality care or patient outcomes. PMID:27135137
... 159384.html For Better Heart Care, Get a Pharmacist on Your Team Canadian study highlights a potential ... cut their chances of future trouble by having pharmacists help manage their care, new Canadian research suggests. ...
Contandriopoulos, Damien; Duhoux, Arnaud; Roy, Bernard; Amar, Maxime; Bonin, Jean-Pierre; Borges Da Silva, Roxane; Brault, Isabelle; Dallaire, Clémence; Dubois, Carl-Ardy; Girard, Francine; Jean, Emmanuelle; Larue, Caroline; Lessard, Lily; Mathieu, Luc; Pépin, Jacinthe
Introduction The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. Methods and analysis The first research component is aimed at supporting the development and implementati...
Grace, Sherry M.
Background: In 2011, a large integrated healthcare organization implemented a primary care team redesign in five pilot practices to improve the delivery of patient-centered chronic illness care and augment the physician-medical assistant dyads by adding two new primary care team roles for each practice - a nurse care manager (NCM) and a patient health coach (PHC). This work examines three aspects of implementing the care team redesign: 1) The facilitators and barriers of implementation, 2) Th...
Hirotsu, Misaki; Sohma, Michiro; Takagi, Hidehiko
In recent years, chemotherapies have been further advanced because of successive launch of new drugs, introduction of molecular targeting, etc., and the concept of so-called Team Medical Care ,the idea of sharing interdisciplinary expertise for collaborative treatment, has steadily penetrated in the Japanese medical society. Dr. Naoto Ueno is a medical oncologist at US MD Anderson Cancer Center, the birthplace of the Team Medical Care. He has advocated the concept of ABC of Team Oncology by positioning pharmaceutical companies as Team C. Under such team practice, we believe that medical representatives of a pharmaceutical company should also play a role as a member of the Team Medical Care by providing appropriate drug use information to healthcare professionals, supporting post-marketing surveillance of treated patients, facilitating drug information sharing among healthcare professionals at medical institutions, etc. PMID:19381051
In this brief overview of the issues relating to health care teams in geriatric care, some advantages of multidisciplinary team care versus care by an individual practitioner are outlined. An examination of barriers to teamwork and strategies to overcome them follows. Finally, a Canadian program in which medical students and family practice residents participated in interdisciplinary teamwork is described. PMID:1537446
Dobbins, Mary Iftner; Thomas, Sheila A; Melton, Stacy L Stokes; Lee, Stacy
The primary care medical home continues to adapt by applying new research to population health approaches to care. With the discovery that life experiences trigger a chain of biologic events linked to chronic illnesses, the role of patient-centered multidisciplinary care teams becomes of paramount importance. Subsequently, mental health professionals are being incorporated into the primary care setting, using their skills in nontraditional models to customize care for each patient. This "integration" of primary care and unique mental health services engenders opportunity for enhanced clinical care, professional workforce development and support, more effective population health initiatives, and informed health care policy. PMID:27262000
Brandstorp, Helen; Kirkengen, Anna Luise; Sterud, Birgitte; Haugland, Bjørgun; Halvorsen, Peder Andreas
The present study, framed as critical action research, aimed at contributing to the improvement of training emergency teams in primary care. The first author was a participating observer in local simulation sessions performed by 10 different teams. Leadership practice as interaction was analysed in three types of communicative spaces: in the review and debriefing sessions; in the author group; and in focus groups involving local stakeholders. The teams practiced both designated and distribute...
A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and e
Pinelle, David; Gutwin, Carl
Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. In this paper, we investigate the difficulties inherent in home care collaboration. We present the results of a study carried out with home care clinicians in Saskatoon District Health, and identify five areas of collaboration that are difficult for home care workers: scheduling, information dissemination, information retriev...
Groenewegen, P.; Heinemann, S.; Greß, S.; Schäfer, W.
Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices
Reader, Tom W; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian H
Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies i...
Physicians' role in team sports goes beyond the traditional ‘Doc’ who attends the game for stitching and primary injury management. Injury and illness prevention, ongoing supervision of rehabilitation, education, fitness evaluation, and training prescription are roles which have often fallen, by default, to paramedicals. The author recounts his experience in medical supervision of major junior hockey in the Western Hockey League.
Full Text Available One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity.
Hall, Pippa; Weaver, Lynda; Handfield-Jones, Richard; Bouvette, Maryse
This project brought together community-based practitioners and academics to develop and deliver interventions designed to enhance the leadership abilities of the designated leaders of seven rural/small town-based palliative care teams. Members of these community-based teams have already gained recognition for their teams' leadership and service delivery in their communities. All of the teams had worked closely with most members of the academic team prior to this project. The team members participated in a needs assessment exercise developed by the Sisters of Charity of Ottawa Health Service and University of Ottawa academic team. Results of the needs assessment identified leadership qualities that had contributed to their success, as well as their needs to further enhance their individual leadership qualities. The team effort, however, was the most important factor contributing to the success of their work. The interventions developed to address the identified needs had to be adapted creatively through the collaborative efforts of both the community and academic teams. The educational interventions facilitated the integration of learning at the individual and community level into the busy work schedules of primary health care providers. PMID:19005956
Nainis, Nancy A.
Oncology nurses are particularly vulnerable to "burnout" syndrome due to the intensity of their work and the ongoing losses they experience while providing oncology care to their patients. High levels of stress in the workplace left untended lead to high job turnover, poor productivity, and diminished quality of care for patients. Attention to…
Pinelle, David; Gutwin, Carl
Collaboration is an important part of healthcare delivery. However, in home care, collaboration is difficult due to the mobility and schedule variability of the workers. In this paper, we investigate the difficulties inherent in home care collaboration. We present the results of a study carried out with home care clinicians in Saskatoon District Health, and identify five areas of collaboration that are difficult for home care workers: scheduling, information dissemination, information retrieval, short-term treatment coordination, and long-term treatment planning. We present recommendations for incorporating support for each of these areas into point-of-care clinical information systems that provide access to shared patient records. Finally, we discuss general design approaches for incorporating this type of support, including the need for workers to maintain awareness of the activities of others, and the need to integrate communication with the presentation of the health record. PMID:12463897
Rani P Mol
Full Text Available The palliative doctor gives the ′touch of God′ as he/she takes care of the terminally ill patient. The oncologist encounters great difficulties in managing oral cavity problems of these patients. A trained dental doctor can help other doctors in dealing with these situations. But the general dental surgeon does not have enough idea about his part in these treatments. The community is also unaware of the role that a nearby dentist can play. Adequate training programs have to be conducted and awareness has to be created. A trained dentist will be a good team mate for the oncologist or radiotherapist or other doctors of the palliative care team. In this paper, a brief attempt is made to list a few areas in which a palliative care dentist can help other members of the palliative care team and also the patient in leading a better life.
O trabalho de equipe no programa de saúde da família: reflexões a partir de conceitos do processo grupal e de grupos operativos El trabajo del equipo en el programa de salud de la familia: reflexión a partir de conceptos del proceso grupal y de grupos operativos Team work in a family health care program: the team process concept and operational teams
Cinira Magali Fortuna
theoretical revision of team work in a family Health Care Program. We define team work in the health care field as a relationship network among people, power, knowledge, affection, and wishes, when there is a possibility of identifying group processes. We deal with concepts of Operational Group from the Argentinean School, which might help health professionals to get training in team work. We have visible (spoken and invisible (unspoken tasks within teams, which are modified and need to be combined and known. Communication, learning, the feeling of belonging, the atmosphere, the actions' pertinence for the team's purpose and power relations may help the team to get to know and analyze each other and to build a team. External supervision may help the team to turn itself into an operational team, working towards a life care project.
Dufour, Sinéad Patricia; Lucy, S. Deborah; Brown, Judith Belle
Purpose: To understand physiotherapists' roles and how they are enacted within Ontario primary health care (PHC) teams. Methods: Following a pragmatic grounded theory approach, 12 physiotherapists practising within Ontario PHC teams participated in 18 semi-structured in-depth in-person interviews. All interviews were audiotaped and transcribed verbatim, then entered into NVIVO-8. Coding followed three progressive analytic stages and was iterative in nature, guided by grounded theory. An expla...
Hutchins, Susan G.; Kemple, William G.; David L. Kleinman; Miller, Scot; Pfeiffer, Karl; Horn, Zachary; Weil, Shawn; Entin, Elliot
The Maritime Operations Center (MOC) was designed to effectively utilize the planning elements of Future Operations (FOPS) to provide more rapid, accurate resource allocations consistent with the vision of the Commander. MOC staff simultaneously participate in the planning effort, while executing the current operation, and supporting headquarters during planning and execution. Frequently, an operational planning team (OPT) – a task-organized team formed to conduct integrated planning for a sp...
The purpose of this thesis was to study, evaluate and estimate how well commercial penetration and Advanced Persistent Threat (ATP) simulation applications suit Cyber Red Team operations. The beginning of the study clarifies the needs, ways of acting and the history of Red Teaming: what it is and why and when it is needed. Later on, more focus is set on the characteristics of Cyber Red Teaming. What are the typical steps in Cyber Red Team operations and what requirements these set to the ...
The number of carers in the community is rising, and the importance of general practice in providing supportfor them has been highlighted. Caring for a disabled friend or relative has been shown to be harmful to the health of the caregiver and changes in social and family structure have led carers to become isolated and more reliant on the formal support services. However, many carersfeel that GPs do not understand their needs, and in turn many GPs and nursesfeel that they lack the relevant r...
Casey, Valentine; Richardson, Ita
peer-reviewed Distributed software development has become the norm for the software industry today. As a result many organizations are leveraging the expertise of their existing staff by establishing virtual teams. Here we outline the results from three independent case studies undertaken over a period of eight years. The first study considered the operation of virtual teams whose members were situated in two locations in the same country. The second investigated why U.S. and Irish team me...
Maria Aparecida Baggio
ABSTRACT: This is an exploratory and descriptive study grounded in a qualitative approach that aimed to know the meaning of care for professionals’ nursing team. The participant subjects are nursing auxiliary and technicians, and health services nurses. The data were collected by structured and semi-structured interview. The analysis of content was the method used to the data analysis. It was possible to identify from the results the following categories of caring the other: the verbal and no...
There has recently been interest in new models of care delivery that promote a team-based approach in psychiatric care. The aim of the study was to clarify the way in which to promote a team-based approach in psychiatric hospitals. Two focus groups were held to collect data from psychiatric hospital nurses who underwent the intervention to improve collaborative behavior. The results indicated the effectiveness of the program to encourage different professionals to meet and interact in learning to improve collaborative practice. We commented on the importance of conflict management and system change. The results are discussed in relation to previous research and practical implications. PMID:24864561
Dormans, John P., Ed.; Pellegrino, Louis, Ed.
Twenty-one papers on caring for children with cerebral palsy are organized into four sections, including: (1) cerebral palsy and the interdisciplinary team approach; (2) management of impairments related to cerebral palsy; (3) preventing disability by optimizing function of the child with cerebral palsy; and (4) preventing handicap by creating…
In this paper I explore the constructive links between co-operation, rivalry, and learning within the structure of team communities. Drawing upon social learning theory, the main purpose of this paper is to argue that both co-operation and rivalry are important triggers for mobilizing learning processes within and between teams. However, social learning theory tends to disregard the positive aspects of rivalry. Consequently, this paper will argue for the need to extend social learning theory ...
Mahrer, A R; Gagnon, R.
Although psychotherapy research teams have been in existence since the 1940s, one of the reasons they are not more popular is the absence of literature on how they operate. There is essentially no literature on the organization and administration of psychotherapy research teams, on the management of their everyday practical issues, decisions, and problems. In order to open the way for a dialogue on these matters, an inside view is provided of one relatively productive psychotherapy research t...
Walsh, Sandra A; Peters, Mark J
All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins. PMID:26382268
... 42 Public Health 4 2010-10-01 2010-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he...
Every nuclear utility has a culture which either drives or becomes a barrier to the vision of high performance and accountability of its personnel. This paper discusses two very powerful cultures at work in the nuclear power industry that may have very different values or ways of doing things. Employees from fossil plants have moved over to the nuclear plants where they meet with personnel who have been raised in the US Navy Nuclear Power Program. If these two cultures collide, as many plants have experienced, no one wins. Left alone, the two cultures may merge naturally, but if not, no amount of technical or procedural training will bridge the gulf. A second powerful influence within nuclear utilities is leadership. While culture explains how we do things around here, leadership has to do with the example people follow. This example may be set by a top executive in the corporate office or by a supervisor in the control room. The influence of leaders, whether positive or negative, can be seen at all levels of the utility. Team training, at any level, begins with a thorough understanding of the parent utility's culture, followed closely by an efficient method of implanting a culture suited to the company's strategy
In recent years, the nuclear industry has increasingly recognized with the technical training given its control room operators. As yet, however, little has been done to determine the actual effectiveness of such nontechnical training. Thus, the questions of how team training should be carried out for maximum impact on the safety and efficiency of control room operation and just what the benefits of such training might be remain open. We are in the early stages of establishing a systematic evaluation process that will help nuclear utilities assess the effectiveness of their existing team skills training programs for control room operators. Research focuses on defining the specific behavioral and attitudinal objectives of team skills training. Simply put, what does good practice look like and sound like in the control room environment? What specific behaviors and attitudes should the training be directed toward? Obviously, the answers to the questions have clear implications for the design of nuclear team skills training programs
Maruthappu, Mahiben; Duclos, Antoine; Zhou, Charlie D; Lipsitz, Stuart R; Wright, John; Orgill, Dennis
Summary Objectives The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. Design Retrospective analysis of all total knee replacements conducted at the host institution in 1996–2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. Setting Tertiary care academic hospital. Participants All patients undergoing TKR at the host institution in 1996–2009. Main outcome measure Operative efficiency. Results A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. Conclusions Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedure-specific quality improvement strategies in surgery. PMID:27053357
Al-Mousawi, Ahmed M.; Mecott-Rivera, Gabriel A.; Jeschke, Marc G.; Herndon, David N
Advances in burn care have been colossal, but while extra work is needed, it is clear that the organized effort of burn teams can continue making improvements in survival rates and quality of life possible for patients. Burn patients are unique, representing the most severe model of trauma,33 and hence this necessitates treatment in the best facilities available for that endeavor. Burn centers have developed to meet these intricate needs but can only function productively and most efficiently...
Earlier studies showed that the most common human errors involving operators at overseas nuclear power plants were those due to insufficient team monitoring, namely errors subsequently committed by superiors or fellow workers rather than an initial error committed by an operator. Although cases of insufficient team monitoring have rarely been reported in Japan, such faults could occur judging from the results of simulator training for operators. We therefore examined possible solutions to this problem. Using Rasmussen's model of human behavior, we analyzed the cases of insufficient team monitoring identified by instructors based on their experience in training. Analyses revealed that errors occur when an operator as a member of a team has gained a wrong situation awareness and this wrong situation awareness has not been corrected in the subsequent team action. The cases of insufficient team monitoring that were found during training can be classified into five types: the intuition type, the labyrinth type, the underestimation type, the dependence-on-experienced-operators type, and the complacency type. Problems identified in these five types of insufficient team monitoring have been analyzed using a newly developed team monitoring behavior model. Common factors that have been identified as the causes of errors committed during busy hours such as an emergency are: (1) the procedures are difficult to use; (2) necessary information cannot be retrieved easily; and (3) the procedure places as undue burden on a shift supervisor. These factors must be improved. Accordingly, we propose adopting a set of remedial measures: (1) the preparation of an easy-to-use procedure that sets forth instructions to be given by a shift supervisor; (2) the preparation of educational materials that are effective in assessing the progress of an event and gaining a broad overview of the situation; and (3) the sharing of responsibility and the delegation of authority to alleviate the burden on
Barry, Arden R.; Pammett, Robert T.
Background: In 2013, Jorgenson et al. published guidelines for pharmacists integrating into primary care teams. These guidelines outlined 10 evidence-based recommendations designed to support pharmacists in successfully establishing practices in primary care environments. The aim of this review is to provide a detailed, practical approach to implementing these recommendations in real life, thereby aiding to validate their effectiveness. Methods: Both authors reviewed the guidelines independently and ranked the importance of each recommendation respective to their practice. Each author then provided feedback for each recommendation regarding the successes and challenges they encountered through implementation. This feedback was then consolidated into agreed upon statements for each recommendation. Results and Discussion: Focusing on building relationships (with an emphasis on face time) and demonstrating value to both primary care providers and patients were identified as key aspects in developing these new roles. Ensuring that the environment supports the practice, along with strategic positioning within the clinic, improves uptake and can maximize the usefulness of a pharmacist in primary care. Demonstrating consistent and competent clinical and documentation skills builds on the foundation of the other recommendations to allow for the effective provision of clinical pharmacy services. Additional recommendations include developing efficient ways (potentially provider specific) to communicate with primary care providers and addressing potential preconceived notions about the role of the pharmacist in primary care. Conclusion: We believe these guidelines hold up to real-life integration and emphatically recommend their use for new and existing primary care pharmacists.
McWhinney, I R; Stewart, M A
Family physicians were asked about their recent experience with caring for dying patients at home and for their evaluation of a recently established Palliative Care Home Support Team. Ninety-four percent of the respondents had cared for at least one dying patient at home during the previous 2 years. About two thirds felt comfortable, competent, confident, supported, and in control. One quarter felt personally drained by the experience, but almost as many found it personally renewing. Of those...
Operator's behavior may be influenced by the atmosphere in a control room. Therefore, it is important to consider operator's emotions especially when abnormal situations occur in a plant. SYBORG (Simulation System for the Behavior of an Operating Group) is a system for simulating the behavior of an operator team. Based on 1) Investigations of how operators feel the situations in a control room and 2) biological and psychological similarities between emotion and immunity, an emotional function was tried to be incorporated into SYBORG using immune algorithm. (author)
Eccles Martin P; Goh Teik T; Steen Nick
Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relatio...
Bilhartz, Jacob L; Shieck, Victoria L
Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population. PMID:27254643
Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit;
BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced....... Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance...
Lemieux-Charles, Louise; McGuire, Wendy L
This review of health care team effectiveness literature from 1985 to 2004 distinguishes among intervention studies that compare team with usual (nonteam) care; intervention studies that examine the impact of team redesign on team effectiveness; and field studies that explore relationships between team context, structure, processes, and outcomes. The authors use an Integrated Team Effectiveness Model (ITEM) to summarize research findings and to identify gaps in the literature. Their analysis suggests that the type and diversity of clinical expertise involved in team decision making largely accounts for improvements in patient care and organizational effectiveness. Collaboration, conflict resolution, participation, and cohesion are most likely to influence staff satisfaction and perceived team effectiveness. The studies examined here underscore the importance of considering the contexts in which teams are embedded. The ITEM provides a useful framework for conceptualizing relationships between multiple dimensions of team context, structure, processes, and outcomes. PMID:16651394
Vecchia, Marcelo Dalla; Martins, Sueli Terezinha Ferreira
The present study aims at analyzing the individual senses and social meanings of mental care actions carried out by professionals working in a Family Health Care Team. The study is based on Vigotsky's (1896-1934) theoretical perspective of a historical and cultural psychology. The work is part of a participant research and as such conducted in the context of a field research. It was observed that the team took into consideration the relevance of social determinants for the disease of the target population, the need for making use of diversified care strategies reaching beyond the clinical setting, the importance of taking care of their own mental health, as well as difficulties related to approaching the families of the patients. We emphasize the importance of overcoming the exclusiveness of the biomedical determination of the health-disease process as pointed out in the operational principles of the Family Health Care Strategy, expressed by responsiveness as a care tool, the establishment of relationships and continued care. PMID:19142322
Saad Al Qahtani
Saad Al Qahtani1,21Intensive Care Department, Critical Care Response Team, King Abdulaziz Medical City (KAMC), National Guard Health Affairs, 2King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Kingdom of Saudi ArabiaIntroduction: Patient care and safety is the main goal and mission of any health care provider. We surveyed nurses in the wards and obtained their feedback about the quality of care delivered by the Critical Care Response Team (CCRT).Methods: Our...
Proper communication within the health care team is especially important in terms of creating safe emotional and professional conditions for the team members and for quality healing. The aim of the study is to explore the factors that hinder appropriate communication between doctors and nurses and thus to make the effective elimination of the communication disturbances possible. Investigation in main medical databases and general search engines were used for analysing the phenomenon. It was revealed that communication between doctors and nurses is restrained by factors that can be observed on individual, professional and system levels as well. Role confusion, lack of trust, communication barriers arising from hierarchical inequalities, leadership problems, differences in qualifications, burnout and organizational problems can equally be found amongst them. The effectiveness of communication between nurses and doctors in Hungary is especially strongly influenced by the fear of losing jobs, the financial problems arising from different degree of gratuity and the phenomenon of burnout. Changes on individual, professional and system levels are equally important for significant improvement in the communication between doctors and nurses. Joint trainings based on strong organizational development skills and joint conferences could promote significantly better flow of information, mutual appreciation and harmonization. PMID:27084439
Auer, Stefanie; Graessel, Elmar; Viereckl, Carmen; Kienberger, Ursula; Span, Edith; Luttenberger, Katharina
Background There is growing concern about how to provide care for persons with dementia in institutions such as nursing homes, day care centers, mobile services and hospitals. Care teams (formal caregivers) have to meet specific expectations from different sides: the Person with Dementia herself, the institution, and from different family members. Out of this situation, considerable burden can emerge hindering the professional development of care team members and counteracting quality of care...
Gomez, Fernando; Curcio, Carmen Lucia
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a theoretical knowledge basis with well-justified priorities, functions, and long-term goals, in Latin America teams are arranged according to subjective interests on solving their problems. Three distinct approaches of interdisciplinary collaboration in gerontology are proposed. The first approach is grounded in the scientific rationalism of European origin. Denominated "logical-rational approach," its core is to identify the significance of knowledge. The second approach is grounded in pragmatism and is more associated with a North American tradition. The core of this approach consists in enhancing the skills and competences of each participant; denominated "logical-instrumental approach." The third approach denominated "logical-subjective approach" has a Latin America origin. Its core consists in taking into account the internal and emotional dimensions of the team. These conceptual frameworks based in geographical contexts will permit establishing the differences and shared characteristics of interdisciplinary collaboration in geriatrics and gerontology to look for operational answers to solve the "complex problems" of older adults. PMID:23384004
Reader, Tom W; Flin, Rhona; Cuthbertson, Brian H
Objectives: To identify the behaviors senior physicians (e.g., specialists, staff attendings) report using to lead multidisciplinary teams in the intensive care unit. Design: Semistructured interviews focusing on team leadership, crisis management, and development of an environment that enable effective team performance in the intensive care unit. Setting: Seven general intensive care units based in National Health Service hospitals in the United Kingdom. Participants: Twenty-five...
Everett, Christine M.; Thorpe, Carolyn T; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A.
Redesigning healthcare systems to deliver team-based care is considered important to improving care for chronically ill patients. Including physician assistants and/or nurse practitioners on primary care teams is one approach to the patient-centered medical home. However, understanding of the impact of team structure on outcomes is limited. Using Medicare claims and electronic health record data from a large physician group, we compared multiple patient outcomes for older patients with diabet...
Stilos, Kalli; Daines, Pat
Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families. PMID:24863582
Today's systems are complex, focused on not just physical tasks, but on elaborate perceptual and cognitive tasks as well. Hence, humans in many complex and dynamic systems are required to act as effective and timely decision makers. Situation Awareness (SA), which is used within human factor research to explain to what extent operators of safety critical and complex real systems know what is going on the system and the environment, is considered a prerequisite factor for effective decision making and performance. Thus, the need for operators to maintain SA in complex and dynamic environments is frequently cited as a key to effective and efficient performance. In terms of understanding SA, much effort has been devoted to the development of a measurement method of SA. Thus far, however, various studies have been limited to addressing the SA of individual operators. However, many complex systems are operated by teams. It is typical of complex systems that they require more than one operator. The purpose of this study is to develop team SA measurement method using verbal protocol data
Schellinger, Sandra; Cain, Cindy L; Shibrowski, Kathleen; Elumba, Deborah; Rosenberg, Erin
This article details team development within a longitudinal cohort study designed to bring team-based, whole person care early in the course of serious illness. The primary innovation of this approach is the use of nonclinically trained care guides who support patients and family members by focusing care around what matters most to patients, linking to resources, collaborating with other providers, and offering continuity through care transitions. By describing the development of this team, we document the kinds of questions others may ask during the process of team creation. PMID:25747670
Cardoso, Clareci Silva; Bandeira, Marina; Ribeiro, Antonio Luiz Pinho; Oliveira, Graziella Lage; Caiaffa, Waleska Teixeira
Satisfaction is an important measure of quality care, of adherence to the treatment and adequate use of health services. The objective here is to build two scales which evaluates team' and patients' satisfaction with cardiovascular disease treatment provided through a distance telecardiology project. The procedure followed international standards for development of measure instruments, including operational definition of satisfaction contents and its area for evaluation; item definition; pre-test and pilot study. The literature review, focal groups and discussion with specialists had delimited the domains to be included in the scales and the elaboration of its items. The CARDIOSATIS-Team included 15 items and the CARDIOSATIS-Patient included 11. Satisfaction was measured through a five-point Likert scale. The scales' items comprised satisfaction with physical structure, human resources, capacity of resolution, attention and care offered by the service and the satisfaction with the received/given care. The scales also included open questions. CARDIOSATIS scales have showed to be an easy and accessible instrument very well accepted by medical team and patients. Preliminary results presented good characteristics of validity and reliability. PMID:21503491
NASA has stepped forward to face the environmental challenge to eliminate the use of Ozone-Layer Depleting Substances (OLDS) and to reduce our Hazardous Air Pollutants (HAP) by 50 percent in 1995. These requirements have been issued by the Clean Air Act, the Montreal Protocol, and various other legislative acts. A proactive group, the NASA Operational Environment Team or NOET, received its charter in April 1992 and was tasked with providing a network through which replacement activities and development experiences can be shared. This is a NASA-wide team which supports the research and development community by sharing information both in person and via a computerized network, assisting in specification and standard revisions, developing cleaner propulsion systems, and exploring environmentally-compliant alternatives to current processes.
Ledford, Christy J W; Canzona, Mollie Rose; Cafferty, Lauren A; Kalish, Virginia B
In the majority of U.S. hospitals, inpatient medicine teams make palliative care decisions in the absence of a formalized palliative system. Using a grounded theory approach, interviews with inpatient team members were systematically analyzed to uncover how participants conceptualize palliative care and how they regard the communicative structures that underlie its delivery. During analysis, Weick's model of organizing emerged as a framework that fit the data. The 39 participant inpatient team members discussed palliative care as primarily a communicative process. Themes describing the meaning of palliative care emerged around the concepts of receiver of care, timeline of care, and location of care. The emerging model included four stages in the communicative processes of inpatient palliative care: (a) interpret the need, (b) initiate the conversation, (c) integrate the processes, and (d) identify what works. In contrast to stable, focused palliative care teams or hospice care teams, which have prescribed patient populations and processes, the inpatient medicine team faces the equivocality of providing palliative care within a broader practice. This research offers a four-phase model to show how these inpatient teams communicate within this context. Implications for the provision of palliative care are discussed. PMID:26431077
Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria
Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental proce...
Smith-Carrier, Tracy; Neysmith, Sheila
Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation. PMID:26261888
Mendez de Leon, Delphine; Stroot, Judy A Klauzer
The process of setting up and monitoring nursing resource teams for maximum effectiveness involves five key steps: Set the resource team goals and approach. Plan for development and oversight. Gather and analyze the relevant information. Deploy the team. Reevaluate staffing levels and effectiveness. PMID:23957189
Gomez, Fernando; Curcio, Carmen Lucia
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a…
Holder, Barbara E.
The Data Systems Operations Team (DSOT) currently monitors the Multimission Ground Data System (MGDS) at JPL. The MGDS currently supports five spacecraft and within the next five years, it will support ten spacecraft simultaneously. The ground processing element of the MGDS consists of a distributed UNIX-based system of over 40 nodes and 100 processes. The MGDS system provides operators with little or no information about the system's end-to-end processing status or end-to-end configuration. The lack of system visibility has become a critical issue in the daily operation of the MGDS. A task analysis was conducted to determine what kinds of tools were needed to provide DSOT with useful status information and to prioritize the tool development. The analysis provided the formality and structure needed to get the right information exchange between development and operations. How even a small task analysis can improve developer-operator communications is described, and the challenges associated with conducting a task analysis in a real-time mission operations environment are examined.
This report discusses a method to evaluate team work through behavior observation under the view points of 12 which consist of the Team Work Element Model proposed in the series of this study. The method includes a check list with which users evaluate team work 5 rating scale for each viewpoint. The check lists are developed and applied to several real operator teams of power plants under the corporation with two training centers of thermal and nuclear power plants, respectively. Evaluators evaluate team work with watching the video-taped team behavior responding to abnormal conditions. This paper discusses the reliability from whether repeated evaluations shows the same result and multi-evaluators' results show the same result. This also discusses the validity of this method form whether the results from this method matches the evaluators' intuition. As a result, this method is applicable to evaluate team work through behavior observation. (author)
van Soeren, Mary; Miles, Adèle
Conflicts arise within teams and with family members in end-of-life decision-making in critical care. This creates unnecessary discomfort for all involved, including the patient. Treatment plans driven by crisis open the team up to conflict, fragmented care and a lack of focus on the patient's wishes and realistic medical outcomes. Methods to resolve these issues involve planned ethical reviews and team meetings where open communication, clear plans and involvement in decision-making for all ...
The series of this study describes the necessity of the evaluation of team work from two aspects of operator's behavior and operators' mind. The authors propose Team Work Element Model which consists of necessary elements to build high performance team. This report discusses a method to evaluate team work from the second aspect, that is, competency trust, competition, for-the team spirit, etc. The authors survey the previous studies on psychological measures and organize a set of questions to evaluate 10 team work sub elements that are the parts of Team Work Element Model. The factor analysis shows that this set of questions is consists of 13 factors such as task-oriented leadership, harmony-oriented team atmosphere, etc. Close examination of the questions in each factor shows that 8 of 10 team work sub elements can be evaluated by this questionnaire. In addition, this questionnaire comprises scales additional 8 scales such as job satisfaction, leadership, etc. As a result, it is possible to evaluate team work from more comprehensive view points. (author)
Shunk, Rebecca; Dulay, Maya; Chou, Calvin L; Janson, Susan; O'Brien, Bridget C
Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team "huddles," or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees' partnerships with staff and full participation in the VA's Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic's larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees. PMID:24362383
Fore, J. M.; And Others
Written for the tractor operator, the manual describes, with the aid of colored illustrations and diagrams, the tasks involved in the proper operation and daily maintenance of tractors. It offers explanations for the desirability of the various servicing and adjustment operations, as well as guidelines for tractor operation and safety. The…
Ahmet Fatih Yılmaz
Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional
Reckrey, Jennifer M.; Soriano, Theresa A.; Hernandez, Cameron R.; DeCherrie, Linda V.; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine
Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address patient, program, and system needs, we restructured a portion of our large, physician-led academic home-based primary care practice into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. Our Team Approach is an innovative way to improve interdisciplinary, team-based care though practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568
Feinberg, Mark E; Chilenski, Sarah M; Greenberg, Mark T; Spoth, Richard L; Redmond, Cleve
This study examined the longitudinal predictors of quality of functioning of community prevention teams during the "operations" phase of team development. The 14 community teams were involved in a randomized-trial of a university-community partnership project, PROSPER (Spoth et al., Prevention Science, 5(1): 31-39, 2004b), that implements evidence-based interventions intended to support positive youth development and reduce early substance use, as well as other problem behaviors. The study included a multi-informant approach to measurement of constructs, and included data from 137 team members, 59 human service agency directors and school administrators, 16 school principals, and 8 Prevention Coordinators (i.e. technical assistance providers). We examined how community demographics and social capital, team level characteristics, and team member attributes and attitudes are related to local team functioning across an 18-month period. Findings indicate that community demographics (poverty), social capital, team member attitudes towards prevention, and team members' views of the acceptability of teen alcohol use played a substantial role in predicting various indicators of the quality of team functioning 18 months later. PMID:17602297
In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study. PMID:23343434
This paper examines the community nursing contribution to primary care by reporting on a qualitative evaluation study of the introduction of integrated nursing teams by an NHS community trust in one location in the United Kingdom. A pluralistic evaluation approach (Smith & Cantley 1985) was used to identify the various criteria by which the different stakeholders involved in the initiative judged the integrated nursing teams to be successful. Six teams at various stages of development were included in the study, together with other groups who had a vested interest in the performance of the teams. Data were collected by means of in-depth individual interviews with team coordinators, team facilitators, senior trust managers, GPs and practice managers; and focus group interviews with team members. The criteria for success identified by the various stakeholders provided a framework through which the overall success of the initiative was judged. Five meanings of success were identified, namely: team working; effective communication; an orientation towards the general practice; changes in working practices; and responsiveness to change. Key findings relating to each of the criteria are presented and consideration given to the implications arising for the development of Primary Care Groups (PCGs). The paper concludes that, paradoxically, by stepping aside from the traditional hierarchy inherent in the primary health care team (PHCT), integrated nursing teams may provide community nurses with the opportunity to make a more active contribution to the future development of primary care. PMID:11560653
Farris, Karen B.; Côté, Isabelle; Feeny, David; Johnson, Jeffrey A.; Tsuyuki, Ross T.; Brilliant, Sandra; Dieleman, Sherry
PROBLEM BEING ADDRESSED: Communication between community-based providers is often sporadic and problem-focused. OBJECTIVE OF PROGRAM: To implement collaborative community-based care among providers distant from one another and to improve or maintain the health of high-risk community-dwelling patients, with a focus on medication use. PROGRAM DESCRIPTION: Six primary health care teams were formed of a family physician, a pharmacist, and a home care case manager (nurse). Three of these teams als...
Shoemaker, Sarah J; Parchman, Michael L; Fuda, Kathleen Kerwin; Schaefer, Judith; Levin, Jessica; Hunt, Meaghan; Ricciardi, Richard
Interprofessional team-based care is increasingly regarded as an important feature of delivery systems redesigned to provide more efficient and higher quality care, including primary care. Measurement of the functioning of such teams might enable improvement of team effectiveness and could facilitate research on team-based primary care. Our aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework, and to create a searchable, web-based atlas of such instruments (available at: http://primarycaremeasures.ahrq.gov/team-based-care/ ). Our conceptual framework was developed from existing frameworks, the teamwork literature, and expert input. The framework is based on an Input-Mediator-Output model and includes 12 constructs to which we mapped both instruments as a whole, and individual instrument items. Instruments were also reviewed for relevance to measuring team-based care, and characterized. Instruments were identified from peer-reviewed and grey literature, measure databases, and expert input. From nearly 200 instruments initially identified, we found 48 to be relevant to measuring team-based primary care. The majority of instruments were surveys (n = 44), and the remainder (n = 4) were observational checklists. Most instruments had been developed/tested in healthcare settings (n = 30) and addressed multiple constructs, most commonly communication (n = 42), heedful interrelating (n = 42), respectful interactions (n = 40), and shared explicit goals (n = 37). The majority of instruments had some reliability testing (n = 39) and over half included validity testing (n = 29). Currently available instruments offer promise to researchers and practitioners to assess teams' performance, but additional work is needed to adapt these instruments for primary care settings. PMID:27212003
Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H
Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622
Chana, Richard; Marshall, Paul; Harley, Clare
The intermediate care team supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how intermediate care team professionals perceive, detect or respond to loneliness in their clients. This study explores intermediate care team professionals' attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data were analysed thematically using framework analysis, applying the theory of planned behaviour as an interpretive framework. Intermediate care team professionals see loneliness as a significant issue for many of their older clients but a low priority for intermediate care team services. They believe that loneliness often goes undetected because it is difficult to measure objectively. Barriers to managing loneliness included high workloads, unsatisfactory referral systems and lack of close working with social care and independent sector services. Brief but reliable loneliness assessments into routine practice, receiving training on detecting and managing loneliness, and improving working relationships with social care and independent sector services were highlighted as strategies that could improve the detection and management of loneliness in intermediate care team clients. PMID:27270197
Balasubramanian, Bijal A.; Chase, Sabrina M.; Nutting, Paul A.; Cohen, Deborah J.; Strickland, Pamela A. Ohman; Crosson, Jesse C.; Miller, William L.; Crabtree, Benjamin F.
PURPOSE The Using Learning Teams for Reflective Adaptation (ULTRA) study used facilitated reflective adaptive process (RAP) teams to enhance communication and decision making in hopes of improving adherence to multiple clinical guidelines; however, the study failed to show significant clinical improvements. The purpose of this study was to examine qualitative data from 25 intervention practices to understand how they engaged in a team-based collaborative change management strategy and the types of issues they addressed. METHODS We analyzed field notes and interviews from a multimethod practice assessment, as well as field notes and audio-taped recordings from RAP meetings, using an iterative group process and an immersion-crystallization approach. RESULTS Despite a history of not meeting regularly, 18 of 25 practices successfully convened improvement teams. There was evidence of improved practice-wide communication in 12 of these practices. At follow-up, 8 practices continued RAP meetings and found the process valuable in problem solving and decision making. Seven practices failed to engage in RAP primarily because of key leaders dominating the meeting agenda or staff members hesitating to speak up in meetings. Although the number of improvement targets varied considerably, most RAP teams targeted patient care-related issues or practice-level organizational improvement issues. Not a single practice focused on adherence to clinical care guidelines. CONCLUSION Primary care practices can successfully engage in facilitated team meetings; however, leaders must be engaged in the process. Additional strategies are needed to engage practice leaders, particularly physicians, and to target issues related to guideline adherence. PMID:20843884
Russell, Rebecca Ann; Burke, Kimberly; Gattis, Katherine
A lack of standardized nursing procedures regarding the management of patients receiving preoperative regional anesthesia in the perianesthesia setting raises a number of issues for perianesthesia nurses. In January 2010, Duke University Hospital's perianesthesia care unit implemented a regional anesthesia "block nurse" team in the preoperative holding area as a patient safety initiative. In January 2011, a retrospective data review was conducted. Results indicated that the implementation of the block nurse team not only increased patient safety but also increased perioperative efficiency and productivity, and decreased delays to operating room start times. This article describes the role of the regional anesthesia block nurse, the development of a block nurse team, and the early benefits of implementing a dedicated regional anesthesia block nurse team in the perianesthesia setting. PMID:23351242
Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team
Thirel, Chrislaine; Cottin, Nathalie; Kholladi, Fanny
An approach implemented within a hospital has enabled the process for reporting adverse events to be defined in its entirety. It was combined with a pedagogical approach with the teams in order to give it meaning. PMID:27085924
Wiecha, John; Pollard, Timothy
An interdisciplinary clinical team is a consistent grouping of people from relevant clinical disciplines, ideally inclusive of the patient, whose interactions are guided by specific team functions and processes to achieve team-defined favorable patient outcomes. Teamwork supported by properly designed eHealth applications could help create more effective systems of care for chronic disease. Given its synchronous and asynchronous communication capacity and information-gathering and -sharing ca...
This paper explores the constructive links between cooperation, rivalry, and learning within the structure of team communities. Drawing upon social learning theory and qualitative data from case studies conducted in Danish team-based firms, the main purpose is to argue that both cooperation and rivalry are important triggers for mobilizing…
... should you ask your health care team about pancreatic cancer? It’s important to have honest, open discussions with ... these questions: When you’re told you have pancreatic cancer What kind of pancreatic cancer do I have? ...
Saba, George W.; Taché, Stephanie; Ward, Lisa; Chen, Ellen H.; Hammer, Hali
Introduction: Nonlicensed allied health workers are becoming increasingly important in collaborative team care, yet we know little about their experiences while filling these roles. To explore their perceptions of working as health coaches in a chronic-disease collaborative team, the teamlet model, we conducted a qualitative study to understand the nature and dynamics of this emerging role.
Saad Al Qahtani
Full Text Available Saad Al Qahtani1,21Intensive Care Department, Critical Care Response Team, King Abdulaziz Medical City (KAMC, National Guard Health Affairs, 2King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Kingdom of Saudi ArabiaIntroduction: Patient care and safety is the main goal and mission of any health care provider. We surveyed nurses in the wards and obtained their feedback about the quality of care delivered by the Critical Care Response Team (CCRT.Methods: Our hospital has 900 beds. A self-administered survey was given onsite to all ward nurses. Survey items were identified, discussed, reviewed, piloted, and finalized over a 3-month period in a focus group discussion format during three CCRT core group meetings. Responses were anonymous and collected by the nurses onsite.Results: The total number of returned and analyzed surveys was 274 (98.6%. Ninety-seven percent agreed that CCRT staff arrived in a timely manner. Ninety-four percent reported that CCRT staff helped in managing sick patients and ~70% reported that it strengthened team dynamics. Only 50% of the nurses felt CCRT staff improved competence at the bedside. The overall satisfaction was 100%; none of the nurses were dissatisfied with the team.Conclusion: The CCRT helped manage sick patients in the wards. However, CRRT staff should remember to involve and communicate with the team initiator and the patient’s physician to optimize patient health care.Keywords: rapid response team, medical emergency team, critical care response team, satisfaction
Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were
Fargason, C A; Haddock, C C
Quality improvement methods first developed in industry can be applied in health care, but major adjustments in the traditional health care organization are needed for continuous improvement processes to work. One change is establishing cross-functional or multidisciplinary teams to carry out integrative decision making in the place of departmental hierarchical decision making within the functional areas and disciplines. This article cites examples from experience with one service process--delivery of care to newborns--and examines techniques from the group behavior and conflict resolution literature which could enhance the success of cross-functional teams in health care organizations. PMID:1614696
Franks, Andrea S.; Guirguis, Alexander B.; George, Christa M.; Howard-Thompson, Amanda; Heidel, Robert E.
Objectives To assess students' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members' perceptions of team-based learning. Methods Using the 2 teaching methods, students' grades were compared. Students' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning. Results The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course. Conclusions Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning. PMID:21301594
Mikles, V. J.
The NOAA/NESDIS Center for Satellite Research and Applications (STAR) provides technical support of the Joint Polar Satellite System (JPSS) algorithm development and integration tasks. Utilizing data from the S-NPP satellite, JPSS generates over thirty Environmental Data Records (EDRs) and Intermediate Products (IPs) spanning atmospheric, ocean, cryosphere, and land weather disciplines. The Algorithm Integration Team (AIT) brings technical expertise and support to product algorithms, specifically in testing and validating science algorithms in a pre-operational environment. The AIT verifies that new and updated algorithms function in the development environment, enforces established software development standards, and ensures that delivered packages are functional and complete. AIT facilitates the development of new JPSS-1 algorithms by implementing a review approach based on the Enterprise Product Lifecycle (EPL) process. Building on relationships established during the S-NPP algorithm development process and coordinating directly with science algorithm developers, the AIT has implemented structured reviews with self-contained document suites. The process has supported algorithm improvements for products such as ozone, active fire, vegetation index, and temperature and moisture profiles.
Chávez, Elisa M; Hendre, Amruta
Providing dental care for seniors with complex medical and/or social needs can seem daunting. Many dental providers may question their resources to manage such patients. However, many of these patients have teams in place that can be accessed to improve the efficacy and satisfaction in providing care to them. Seeking out patients' other health care providers, and understanding how to work effectively with them, is important to improve total patient care, comfort, function and dignity. PMID:26798913
In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place...
Soones, TN; O Brien, BC; Julian, KA
© 2015, Society of General Internal Medicine. BACKGROUND : In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents’ education in the ambulatory setting. OBJECTIVE: To identify factors affecting residents’ experience of team-based care within continuity clinics and the impact of these teams ...
Condra, M; Groll, L; Walker, D M; Abrams, M O; Sims, P.
We describe the development and operation of an emergency support service team in the Emergency Department of the Kingston General Hospital, Kingston, Ont. The team, composed of professionals from other departments of the hospital, provides emotional and practical support to family members or survivors in medical emergencies. We discuss the roles of the team members and their procedures for dealing with distress and grief.
Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji
Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. PMID:26348238
Jennifer Rossiter; Gursharan Soor; Deanna Telner; Babak Aliarzadeh; Jennifer Lake
Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodt...
This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician's assistant, a physical therapist, and a radiation therapist. As part of the agent-based…
Full Text Available This study aimed to investigate the social representations of professionals included in the team of Family Health Strategy (physicians, nurses and dentists respecting the action possibilities and contributions of the pharmacist for the basic care, and based on social psychology and, particularly, on the theory of social representations. The epistemological basis of the research is qualitative, and the data were collected by means of individual semi-structured interviews, which were submitted to analysis of categorical thematic content. Apparently, the majority of professionals already inserted in the team know and recognize the importance of professional pharmacists in the basic care, as well as their potential contribution to this topic. The representations were constructed according to the following parameters: a the study object and the intervention area, b the individual practice of every professional and c his/her action in specific cases. The quality of the professional or personal experience concerning the action of these professionals has contributed for the knowledge about the possibilities of pharmacists' intervention in basic care.Este estudo teve por objetivo investigar as representações sociais dos profissionais incluídos na equipe de Estratégia em Saúde da Família (médico, enfermeiro e odontólogo, sobre as possibilidades de atuação e as contribuições do farmacêutico na atenção básica, tendo por fundamento a psicologia social e, particularmente, a teoria das representações sociais. A base epistemológica da pesquisa é qualitativa, sendo os dados coletados por meio de entrevistas individuais semi-estruturadas e analisados por meio de análise de conteúdo categorial temático. Constatou-se que a maioria dos profissionais já inseridos na equipe conhece e reconhece a importância do profissional farmacêutico na atenção básica e as suas possibilidades de contribuição. As representações foram construídas a
Ogunleye, Ayodele; Osunlana, Adedayo; Asselin, Jodie; Cave, Andrew; Sharma, Arya Mitra; Campbell-Scherer, Denise Lynn
Background Despite opportunities for didactic education on obesity management, we still observe low rates of weight management visits in our primary care setting. This paper describes the co-creation by front-line interdisciplinary health care providers and researchers of the 5As Team intervention to improve obesity prevention and management in primary care. Methods We describe the theoretical foundations, design, and core elements of the 5AsT intervention, and the process of eliciting practi...
MacNaughton, Kate; Chreim, Samia; Bourgeault, Ivy Lynn
Background The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. Methods A comparative case...
Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B; Safran, Charles A
We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient's care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care. PMID:22195103
Full Text Available Background: Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses′ perceptions of the role of physiotherapists in the critical care team. Methods: Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. Results: Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. Conclusion: Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.
Letchworth, Gary; Schlierf, Roland
Topics in this presentation are: Constellation Ares I/Orion/Ground Ops Elements Orion Ground Operations Flow Orion Operations Planning Process and Toolset Overview, including: 1 Orion Concept of Operations by Phase 2 Ops Analysis Capabilities Overview 3 Operations Planning Evolution 4 Functional Flow Block Diagrams 5 Operations Timeline Development 6 Discrete Event Simulation (DES) Modeling 7 Ground Operations Planning Document Database (GOPDb) Using Operations Planning Tools for Operability Improvements includes: 1 Kaizen/Lean Events 2 Mockups 3 Human Factors Analysis
This report discusses the range of application of the behavior observation-based teamwork evaluation sheet. Under the concept of this method, teamwork evaluation sheet is developed, which assumes a certain single failure (failure of feed water transmitter). The evaluation sheets are applied to evaluate team work of 26 thermal power plant operator teams in combined under abnormal operating conditions of failure of feed water transmitter, feed draft fan or steam flow governor. As a result of ANOVA, it finds that there are no differences between 3 kinds of single failure. In addition, the similar analysis is executed to 3 kinds of multiple failures (steam generator tube rapture, loss of coolant accident and loss of secondary coolant accident) under which 7 PWR nuclear power plant operator teams are evaluated. As a result, ANOVA shows no differences between 3 kinds of multiple failures. These results indicate that a behavior observation-based team work evaluation sheet, which is designed for a certain abnormal condition, is applicable to the abnormal conditions that have the same development of abnormal conditions. (author)
Grier, Phillip M.
An historical perspective of the American College Health Association emphasizes the importance of teamwork among health personnel. The current trend in litigation toward health care professionals and the regulatory role of government has resulted in an apparent increase in legal activity, and necessitates teamwork between doctors and lawyers. (JN)
NOET is a NASA-wide team which supports the research and development community by sharing information both in person and via a computerized network, assisting in specification and standard revisions, developing cleaner propulsion systems, and exploring environmentally compliant alternatives to current processes. NOET's structure, dissemination of materials, electronic information, EPA compliance, specifications and standards, and environmental research and development are discussed.
Mazzocato Pamela; Hvitfeldt Forsberg Helena; von Thiele Schwarz Ulrica
Abstract Objective Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. Methods The study was set in a Swedish university hospital ED during the initial ph...
Head, Barbara A; Schapmire, Tara; Earnshaw, Lori; Faul, Anna; Hermann, Carla; Jones, Carol; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Ziegler, Craig; Pfeiffer, Mark
For students of the health care professions to succeed in today's health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university's effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences. PMID:25708910
Leach, Linda Searle; Myrtle, Robert C; Weaver, Fred A
Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance. PMID:21471578
Full Text Available Background. Transitions in care are one of the most important and challenging client safety issues in healthcare. This project was undertaken to gain insight into the practice setting realities for nurses and other health care providers as they manage increasingly complex care transitions across multiple settings. Methods. The Appreciative Inquiry approach was used to guide interviews with sixty-six healthcare providers from a variety of practice settings. Data was collected on participants’ experience of exceptional care transitions and opportunities for improving care transitions. Results. Nurses and other healthcare providers need to know three things to ensure safe care transitions: (1 know your client; (2 know your team on both sides of the transfer; and (3 know the resources your client needs and how to get them. Three themes describe successful care transitions, including flexible structures; independence and teamwork; and client and provider focus. Conclusion. Nurses often operate at the margins of acceptable performance, and flexibility with regulation and standards is often required in complex sociotechnical work like care transitions. Priority needs to be given to creating conditions where nurses and other healthcare providers are free to creatively engage and respond in ways that will optimize safe care transitions.
Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria
Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work. PMID:25361530
Full Text Available Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT. The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.
Full Text Available Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of the weekly Multidisciplinary Review Committee (MDRC meetings was modified with the list of attendees broadened to include a larger interdisciplinary team. Additionally, the approach to patient care was analyzed for process improvement. Results: The quality improvements are improved communication and throughput, quantified in an 85% decrease in time to complete transplant evaluation, a 37% decrease in median length of stay posttransplantation, and a 33% reduction in the 30 day readmission rate. In addition, pre- and posttransplant caregivers now participate in MDRC in person or via an electronic meeting platform to support the continuum of care. Quality metrics were chosen and tracked via a transparent electronic platform allowing all involved to assess progress toward agreed upon goals. These were achieved in an 18 month time period following the recruitment of new leadership and invested team members working together as a multidisciplinary team to improve the quality of cardiac transplant care. Discussion: Implementation of daily multidisciplinary rounds and
Ahmet Fatih Yılmaz; Ertuğrul Kılıç; Sema Gürsel; Nazlı Tiryaki
Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU), the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Hea...
Stocker, Martin; Pilgrim, Sina B; Burmester, Margarita; Allen, Meredith L; Gijselaers, Wim H
Background Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous. Methods We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts. Findings The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted. Conclusion Bottom–up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of
Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Vinnell, Tina
Accidents in health care are mainly due to systemic communication errors. Errors occur more frequently in the operating theatre (OT) than other clinical settings. Hence, it is important that preventive communication practices are adopted in OT teams. Formal team pre-briefing has been shown to improve safety in high risk settings such as aviation, but such briefing is not common practice in OT teams. This paper reviews key literature demonstrating the value of briefing in high-risk practices; presents and analyses the results of a questionnaire survey on the status of briefing after its introduction to OT teams in one UK hospital; and analyses processes that frustrate widespread adoption of briefing. In comparison with other OT practitioners, surgeons generally reported differing perceptions of the meaning and value of briefing, often holding broad notions of what constitutes a "brief", but also showing scepticism towards briefing. However, surgeons who had introduced briefing reported positive results such as greater efficiency, shared understanding, and increased team morale. Collaborative briefing that extends beyond the technical to include the interpersonal could be initiated in principle by any member of the OT team, but a number of factors inhibit this, and surgeons play a pivotal role in establishing briefing. PMID:17365392
Full Text Available Martin Stocker,1 Sina B Pilgrim,2 Margarita Burmester,3 Meredith L Allen,4 Wim H Gijselaers5 1Neonatal and Pediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, 2Pediatric Intensive Care, University Children's Hospital Berne, Berne, Switzerland; 3Pediatric Intensive Care Unit, Royal Brompton Hospital, London, UK; 4Department of Pediatrics, The Royal Children's Hospital, Victoria, Australia; 5Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, the Netherlands Background: Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.Methods: We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal
Full Text Available Russell P Saneto1,2 1Department of Neurology, University of Washington, 2Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, USA Abstract: Alpers–Huttenlocher syndrome (AHS is a mitochondrial DNA-depletion syndrome. Age of onset is bimodal: early onset at 2–4 years and later adolescent onset at 17–24 years of age. Early development is usually normal, with epilepsy heralding the disorder in ~50% of patients. The onset of seizures is coupled with progressive cognitive decline. Hepatopathy is variable, and when present is a progressive dysfunction leading to liver failure in many cases. These features of seizures, cognitive degeneration, and hepatopathy represent the “classic triad” of AHS. However, most patients develop other system involvement. Therefore, although AHS is ultimately a lethal disorder, medical care is required for sustained quality of life. Frequently, additional organ systems – gastrointestinal, respiratory, nutritional, and psychiatric – abnormalities appear and need treatment. Rarely, cardiovascular dysfunction and even pregnancy complicate medical treatment. Optimal care requires a team of physicians and caretakers to make sure quality of life is optimized. The care team, together with the family and palliative care specialists, need to be in communication as the disease progresses and medical changes occur. Although the unpredictable losses of function challenge medical care, the team approach can foster the individual quality-of-life care needed for the patient and family. Keywords: Mitochondrial depletion syndrome, polymerase gamma 1, clinical care, mitochondria
Current trends in health care research point to a shift from disciplinary models to interdisciplinary team-based mixed methods inquiry designs. This keynote address discusses the problems and prospects of creating vibrant mixed methods health care interdisciplinary research teams that can harness their potential synergy that holds the promise of addressing complex health care issues. We examine the range of factors and issues these types of research teams need to consider to facilitate efficient interdisciplinary mixed methods team-based research. It is argued that concepts such as disciplinary comfort zones, a lack of attention to team dynamics, and low levels of reflexivity among interdisciplinary team members can inhibit the effectiveness of a research team. This keynote suggests a set of effective strategies to address the issues that emanate from the new field of research inquiry known as team science as well as lessons learned from tapping into research on organizational dynamics. PMID:26984708
Paradis, Elise; Leslie, Myles; Gropper, Michael A
Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed. PMID:26704051
Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D
Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. PMID:26815638
Frame, Tracy R; Gryka, Rebecca; Kiersma, Mary E; Todt, Abby L; Cailor, Stephanie M; Chen, Aleda M H
Objective. To evaluate changes in student perceptions of and confidence in self-care concepts after completing a team-based learning (TBL) self-care course. Methods. Team-based learning was used at two universities in first professional year, semester-long self-care courses. Two instruments were created and administered before and after the semester. The instruments were designed to assess changes in student perceptions of self-care using the theory of planned behavior (TPB) domains and confidence in learning self-care concepts using Bandura's Social Cognitive Theory. Wilcoxon signed rank tests were used to evaluate pre/post changes, and Mann Whitney U tests were used to evaluate university differences. Results. Fifty-three Cedarville University and 58 Manchester University students completed both instruments (100% and 92% response rates, respectively). Student self-care perceptions with TPB decreased significantly on nine of 13 items for Cedarville and decreased for one of 13 items for Manchester. Student confidence in self-care concepts improved significantly on all questions for both universities. Conclusion. Data indicate TBL self-care courses were effective in improving student confidence about self-care concepts. Establishing students' skill sets prior to entering the profession is beneficial because pharmacists will use self-directed learning to expand their knowledge and adapt to problem-solving situations. PMID:27170817
Gryka, Rebecca; Kiersma, Mary E.; Todt, Abby L.; Cailor, Stephanie M.; Chen, Aleda M. H.
Objective. To evaluate changes in student perceptions of and confidence in self-care concepts after completing a team-based learning (TBL) self-care course. Methods. Team-based learning was used at two universities in first professional year, semester-long self-care courses. Two instruments were created and administered before and after the semester. The instruments were designed to assess changes in student perceptions of self-care using the theory of planned behavior (TPB) domains and confidence in learning self-care concepts using Bandura’s Social Cognitive Theory. Wilcoxon signed rank tests were used to evaluate pre/post changes, and Mann Whitney U tests were used to evaluate university differences. Results. Fifty-three Cedarville University and 58 Manchester University students completed both instruments (100% and 92% response rates, respectively). Student self-care perceptions with TPB decreased significantly on nine of 13 items for Cedarville and decreased for one of 13 items for Manchester. Student confidence in self-care concepts improved significantly on all questions for both universities. Conclusion. Data indicate TBL self-care courses were effective in improving student confidence about self-care concepts. Establishing students’ skill sets prior to entering the profession is beneficial because pharmacists will use self-directed learning to expand their knowledge and adapt to problem-solving situations. PMID:27170817
Brown, Judith; Lewis, Laura; Ellis, Kathy; Stewart, Moira; Freeman, Thomas R; Kasperski, M Janet
Increasingly, primary health care teams (PHCTs) depend on the contributions of multiple professionals. However, conflict is inevitable on teams. This article examines PHCTs members' experiences with conflict and responses to conflict. This phenomenological study was conducted using in-depth interviews with 121 participants from 16 PHCTs (10 urban and 6 rural) including a wide range of health care professionals. An iterative analysis process was used to examine the verbatim transcripts. The analysis revealed three main themes: sources of team conflict; barriers to conflict resolution; and strategies for conflict resolution. Sources of team conflict included: role boundary issues; scope of practice; and accountability. Barriers to conflict resolution were: lack of time and workload; people in less powerful positions; lack of recognition or motivation to address conflict; and avoiding confrontation for fear of causing emotional discomfort. Team strategies for conflict resolution included interventions by team leaders and the development of conflict management protocols. Individual strategies included: open and direct communication; a willingness to find solutions; showing respect; and humility. Conflict is inherent in teamwork. However, understanding the potential barriers to conflict resolution can assist PHCTs in developing strategies to resolve conflict in a timely fashion. PMID:20795830
Accidents are the most common cause of mortality in children and account for considerable childhood morbidity. The identification of risk factors for childhood accidents suggests that many are predictable and therefore preventable. Numerous interventions have been found to be effective in reducing the morbidity and mortality from childhood accidents. The scope for accident prevention within the primary care setting and the roles of the members of the primary health care team are discussed. Fi...
Saneto, Russell P
Alpers-Huttenlocher syndrome (AHS) is a mitochondrial DNA-depletion syndrome. Age of onset is bimodal: early onset at 2-4 years and later adolescent onset at 17-24 years of age. Early development is usually normal, with epilepsy heralding the disorder in ~50% of patients. The onset of seizures is coupled with progressive cognitive decline. Hepatopathy is variable, and when present is a progressive dysfunction leading to liver failure in many cases. These features of seizures, cognitive degeneration, and hepatopathy represent the "classic triad" of AHS. However, most patients develop other system involvement. Therefore, although AHS is ultimately a lethal disorder, medical care is required for sustained quality of life. Frequently, additional organ systems - gastrointestinal, respiratory, nutritional, and psychiatric - abnormalities appear and need treatment. Rarely, cardiovascular dysfunction and even pregnancy complicate medical treatment. Optimal care requires a team of physicians and caretakers to make sure quality of life is optimized. The care team, together with the family and palliative care specialists, need to be in communication as the disease progresses and medical changes occur. Although the unpredictable losses of function challenge medical care, the team approach can foster the individual quality-of-life care needed for the patient and family. PMID:27555780
van der Weijden Trudy
Full Text Available Abstract Background Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Methods We conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory and organizational culture (Competing Values Framework, and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering. Results A strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04, whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03. No associations were found between organizational culture, team climate and clinical patient outcomes. Conclusion Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea
This article presents a critical evaluation of the concepts of accountability and delegated authority and how this impacts on integrated working in cancer care teams. It looks at the difficulties experienced by radiographers in establishing their roles in integrated teams through an analysis of how professional teams have developed from a sociological and historical perspective. The paper highlights the contestability of the terms and contends that many non-medical professional practitioners experience problems with assuming full accountability. The article acknowledges and advocates that the wishes of patients and clients must be prioritised in the decision making process, thus requiring professionals to embrace accountability fully and differentiate and manage risk. The importance of leadership in furthering the achievement of integrated working is recognised. In conclusion, the article proposes that shared accountability among teams is challenging for radiographers and others, and that education providers should take this into account when designing curricula.
Full Text Available Abstract Background While the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service. Methods The study was undertaken (February March 2009-June 2010 in three phases. Development (Phase 1 involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3 of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs. Results The pharmacist screened most patients (88.4%, 373/422 referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52, and a variety of DRPs (113 were detected at this point, the most common being "patient requests drug information" (25%, 28/113 and "condition not adequately treated" (22%, 25/113. The pharmacist made 120 recommendations in relation to her interventions. Fifty percent of online
Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F
The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency
Greicimar de Oliveira
Full Text Available Objective: To evaluate the knowledge of health team from Basic Health Units in the city of Coari-AM, Brazil, on the action of physical therapist in primary care. Methods: A quantitative,exploratory and descriptive study, like a field survey conducted in 11 primary care units in Coari, Amazonas state. The data were collected through a questionnaire comprising closed questions regarding the action of physical therapist in primary care. 76 professionals joinedin the survey by category: (05 physicians, (10 nurses, (08 nursing technicians and (53 community health workers. Results: 61.64% (n = 45 of the professionals working in the family health team reported knowing the action of physical therapist in primary care; 79.45%(n = 58 referred it in secondary level and 69.86% (n = 51 at the tertiary level of health care. Conclusion: This work showed some knowledge of professionals on the professional action of physical therapists in primary care; however, the knowledge for this level presents itself disadvantaged in relation to other levels of health care. We demonstrated that a share of professionals presented difficulties to consider the possibility of physiotherapeuticintervention in diseases mostly worked in primary care, but the reference to the viability of action of physical therapist for different publics was satisfactory. This conclusion does notexhaust the possibility of discussing the proposed theme.
Greicimar de Oliveira
Full Text Available Objective: To evaluate the knowledge of health team from Basic Health Units in the city of Coari-AM, Brazil, on the action of physical therapist in primary care. Methods: A quantitative, exploratory and descriptive study, like a field survey conducted in 11 primary care units in Coari, Amazonas state. The data were collected through a questionnaire comprising closed questions regarding the action of physical therapist in primary care. 76 professionals joined in the survey by category: (05 physicians, (10 nurses, (08 nursing technicians and (53 community health workers. Results: 61.64% (n = 45 of the professionals working in the family health team reported knowing the action of physical therapist in primary care; 79.45% (n = 58 referred it in secondary level and 69.86% (n = 51 at the tertiary level of health care. Conclusion: This work showed some knowledge of professionals on the professional action of physical therapists in primary care; however, the knowledge for this level presents itself disadvantaged in relation to other levels of health care. We demonstrated that a share of professionals presented difficulties to consider the possibility of physiotherapeutic intervention in diseases mostly worked in primary care, but the reference to the viability of action of physical therapist for different publics was satisfactory. This conclusion does not exhaust the possibility of discussing the proposed theme.
Benjamin Tam; Mary Salib; Alison Fox-Robichaud
BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care.OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes.METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The ...
Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.
Chesluk, Benjamin J; Holmboe, Eric S
We conducted a field study in three primary care practices representing different practice types: a solo practice; a certified patient-centered medical home; and a multiphysician, multispecialty practice connected to a local university. All three practices shared a common culture in the way that practice members related to each other. In each instance, the practice team operated in separate social "silos," isolating physicians from each other and from the rest of the practice staff. We concluded that current practice structures are primarily focused on supporting physicians' hectic routines and have trouble accommodating the diversity of patients' needs. For practices to succeed in managing diverse patients and in helping them understand and manage their own health, it will be critical to break down the silos and organize teams with shared roles and responsibilities. PMID:20439874
Hollier, Lisa M; Promecene, Pamela A; Owens, Michelle Y; Hampton, Moss; Gala, Rajiv; Kulbida, Nicholas; Tomich, Paul; Gregg, Laurie; Rothenberg, Jeffrey; Phelan, Sharon T; Jennings, John C
Health care delivery is in a stage of transformation and a meaningful change in provision of care must also be accompanied by changes in the educational process of health care professionals. This article lays out a roadmap to better prepare obstetrician-gynecologists (ob-gyns) to succeed in interdisciplinary women's health care teams. Just as our current educational programs emphasize the development of competent surgical skills, our future programs must encourage and support the development of communication, teamwork, and leadership skills for ob-gyns. Formal integration of these fundamentals at all levels of the health care training continuum will create an educational system designed to equip all practitioners with a basic level of knowledge and provide opportunities to acquire additional knowledge and skills as needs and interest dictate. Integral to the implementation will be the evaluation of the effects of the contributions of interprofessional education on patient, practice, and health system outcomes. Successful demonstration of value will lead to the sustainability of the educational programs through recognition by physicians, health care teams, academia, health care systems, and payers. PMID:26551185
Dalal, Anuj K; Schnipper, Jeffrey L
Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. PMID:26762584
Flores Jennifer A
Full Text Available Abstract Background Clinical interventions based on collaborative models require effective communication between primary care providers (PCPs and collaborative support teams. Despite growing interest in collaborative care, we have identified no published studies describing how PCPs prefer to communicate and interact with collaborative support teams. This manuscript examines the communication and interaction preferences of PCPs participating in an ongoing randomized clinical trial of a collaborative intervention for chronic pain and depression. Methods The trial is being conducted in five primary care clinics of a Veterans Affairs Medical Center. Twenty-one PCPs randomized to the study intervention completed a survey regarding preferences for interacting with the collaborative support team. Results A majority of PCPs identified email (95% and telephone calls (68% as preferred modes for communicating with members of the support team. In contrast, only 29% identified in-person communications as preferred. Most PCPs preferred that the care manager and physician pain specialist assess patients (76% and make initial treatment changes (71% without first conferring with the PCP. One-half wanted to be designated cosigners of all support team notes in the electronic medical record, one-half wanted to receive brief and focused information rather than in-depth information about their patients, and one-half wanted their practice nurses automatically included in communications. Panel size was strongly associated (p Conclusion The substantial variation in PCP communication preferences suggests the need for knowledge of these preferences when designing and implementing collaborative interventions. Additional research is needed to understand relationships between clinician and practice characteristics and interaction preferences.
Adler, D. S.; Taylor, D. K.
The Science Planning and Scheduling Team of the Space Telescope Science Institute currently uses the VMS operating system. SPST began a transition to Unix-based operations in the summer of 1999. The main tasks for SPST to address in the Unix transition are: (1) converting the current SPST operational tools from DCL to Python; (2) converting our database report scripts from SQL; (3) adopting a Unix-based code management system; and (4) training the SPST staff. The goal is to fully transition the team to Unix operations by the end of 2001.
OBJECTIVES--To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS--274 adult diabetic patients attending a hospital clinic and registered with one of three general practices. INTERVENTION--Random allocation to conventional hospital clinic care or integrated care. Integrated care patients seen in general practice every three or four mon...
The operation of a nuclear power plant is so complex that it requires teamwork. To support team performance, a system need to provide all team members integrated information displays as well as decision aids (e.g., computerized procedures). Two experiments were conducted to investigate the effects of computerized procedures and team size on operating performance. Forty-five participants were involved in the experiments. Each participant executed decision and action tasks to deal with alarm signals, while detecting occasional system errors in the interface. Results showed that effects of computerized procedures were significant on various performance indicators, such as operation time, operation errors, and learning effect, and that two operators would be a satisfactory size in the teamwork system providing computerized procedures
Bleakley, Alan; Hobbs, Adrian; Boyden, James; Walsh, Linda
Work in progress is reported for a research project aiming to improve multiprofessional teamworking in operating theatres through iterative educational intervention. Experimental design is combined with collaborative inquiry. The hypothesis is: will planned, complex educational intervention focused upon improving communication in teamwork lead to…
Organisation of nuclear power plants in the Federal Republic of Germany is discussed. The training stages for reactor operators, shift managers and shift engineers are outlined. Simulator training is described in detail. Guidelines for refresher courses are given. Instructions are laid down in a series of handbooks
Hilde de Vocht
Full Text Available BackgroundCancer often has a profound and enduring impact on sexuality, affecting both patients and their partners. Most healthcare professionals in cancer and palliative care are struggling to address intimate issues with the patients in their care.MethodsStudy 1: An Australian study using semi-structured interviews and documentary data analysis.Study 2: Building on this Australian study, using a hermeneutic phenomenological approach, data were collected in the Netherlands through interviewing 15 cancer patients, 13 partners and 20 healthcare professionals working in cancer and palliative care. The hermeneutic analysis was supported by ATLAS.ti and enhanced by peer debriefing and expert consultation.ResultsFor patients and partners a person-oriented approach is a prerequisite for discussing the whole of their experience regarding the impact of cancer treatment on their sexuality and intimacy. Not all healthcare professionals are willing or capable of adopting such a person-oriented approach.ConclusionA complementary team approach, with clearly defined roles for different team members and clear referral pathways, is required to enhance communication about sexuality and intimacy in cancer and palliative care. This approach, that includes the acknowledgement of the importance of patients’ and partners’ sexuality and intimacy by all team members, is captured in the Stepped Skills model that was developed as an outcome of the Dutch study.
Clarice Magalhães Rodrigues dos Reis
Full Text Available Objective: To describe the primary care actions performed by oral health teams (OHTs that participated in a large national survey led by the Ministry of Health in 2012. Methods: A total of 12,403 dentists from OHTs completed a set of survey questions (response rate = 85.01% on the organization of care, basic dental procedures and oral health surveillance actions of OHTs. Descriptive and hierarchical cluster analyses were developed. Results: The majority of OHTs (85.2% reported that they performed “patient welcoming”. The delivery of services was based on a patient’s identified disease risk (83.1%, and continuity of care was ensured by 85.9% of OHTs. Individual preventive, restorative and surgical procedures were performed by the majority of the teams; however, screening for oral cancer and construction of dental prostheses/dentures occurred less frequently. Cluster 1 was composed of OHTs with the lowest proportion of oral healthcare actions related to oral cancer and dental prostheses/dentures, and the Southeastern and Southern regions had higher proportions of OHTs from cluster 2. Conclusions: OHTs adhere to some of the principles of primary care organizations; however, the teams perform fewer actions related to oral cancer treatment and rehabilitation with complete dentures. The geographical distribution of the clusters was unequal in Brazil.
Rudval Souza da Silva
Full Text Available The aim of this study was to identify the terms that characterize specific nursing jargon, used by the nursing team at the intensive care unit of an oncology hospital when assisting people in palliative care, as well as mapping them alongside with the 7-Axis Model of the ICNP® 2011. This study was conducted between January and April 2013 through interviews with the nursing team professionals. The terms that characterize assistance to people in palliative care were identified in the interviews and later grouped together. Once the mapping was finished, 432 terms were identified. After the terms had been standardized, we applied cross-mapping and identified the terms that were either listed or not listed in the ICNP® 2011. We found 167 listed terms and 95 that were not listed. The development of this study allowed to learn the terms used by the nursing team when assisting people in palliative care, which will enable further contributions to the terminology of this area.
Inappropriate communications within operational teams can lead to serious consequences of a system since it can cause lack of exchange of important information to perform the task to secure the safety of the system in nuclear power plants (NPPs). For that reason, we studied the communication characteristics However, existing studies on the communication characteristics seem to have problem since they have characterized team communications from a single perspective. According that, we have developed an evaluation method to characterize team communications using social network techniques which can evaluate them from various perspectives which are group cohesiveness, frequency of communications, degree of hierarchy, and communication contents. In addition, we suggested some kids of specific communication characteristics of operating teams that can reduce the occurrence of inappropriate communications. Eight verbal protocol data which are audio-visual recorded under emergency training sessions by main control room (MCR) operating teams are used. As a result of the study, there was negative relationship between group cohesiveness and the ratio of inappropriate communications. Moreover, some kinds of specific communication contents are related to the ratio of inappropriate communications. Consequently, we can evaluate communications characteristics of operating teams in NPPs and suggest specific characteristics to provide useful insights to prevent inappropriate communications
The IAEA works to provide a global nuclear safety and security framework for the protection of people and the environment from the effects of ionizing radiation, the minimization of the likelihood of accidents that could endanger life and property, and effective mitigation of the effects of any such events, should they occur. The strategic approach to achieving such a framework involves continual improvement in four areas: national and international safety infrastructures; the establishment and global acceptance of IAEA safety standards; an integrated approach to the provision for the application of the safety standards; and a global network of knowledge and experience. The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the safety of nuclear power plants during commissioning and operation. The OSART programme, initiated in 1982, is available to all Member States with nuclear power plants under commissioning or in operation. Conservative design, careful manufacture and sound construction are all prerequisites for the safe operation of nuclear power plants. However, the safety of the plant also depends ultimately on: sound management, policies, procedures, processes and practices; the capability and reliability of commissioning and operating personnel; comprehensive instructions; sound accident management and emergency preparedness; and adequate resources. Finally, a positive attitude and conscientiousness on the part of all staff in discharging their responsibilities is important to safety. The OSART programme is based on the safety standards applicable to nuclear power plants. IAEA safety standards reflect the consensus of Member States on nuclear safety matters. The reports of the International Nuclear Safety Group identify important current nuclear safety issues and also serve as references during an OSART review. The publication OSART Guidelines provides overall guidance on the conduct of OSART
Highlights: ► A method for measuring team situation awareness is developed. ► Verbal protocol analysis is adopted in this method. ► This method resolves uncertainties from conventional methods. ► This method can be used in evaluating the human–system interfaces. - Abstract: Situation awareness (SA) continues to receive a considerable amount of attention from the ergonomics community given that need for operators to maintain SA is frequently cited as a key to effective and efficient performance. Although complex and dynamic environments such as that of a main control room (MCR) in a nuclear power plant (NPP) are operated by operation teams, and while team situation awareness (TSA) is also cited as an important factor, research is limited to individual SA. However, understanding TSA can provide a window onto the characteristics of team acquisition as well as the performance of a complex skill. Therefore, such knowledge can be valuable in diagnosing team performance successes and failures. Moreover, training and design interventions can target the cognitive underpinnings of team performance, with implications for the design of technological aids to improve team performance. Despite these advantages and the importance of understanding TSA, measures and methods targeting TSA are sparse and fail to address it properly. In this study, an objective TSA measurement method is developed in an effort to understand TSA. First, key considerations for developing a method are derived. Based on these considerations, the proposed method is developed while mainly focusing on the creation of logical connections between team communications and TSA. A speech act coding scheme is also implemented to analyze team communications. The TSA measurement method developed in this study provides a measure for each level of TSA. It was revealed from a preliminary study that this TSA measurement method is feasible for measuring TSA to a fair extent. Useful insight into TSA is also derived.
Andersson, Kristin; Krevers, Barbro; Bendtsen, Preben
Background: Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. Methods: A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional ...
Parsons, Mickey L; Clark, Paul; Marshall, Michelle; Cornett, Patricia A
Leaders are bombarded with healthy workplace articles and advice. This article outlines a strategy for laying the foundation for healthy patient care workplaces at the pivotal unit level. This process facilitates the nursing unit staff to create and implement a shared vision for staff working relationships. Fourteen acute care hospital units, all participants in a healthy workplace intervention, were selected for this analysis because they chose team behavioral norms as a top priority to begin to implement their vision for a desired future for their units, a healthy workplace. These units developed specific team behavioral norms for their expectations of each other. The findings revealed 3 major norm themes and attributes: norms for effective communication, positive attitude, and accountability. Attributes of each norm are described to assist nurses to positively influence their core unit work culture. PMID:17579304
Yeung, Wilfred Wai Kit
The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recov...
Takano, K; Sunaoshi, W; Suzuki, K
In a large and complex system (i.e., a space aeronautics and nuclear power plant) it would be valuable to conduct operator training and support to demonstrate standard operators' behavior in coping with an anomaly caused by multiple malfunctions in which procedures would not have been stipulated previously. A system simulating operator team behavior including individual operator's cognitive behavior, his operations and physical behavior, and even verbal communication among team members, has been developed for a typical commercial nuclear power plant. This simulation model is not a scenario-based system but a complete knowledge-based system, based on the mental model that was envisaged by detailed analyses of experimental results obtained in the full-scope plant simulator. This mental model is composed of a set of knowledge bases and rules able to generate both diagnosis and prognosis depending on the observed situation even for multiple malfunctions. Simulation results of operator team behavior and plant dynamics were compared with corresponding experiments in several anomalies of multiple malfunctions. The comparison showed a reasonable agreement, so the simulation conditions were varied on cognitive task processing speed of individual operators, on team role sharing scheme, and on human machine interface (1st generation to 2nd generation control panel) to assess the sensitivity of this simulation model. Finally, it was shown that this simulation model has applications for the use of training standards and computer aided operator support systems. PMID:10993327
Logan, V; Barclay, S; Caan, W.; McCabe, J; Reid, M.
Lymphoedema usually develops following surgery or radiotherapy for cancer, but can also occur in advanced malignant disease or be primary in origin. Lower limb lymphoedema may present particular difficulties in diagnosis, treatment and management. All types of lymphoedema can seriously impair quality of life for those affected. This study aimed to determine the level of knowledge among primary health care team members concerning the identification and management of patients at risk of develop...
Chana, R.; Marshall, P.; Harley, C
The Intermediate Care Team (ICT) supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how ICT professionals perceive, detect, or respond to loneliness in their clients. This study explores ICT professional’s attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight ICT professionals (n...
Churchill, Julie; Ward, Ernie
Obesity continues to be the most prevalent nutritional problem of dogs and cats as well as one of the most frustrating conditions to treat successfully. Educating and assigning roles to all members of the health care team will improve staff engagement and the consistency and effectiveness of nutritional counseling for preventive care and weight loss treatment plans. Excellent communication skills can be used to assess the client's ability to change and implement a weight loss plan at the right time in the right way to achieve better adherence and improve patient health. PMID:27264055
Kallas, Kathryn D
The purpose of this research was to identify the profile of an excellent nurse manager who can lead effective health care teams. Leadership attributes and competencies that characterize an excellent nurse manager and tools to identify them are lacking in the literature but are required to efficiently and effectively address the growing shortage of registered nurses (RNs) in health care team leadership roles and the critical linkage of these roles to patient outcomes. A profile of an excellent nurse manager was developed on the basis of the responses of nurse managers across the United States who had been identified as excellent or competent by chief nurse executive assessment or/and the Nurse Manager Ability, Leadership, and Support of Nurses staff survey to the Kouzes and Posner Leadership Practices Inventory: Self Instrument. Statistically significant distinctions exist between nurse managers who are excellent and those who are competent as assessed by the Five Practices of Exemplary Leadership, which together comprise the profile of an excellent nurse manager. The Kouzes and Posner Leadership Practices Inventory: Self Instrument can be used to identify, recruit, and develop RNs in the nurse manager role as excellent leaders of effective health care teams. PMID:24896579
Jones Ian Rees
Full Text Available Abstract Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information
It is important to develop safer medical systems and follow manuals of medical procedures for patient safety. However, these approaches do not always result in satisfactory results because of many human factors. It is known that defects of nontechnical skills are more important than those of technical skills regarding medical accidents and incidents. So, it is necessary to improve personal nontechnical skills and compensate for each other's defects based on a team approach. For such purposes, we have implemented TeamSTEPPS to enhance performance and patient safety in our hospital. TeamSTEPPS (team strategies and tools to enhance performance and patient safety) is a useful method to improve the nontechnical skills of each member and the team. In TeamSTEPPS, leadership to share mental models among the team, continuous monitoring and awareness for team activities, mutual support for workload and knowledge, and approaches to complete communication are summarized to enhance teamwork and patient safety. Other than improving nontechnical skills and teamwork, TeamSTEPPS is also very important as a High Reliability Organization (HRO). TeamSTEPPS is worth implementing in every hospital to decrease medical errors and improve patient outcomes and satisfaction. PMID:26591437
Jeong, Kwang Sub; Park, Jin Kyun; Jung, Won Dae
Team performance is a major measure to evaluate the ability of team when a lot of people perform a task of common purpose such as the main control room operators in the nuclear power plant. A team performance is affected the collaboration and communication among operators under dynamic situation as well as by the cognitive process of each team member. Specially, under the emergency situation, more clear and apparent communication in a team is a critical key for the appropriate response to emergency situation. As a general human factor analysis accesses the operator's behavior, it leads to a resulting action of planning, decision, problem-solving. In order to access the internal information and background information of his/her behavior, the verbal protocol analysis is applied. The impact factors on the team performance are derived from the state of the art for team performance, and it is found that the communication is a common key for all impact factors. And, in turn, the impact factors for the communication are accesses and the more detailed analysis is performed. The recorded data for the operator training for emergency situation of nuclear power plant training center are analyzed according to the verbal protocol analysis that are being generally utilized in cognitive psychology, educational psychology, and cognitive science. Two aspects, external (syntax) and internal (symantic) aspects of communication are reviewed. From the syntax analysis, it is found that the task of each step in EOP is separated according to each corresponding operator and the ordinary training is important, and the weak-points for a sentence presentation can be found team-by-team. And, from the symantic analysis for the diagnostic procedure of EOP is performed and the communication errors due to different situation awareness by operators could be found, and it lead to a diagnosis failure. The factors for different symantic cognition for a situation are analyzed and the affecting
Team performance is a major measure to evaluate the ability of team when a lot of people perform a task of common purpose such as the main control room operators in the nuclear power plant. A team performance is affected the collaboration and communication among operators under dynamic situation as well as by the cognitive process of each team member. Specially, under the emergency situation, more clear and apparent communication in a team is a critical key for the appropriate response to emergency situation. As a general human factor analysis accesses the operator's behavior, it leads to a resulting action of planning, decision, problem-solving. In order to access the internal information and background information of his/her behavior, the verbal protocol analysis is applied. The impact factors on the team performance are derived from the state of the art for team performance, and it is found that the communication is a common key for all impact factors. And, in turn, the impact factors for the communication are accesses and the more detailed analysis is performed. The recorded data for the operator training for emergency situation of nuclear power plant training center are analyzed according to the verbal protocol analysis that are being generally utilized in cognitive psychology, educational psychology, and cognitive science. Two aspects, external (syntax) and internal (symantic) aspects of communication are reviewed. From the syntax analysis, it is found that the task of each step in EOP is separated according to each corresponding operator and the ordinary training is important, and the weak-points for a sentence presentation can be found team-by-team. And, from the symantic analysis for the diagnostic procedure of EOP is performed and the communication errors due to different situation awareness by operators could be found, and it lead to a diagnosis failure. The factors for different symantic cognition for a situation are analyzed and the affecting factors
Freund, T.; Everett, C.; Griffiths, P.; Hudon, C.; Naccarella, L.; Laurant, M.G.H.
World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered n
This presentation describes a team approach, at the totalproject level that focused team members with common objectives, for the transition to start-up and operation of the project. The Integrated Management Team (IMT) approach has been successful for this US Department of Energy (DOE) environmental restoration project at the Hanford Site in Richland, Washington. The $53.8-million project will collect, treat, and dispose of low-level mixed waste water discharges from the Hanford Site. Construction is scheduled for completion in September 1994 and facility start-up in June 1995. The project challenge is for leadership that is committed to the transition from construction to operation of the environmental restoration project.
This presentation describes a team approach, at the totalproject level that focused team members with common objectives, for the transition to start-up and operation of the project. The Integrated Management Team (IMT) approach has been successful for this US Department of Energy (DOE) environmental restoration project at the Hanford Site in Richland, Washington. The $53.8-million project will collect, treat, and dispose of low-level mixed waste water discharges from the Hanford Site. Construction is scheduled for completion in September 1994 and facility start-up in June 1995. The project challenge is for leadership that is committed to the transition from construction to operation of the environmental restoration project
Spooner, A. J.; Aitken, L. M.; Corley, A.; Fraser, J. F.; Chaboyer, W.
Background: Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. Objective: The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. Design: A prospective observational study. Setting: A 21-bed medical/s...
Patel, Beena Ishwar
This quality improvement (QI) dissertation is a case study of the homeless-oriented Patient Centered Medical Home demonstration program, referred to as the Homeless Patient Aligned Care Team (HPACT) at West Los Angeles VA Medical Center (WLA). The WLA HPACT program was implemented to address the complex needs of the homeless and at-risk for homelessness population using the Patient Centered Medical Home model (PCMH) - a multi-disciplinary, team-based approach to primary care. Unlike tradition...
The International Atomic Energy Agency (IAEA) has put forward the vision of a global nuclear safety regime that provides for the protection of people and the environment from the effects of ionizing radiation from nuclear facilities, the minimization of the likelihood of accidents that could endanger life and property and effective mitigation of the effects of any such events should they occur. The strategic approach for achieving the vision of enhancing this regime involves four elements and aims at ensuring that the overall nuclear safety level in Member States continues to improve: - Improvement of national and international safety infrastructures: - Establishment and global acceptance of IAEA safety standards. - Integrated approach to the provision for the application of safety standards. And - Global network of knowledge and experience. The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the safety of nuclear power plants during commissioning and operation. The OSART programme, initiated in 1982, is available to all Member States with nuclear power plants under commissioning or in operation. The OSART methodology and its safety services may also be applied to other nuclear installations (e.g. fuel cycle facilities, research reactors). Conservative design, careful manufacture and sound construction are all prerequisites for safe operation of nuclear power plants. However, the safety of the plant depends ultimately on sound policies, procedures, processes and practices. On the capability and reliability of the commissioning and operating personnel. On comprehensive instructions. And on adequate resources. A positive attitude and conscientiousness on the part of the management and staff in discharging their responsibilities is important to safety. OSART missions consider these aspects in assessing a facility's operational practices in comparison with those used successfully in other countries and
The International Atomic Energy Agency (IAEA) has put forward the vision of a global nuclear safety regime that provides for the protection of people and the environment from the effects of ionizing radiation from nuclear facilities, the minimization of the likelihood of accidents that could endanger life and property and effective mitigation of the effects of any such events should they occur. The strategic approach for achieving the vision of enhancing this regime involves four elements and aims at ensuring that the overall nuclear safety level in Member States continues to improve: - Improvement of national and international safety infrastructures: - Establishment and global acceptance of IAEA safety standards; - Integrated approach to the provision for the application of safety standards; and - Global network of knowledge and experience. The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the safety of nuclear power plants during commissioning and operation. The OSART programme, initiated in 1982, is available to all Member States with nuclear power plants under commissioning or in operation. The OSART methodology and its safety services may also be applied to other nuclear installations (e.g. fuel cycle facilities, research reactors). Conservative design, careful manufacture and sound construction are all prerequisites for safe operation of nuclear power plants. However, the safety of the plant depends ultimately on sound policies, procedures, processes and practices; on the capability and reliability of the commissioning and operating personnel; on comprehensive instructions; and on adequate resources. A positive attitude and conscientiousness on the part of the management and staff in discharging their responsibilities is important to safety. OSART missions consider these aspects in assessing a facility's operational practices in comparison with those used successfully in other countries and
Full Text Available Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive thatpatients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care team about the services given to patients.Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10 explored patients’ knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients’ diabetes clinic. Professional focus group (n = 8 explored the health care team’s experiences, barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management, working in the community (public health or working directly with patients with type 2 diabetes. Five health care professionals were interviewed using the same guide of questions as for the focus group.Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients’ knowledge; education programmes; behaviour change; support; and a patient-centred approach.Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients’ knowledge, encouraging behaviour change whilst taking into consideration patients’ backgrounds. The health care team needs to utilise a patient-centred approach.
Full Text Available Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive that patients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care team about the services given to patients.Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10 explored patients’ knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients’ diabetes clinic. Professional focus group (n = 8 explored the health care team’s experiences, barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management, working in the community (public health or working directly with patients with type 2 diabetes. Five health care professionals were interviewed using the same guide of questions as for the focus group.Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients’ knowledge; education programmes; behaviour change; support; and a patient-centred approach.Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients’ knowledge, encouraging behaviour change whilst taking into consideration patients’ backgrounds. The health care team needs to utilise a patient-centred approach.
Full Text Available Abstract Background There are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT. One way would be to consider its effect on the consumption of opioids expressed in total amounts and different formulations administered. We perform this study to evaluate the impact of a hospital PCCT on the trends of opioid prescription in a University Hospital. Methods A seven year retrospective study on opioid prescription was carried out in the Clínica Universidad de Navarra. The period includes three years before and three years after the PCCT was implemented. Prescription was analysed calculating yearly the Defined Daily Dose (DDD adjusted to 1000 hospital stays (DDD/1000HS. Indicators considered were the proportion of patients treated using opioids compared to the total estimated in need of treatment (rate of effectiveness and the proportion of patients potentially requiring opioids but not treated who were incorporated into the treatment group (rate of improvement. Results From 2001 to 2007, total opioid prescription was low in non-oncology Departments (range: 69–110 DDD/1000HS while parenteral morphine and fentanyl did not register any changes. In the same period of time, total opioid prescription increased in the Oncology Department from 240 to 558 DDD/1000HS. The rate of effectiveness in the three years prior to the implantation of the consultation team was 64% and in the three following years rose to 87%. The rate of improvement prior to the palliative care consultation team was 43% and in the three following years was 64%. A change in opioid prescription was registered after the implementation of the PCCT resulting in an increase in the prescription of parenteral morphine and methadone and a decrease in transdermal fentanyl. Conclusion Implementation of a PCCT in a University Hospital is associated with a higher and more adequate use of opioids.
Integrated Hatchery Operations Team (Northwest Power Planning Council, Portland, OR)
This document outlines regional policies and procedures for hatchery operations in the Columbia River Basin. The purpose of these policies is to provide regional guidelines by which all anadromous fish hatcheries will be operated. These policies will be adopted by the fisheries co-managers, and will provide guidance to operate hatcheries in an efficient and biologically sound manner. The hatchery policies presented in this manual are not intended to establish production priorities. Rather, the intent is to guide hatchery operations once production numbers are established. Hatchery operations discussed in this report include broodstock collection, spawning, incubation of eggs, fish rearing and feeding, fish release, equipment maintenance and operations, and personnel training. Decisions regarding production priorities must be provided by fishery managers through a comprehensive plan that addresses both natural and hatchery fish production. The Integrated Hatchery Operations Team is a multi-agency group called for by the Northwest Power Planning Council. This team was directed to develop new basinwide policies for managing and operating all existing and future anadromous fish hatcheries in the Columbia River Basin. The parties pledge to confer with each other and to use their authorities and resources to accomplish these mutually acceptable hatchery practices.
Rossiter, Jennifer; Soor, Gursharan; Telner, Deanna; Aliarzadeh, Babak; Lake, Jennifer
Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings. PMID:24455250
Buchlak, Quinlan D; Yanamadala, Vijay; Leveque, Jean-Christophe; Sethi, Rajiv
Complication rates for complex adult lumbar scoliosis surgery are unacceptably high. Standardized preoperative evaluation protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. To increase patient safety and reduce complication risk, an entire medical and surgical team should work together to care for adult lumbar scoliosis patients. This article describes preoperative patient evaluation strategies with a particular focus on adult lumbar scoliosis surgery involving six or more levels of spinal fusion. Domains considered include recent preoperative evaluation literature, predictive risk modeling, the appropriate management of medical conditions, and the composition and activities of a multidisciplinary conference review team. An evidence-based comprehensive systematic preoperative surgical evaluation process is described. PMID:27260267
Conclusion: It seems that inter-professional education can improve the quality of health care to some extent through influencing knowledge and collaborative performance of health care teams. It also can make the health-related messages provided to the covered population more consistent in addition to enhancing self-confidence of the personnel.
Bridges, J.; Fuller, A.
Background The consistent delivery of compassionate health and social care to older people is a matter of global concern to the nursing profession and the public it serves. The development and evaluation of effective interventions to address this concern is of prime importance. Aims and objectives This paper draws on findings from previous research to propose the use of a novel implementation programme designed to improve and support the delivery of compassionate care by health an...
Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R. Michael; Bailit, Howard L.; Huebner, Colleen E; Conrad, Douglas; Ludwig, Sharity; Mitchell, Melissa; Dysert, Jeanne; Allen, Gary; Scott, JoAnna; Mancl, Lloyd
Background To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. Me...
The primary payload for Space Shuttle Mission STS-42, launched January 22, 1992, was the International Microgravity Laboratory-1 (IML-1), a pressurized manned Spacelab module. The goal of IML-1 was to explore in depth the complex effects of weightlessness of living organisms and materials processing. Around-the-clock research was performed on the human nervous system's adaptation to low gravity and effects of microgravity on other life forms such as shrimp eggs, lentil seedlings, fruit fly eggs, and bacteria. Materials processing experiments were also conducted, including crystal growth from a variety of substances such as enzymes, mercury iodide, and a virus. The Huntsville Operations Support Center (HOSC) Spacelab Payload Operations Control Center (SL POCC) at the Marshall Space Flight Center (MSFC) was the air/ground communication channel used between the astronauts and ground control teams during the Spacelab missions. Featured is the Gravity Plant Physiology Facility (GPPF) team in the SL POCC during the IML-1 mission.
Full text: An international team of nuclear installation safety experts, led by the International Atomic Energy Agency (IAEA), has reviewed safety practices at France's Saint-Alban Nuclear Power Plant (NPP) and has highlighted a set of strong practices as well as a series of recommendations to reinforce them. The IAEA assembled the team at the request of the Government of France to conduct an Operational Safety Review (OSART) of the Saint-Alban NPP. Under the leadership of the IAEA's Division of Nuclear Installation Safety in Vienna, the OSART team performed an in-depth operational safety review from 20 September to 6 October 2010. The team was made up of experts from Belgium, Canada, the Czech Republic, Germany, Lithuania, the Netherlands, Slovakia, Sweden and the USA. An OSART mission is designed to review programmes and activities essential to operational safety. It is not a regulatory inspection, nor is it a design review or a substitute for an exhaustive assessment of the plant's overall safety status. The team at Saint-Alban conducted an in-depth review of the aspects essential to the safe operation of the NPP, which largely are under the control of the site management. The conclusions of the review are based on the IAEA's Safety Standards and proven good international practices. The review covered the areas of Management, Organization and Administration; Training and Qualification; Operations; Maintenance; Technical Support; Operating Experience; Radiation Protection; Chemistry; and Emergency Planning and Preparedness. The OSART team has identified good plant practices, which will be shared with the rest of the nuclear industry for consideration of their application. Examples include: A safety guideline for outages; The use of remote video surveillance of fuel inspection and handling activities; A motivational tool for plant staff regarding the benefits of operating experience and associated corrective actions; and Use of a sophisticated key control system
The primary payload for Space Shuttle Mission STS-42, launched January 22, 1992, was the International Microgravity Laboratory-1 (IML-1), a pressurized manned Spacelab module. The goal of IML-1 was to explore in depth the complex effects of weightlessness of living organisms and materials processing. Around-the-clock research was performed on the human nervous system's adaptation to low gravity and effects of microgravity on other life forms such as shrimp eggs, lentil seedlings, fruit fly eggs, and bacteria. Materials processing experiments were also conducted, including crystal growth from a variety of substances such as enzymes, mercury iodide, and a virus. The Huntsville Operations Support Center (HOSC) Spacelab Payload Operations Control Center (SL POCC) at the Marshall Space Flight Center (MSFC) was the air/ground communication channel used between the astronauts and ground control teams during the Spacelab missions. Featured is the Mental Workload and Performance Experiment (MWPE) team in the SL POCC) during STS-42, IML-1 mission.
McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L
Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease. PMID:27490299
Page, Charles M.; And Others
The CARES project (Coordinated Ambulatory Rehabilitation Evaluation Services) presents a model to provide multidisciplinary services for multiply disabled children in rural settings. Background, information about model components, and descriptive data are presented to illustrate project evolution and operation. Nearly 400 children with multiple…
Full Text Available OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument.CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units.
Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia
OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670
J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); A.M. van Eijsden (A.); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)
textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional s
Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven I...
Kang, Kyung-Ah; Kim, Shin-Jeong; Oh, Jina; Kim, Sunghee; Lee, Myung-Nam
This study determines the effect of simulation with team-based learning (TBL) on newborn nursing care. This randomized controlled trial included 74 nursing students from one university located in Seoul, South Korea. Participants were categorized into two groups according to educational modality: one group involved both simulation and TBL, and the other involved simulation alone. Learning attitudes, academic achievement, and simulation performance were examined to assess effectiveness. The mean difference in learning attitudes between the two groups was non-significant. Low academic achievement differed significantly between the two groups (t = 3.445, P = 0.002). There was no significant difference in mean scores for simulation performance between the two groups. In this study, simulation with TBL was effective in improving learning outcomes. In current nursing education, various learning methods are employed within complex nursing situations and require flexibility and problem-solving approaches. PMID:26581785
Full Text Available Abstract Background Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. Methods and measurements A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum – maximum at referral, patient characteristics, were recorded by staff, and later compared with actual survival. Results Minimum survival estimates ranged Conclusions Offering a prognosis range has higher levels of accuracy (about double than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.
Full text: Improving patient care should be the primary focus of all healthcare providers, regardless of country, setting or department; radiology is no exception. Roles within radiology have evolved and professional boundaries blurred; assistant practitioners contribute to image acquisition and advanced and consultant radiographers undertake tasks historically performed by medical professionals. Team working and appropriate use of skill mix has been highlighted as a way of managing ever increasing imaging workloads.In the United Kingdom, trained radiographers have developed their roles to include tasks historically performed by medical practitioners, including definitive clinical reporting and interventional procedures. The aim of this study was to demonstrate how a radiology department within an acute district general hospital optimizes imaging services to improve access for patients and support for referrers through a strong emphasis on team-working. Data about service delivery was analyzed across three consecutive years and interrogated by modality, referral source and reporting practitioner to determine how workload had evolved. Feedback from referring clinicians was sought. Overall trend was for increased activity (13%) with significant reductions (p<0.001) in waiting and reporting times, with some modality variation. Radiographers interpreted >50% of x-ray and ultrasound examinations. Novel services and patient pathway redesigns were implemented with high clinician satisfaction. Radiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesigned patient pathwayshave produced significant improvements
Highlights: → We develop an estimation model for evaluation of the team performance of MCR. → To build the model, we extract team performance factors through reviewing literatures and identifying behavior markers. → We validate that the model is adaptable to the advanced MCR of nuclear power plants. → As a result, we find that the model is a systematic and objective to measure team performance. - Abstract: The global concerns about safety in the digital technology of the main control room (MCR) are growing as domestic and foreign nuclear power plants are developed with computerized control facilities and human-system interfaces. In a narrow space, the digital technology contributes to a control room environment, which can facilitate the acquisition of all the information needed for operation. Thus, although an individual performance of the advanced MCR can be further improved; there is a limit in expecting an improvement in team performance. The team performance depends on organic coherence as a whole team rather than on the knowledge and skill of an individual operator. Moreover, a good team performance improves communication between and within teams in an efficient manner, and then it can be conducive to addressing unsafe conditions. Respecting this, it is important and necessary to develop methodological technology for the evaluation of operators' teamwork or collaboration, thus enhancing operational performance in nuclear power plant at the MCR. The objectives of this research are twofold: to develop a systematic methodology for evaluation of the team performance of MCR operators in consideration of advanced MCR characteristics, and to validate that the methodology is adaptable to the advanced MCR of nuclear power plants. In order to achieve these two objectives, first, team performance factors were extracted through literature reviews and methodological study concerning team performance theories. Second, the team performance factors were identified and
Annis, Ann M; Harris, Marcelline; Robinson, Claire H; Krein, Sarah L
Patient-Centered Medical Home (PCMH) evaluations have primarily focused on primary care providers and not on the primary care team. This systematic literature review examined the extent to which access and care coordination measures in PCMH reflect the involvement of associate care providers (ACPs), which include registered and licensed practical nurses, nursing and medical assistants, clerks, pharmacists, social workers, and dietitians. Among 42 studies, few measures specified ACP roles or linked ACP care to outcomes. Increasing attention on team-based care emphasizes a vital need to reframe measures within a team context. PMID:27219827
Full Text Available An operating or surgical microscope is an optical instrument that provides the surgeon with a stereoscopic, high quality magnified and illuminated image of the small structures in the surgical area.
Hartgerink, J. M.; Cramm, J.M.; Bakker, T.J.E.M.; Eijsden, A.M. van; Mackenbach, J. P.; Nieboer, A.P.
Aim To identify predictors of relational coordination among professionals delivering care to older patients. Background Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods This study was performed in spring 2010 among ...
Polk, James D.; Doerr, Harold K.; Hurst, Victor W., IV; Schmid, Josef
Medical Operations Support Team (MOST) is introducing/integrating teaching practices associated with high fidelity human patient simulation into the NASA culture, in particular, into medical training sessions and medical procedure evaluations. Current/Future Products iclude: a) Development of Sub-optimal Airway Protocols for the International Space Station (ISS) using the ILMA; b) Clinical Core Competency Training for NASA Flight Surgeons (FS); c) Post-Soyuz Landing Clinical Training for NASA FS; d) Experimental Integrated Training for Astronaut Crew Medical Officers and NASA FS; and e) Private Clinical Refresher Training.
Full Text Available The paper describes a novel methodology for synthesis a high-level control of autonomous multi robot teams. The approach is based on multilayer network operator method that belongs to a symbolic regression class. Synthesis is accomplished in three steps: stabilizing robots about some given position in a state space, finding optimal trajectories of robots’ motion as sets of stabilizing points and then approximating all the points of optimal trajectories by some multi-dimensional function of state variables. The feasibility and effectiveness of the proposed approach is verified on simulations of the task of control synthesis for three mobile robots parking in the constrained space.
Lyons, Damian M.; Shrestha, Karma; Liu, Tsung-Ming
We address the problem of fusing laser ranging data from multiple mobile robots that are surveying an area as part of a robot search and rescue or area surveillance mission. We are specifically interested in the case where members of the robot team are working in close proximity to each other. The advantage of this teamwork is that it greatly speeds up the surveying process; the area can be quickly covered even when the robots use a random motion exploration approach. However, the disadvantage of the close proximity is that it is possible, and even likely, that the laser ranging data from one robot include many depth readings caused by another robot. We refer to this as mutual interference. Using a team of two Pioneer 3-AT robots with tilted SICK LMS-200 laser sensors, we evaluate several techniques for fusing the laser ranging information so as to eliminate the mutual interference. There is an extensive literature on the mapping and localization aspect of this problem. Recent work on mapping has begun to address dynamic or transient objects. Our problem differs from the dynamic map problem in that we look at one kind of transient map feature, other robots, and we know that we wish to completely eliminate the feature. We present and evaluate three different approaches to the map fusion problem: a robot-centric approach, based on estimating team member locations; a map-centric approach, based on inspecting local regions of the map, and a combination of both approaches. We show results for these approaches for several experiments for a two robot team operating in a confined indoor environment .
Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer
Soheilipour, Saeed; Soheilipour, Fatemeh; Derakhshandeh, Fatemeh; Hashemi, Hedieh; Memarzadeh, Mehrdad; Salehiniya, Hamid; Soheilipour, Fahimeh
Background: Due to numerous difficulties in patients suffering from varieties of cleft lip and palate, their therapeutic management involves interdisciplinary teamwork. This study was conducted to compare the age of commencing treatments such as speech therapy, secondary palate and alveolar bone grafting and orthodontics between those who sought treatment early and late. Materials and Methods: In this retrospective study, 260 files of patients with cleft lip and palate based on their age at the time of admission to a cleft care team were divided into two groups: The early admission and late admission. Both groups compared based on four variables including the mean age of beginning speech therapy, palatal secondary surgery, alveolar bone grafting, and receiving orthodontics using t-test. Results: Based on the results, among 134 patients admitted for speech therapy, the mean age of initiating speech therapy in early clients was 3.3 years, and in the late ones was 9 years. Among 47 patients with secondary surgery, the mean age in early clients was 3.88 years, and in the late clients was 15.7 years. Among 17 patients with alveolar bone grafting, the mean age in the first group was 9 years, and in the other was 16.69 years. Among 24 patients receiving orthodontic services, the mean age in early clients was 7.66 years, and in the second group was 17.05 years. Conclusion: There was a significant difference between the age of performing secondary surgery and alveolar bone grafting and the age of beginning speech therapy and receiving orthodontic services in early references and late references to the team. PMID:27274350
Olson, Curtis A.; Tooman, Tricia R.; Alvarado, Carla J.
Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge Systems as a conceptual framework. The purpose was to describe how teams produced, obtained, and used knowledge and information to bring about success...
Fourteen Tiger Team Assessment and eight Technical Safety Appraisal (TSA) final reports have been received and reviewed by the DOE Training Coordination Program during Fiscal Year 1992. These assessments and appraisals included both reactor and non-reactor nuclear facilities in their reports. The Tiger Team Assessments and TSA reports both used TSA performance objectives, and list ''concerns'' as a result of their findings. However, the TSA reports categorized concerns into the following functional areas: (1) Organization and Administration, (2) Radiation Protection, (3) Nuclear Criticality Safety, (4) Occupational Safety, (5) Engineering/Technical Support, (6) Emergency Preparedness, (7) Safety Assessments, (8) Quality Verification, (9) Fire Protection, (10) Environmental Protection, and (11) Energetic Materials Safety. Although these functional areas match most of the TSA performance objectives, not all of the TSA performance objectives are addressed. For example, the TSA reports did not include Training, Maintenance, and Operations as functional areas. Rather, they included concerns that related to these topics throughout the 11 functional areas identified above. For consistency, the Operations concerns that were identified in each of the TSA report functional areas have been included in this summary with the corresponding TSA performance objective
The increasing number of nuclear power plants necessitates the reduction of radioactive effluent release to as low a level as possible. The operating teams are exposed to radiation during operation in the course of work on active components, particularly during repair and maintenance work, and it is desirable, for economic as well as for more general social reasons, to keep the levels of exposure as low as possible. The release of radioactive effluent and the personnel irradiation levels depend upon the type of reactor. The design of the Phenix LMFBR made it possible from the start to forecast very good results, and after more than two years of normal industrial operation with high load factors the results more than confirm the forecasts of very small liquid and gaseous effluent releases and low irradiation levels, thanks mainly to integral design and in-sodium fuel handling. The figures are given in the paper. The Phenix-type LMFBR has thus proven to be particularly ''clean'' as regards the environment; and as far as operation is concerned, there are few constraints due to personnel exposure. Fast breeder reactors accordingly hold out great promise because, in this sphere, they represent a great advance on present-day nuclear plants. (author)
Ali, Jameel; Kumar, Subodh; Gautam, Subash; Sorvari, Anne; Misra, Mahesh C
The Rural Trauma Team Development Course (RTTDC) was devised to optimize trauma resuscitation training in under-resourced rural institutions. This program appears ideal for India because of its dense traffic, large population, and high frequency of rural trauma. We report on the feasibility and desirability of introducing RTTDC in India. An instructor course for 20 faculties and a provider course for 23 were conducted in New Delhi, India. The courses were evaluated by multiple choice question (MCQ) performance, by rating the modules on a three-point scale (1 = very relevant, 2 = relevant, and 3 = not relevant) for communication skills, principles of performance improvement and patient safety (PIPS), and clinical scenarios. Evaluation questionnaires including desirability of promulgation in India were completed using a five-point Likert Scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Overall written comments were also provided. Both faculty and providers improved post-course MCQ scores (p < 0.05) with lower scores in the provider group. Seventy-eight percent faculty and 74 % providers rated the communication module very relevant. PIPS was rated very relevant by 72 % faculty and 65 % providers. There were over 150 comments, generally positive with over 90 % of both faculty and providers rating strongly agree to agree that the course be promulgated widely in India. The RTTDC including plans for promulgation was enthusiastically received in India, and its potential for improving trauma care including communication skills and PIPS appears excellent. PMID:26729998
Phillips, Louise Jane
to residents with dementia. Drawing on Bakhtinian dialogic communication theory, an empirical analysis is presented of how knowledge is co-produced collaboratively in team case meetings. The focus is on the shifting relations between different voices, articulating different knowledge forms and...... professional identities, and on the relational construction of ”person-centred care” and the collective identity of the team in opposition to the practices and identities of residential care workers and relatives of residents. In conclusion, the paper discusses the implications of the empirical results in...
Craig, Shelley; Frankford, Rachel; Allan, Kate; Williams, Charmaine; Schwartz, Celia; Yaworski, Andrea; Janz, Gwen; Malek-Saniee, Sara
Despite being identified as significant determinants of health, depression and anxiety continue to be underdiagnosed and undertreated in primary care settings. This study examined the psychosocial health needs of patients at four urban interdisciplinary primary health teams. Quantitative analysis revealed that nearly 80% of patients reported anxiety and/or depression. Self-reported anxiety and depression was correlated with poor social relationships, compromised health status and underdeveloped problem-solving skills. These findings suggest that social workers have a vital role to play within interdisciplinary primary health teams in the amelioration of factors associated with anxiety and depression. PMID:26727556
Graf Bernhard M
Full Text Available Abstract Background During the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The study aims to show the influence of our palliative care team to reducing emergency calls by cancer patients or their relatives during the last six month of life. Methods Fifty relatives of deceased patients who had been attended by our palliative care team were randomly selected. Data was obtained retrospectively during a structured interview. In addition to demographic data, the number of emergency calls made during the final six months of the patient's life, the reason for the call and the mental compound score (MCS-12 of the caregivers was registered. Results Forty-six relatives agreed to the interview. Emergency calls were placed for 18 patients (39% during the final six months of their lives. There were a total of 23 emergency calls. In 16 cases (70% the patient was admitted to the hospital. Twenty-one (91% of the calls were made before patients had been enrolled to receive palliative care from the team, and two (9% were made afterwards. The mean mental compound score of the caregivers at the time of the interview was 41 (range 28–57. There was a lack of correlation between MCS-12 and number of emergency calls. Conclusion Emergency calls were more likely to occur if the patients were not being attended by our palliative care team. Because of the lack of correlation between MCS-12 and the number of emergency calls, the MCS-12 cannot indicate that acutely stressful situations triggered the calls. However, we conclude that special palliative care programs can reduce psychosocial strain in family caregivers. Therefore, the number of emergency calls may be reduced and this fact allows more palliative patients to die at home.
Kayış, Enis; Khaniyev, Taghi T; Suermondt, Jaap; Sylvester, Karl
For effective operating room (OR) planning, surgery duration estimation is critical. Overestimation leads to underutilization of expensive hospital resources (e.g., OR time) whereas underestimation leads to overtime and high waiting times for the patients. In this paper, we consider a particular estimation method currently in use and using additional temporal, operational, and staff-related factors provide a statistical model to adjust these estimates for higher accuracy.The results show that our method increases the accuracy of the estimates, in particular by reducing large errors. For the 8093 cases we have in our data, our model decreases the mean absolute deviation of the currently used scheduled duration (42.65 ± 0.59 minutes) by 1.98 ± 0.28 minutes. For the cases with large negative errors, however, the decrease in the mean absolute deviation is 20.35 ± 0.74 minutes (with a respective increase of 0.89 ± 0.66 minutes in large positive errors). We find that not only operational and temporal factors, but also medical staff and team experience related factors (such as number of nurses and the frequency of the medical team working together) could be used to improve the currently used estimates. Finally, we conclude that one could further improve these predictions by combining our model with other good prediction models proposed in the literature. Specifically, one could decrease the mean absolute deviation of 39.98 ± 0.58 minutes obtained via the method of Dexter et al (Anesth Analg 117(1):204-209, 2013) by 1.02 ± 0.21 minutes by combining our method with theirs. PMID:25501470
The future of enterprises mainly depends on product research and development. For the modern enterprises, high performance project team is the most important means of R ＆ D projects. According to the interviews and survey found of a plurality of enterprise project R ＆ D team. the internal high performance team of modern business is good or bad, its key lies in whether the team managers for the team creation and management is in place, this is the most difficult place for the high performance team management system, especially the team leadership. Based on this, this paper discusses on the creation and management of high performance modern enterprise team, aiming to provide valuable reference for the enterprise team management.
Tobin-Tyler, Elizabeth; Teitelbaum, Joel
For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH's effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical-legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities. PMID:26445082
Full Text Available Samuel GrossmanDepartment of Veterans Affairs, New York Harbor Healthcare System, New York, NY, USA; Diabetes Care On-The-Go Inc, Brooklyn, NY, USA; Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY, USA; Arnold and Marie Schwartz College of Pharmacy of Long Island University, Brooklyn, NY, USA; Garden State Association of Diabetes Educators, Edison, NJ, USAAbstract: Intensive glycemic control using insulin therapy may be appropriate for many healthy older adults to reduce premature mortality and morbidity, improve quality of life, and reduce health care costs. However, frail elderly people are more prone to develop complications from hypoglycemia, such as confusion and dementia. Overall, older persons with type 2 diabetes mellitus are at greater risk of death from cardiovascular disease (CVD than from intermittent hyperglycemia; therefore, diabetes management should always include CVD prevention and treatment in this patient population. Pharmacists can provide a comprehensive medication review with subsequent recommendations to individualize therapy based on medical and cognitive status. As part of the patient’s health care team, pharmacists can provide continuity of care and communication with other members of the patient’s health care team. In addition, pharmacists can act as educators and patient advocates and establish patient-specific goals to increase medication effectiveness, adherence to a medication regimen, and minimize the likelihood of adverse events.Keywords: glycemic control, hyperglycemia, continuity of care, hypertension and cardiovascular disease, elderly, type 2 diabetes, pharmacist
Thronesbery, Carroll; Malin, Jane T.; Jenks, Kenneth; Overland, David; Oliver, Patrick; Zhang, Jiajie; Gong, Yang; Zhang, Tao
Concepts and prototypes1,2 are discussed for a data-based console logger (D-Logger) to meet new challenges for coordination among flight controllers arising from new exploration mission concepts. The challenges include communication delays, increased crew autonomy, multiple concurrent missions, reduced-size flight support teams that include multidisciplinary flight controllers during quiescent periods, and migrating some flight support activities to flight controller offices. A spiral development approach has been adopted, making simple, but useful functions available early and adding more extensive support later. Evaluations have guided the development of the D-Logger from the beginning and continue to provide valuable user influence about upcoming requirements. D-Logger is part of a suite of tools designed to support future operations personnel and crew. While these tools can be used independently, when used together, they provide yet another level of support by interacting with one another. Recommendations are offered for the development of similar projects.
Stevenson, Lauren; Kelley, Marian; Gorovits, Boris; Kingsley, Clare; Myler, Heather; Österlund, Karolina; Muruganandam, Arumugam; Minamide, Yoshiyuki; Dominguez, Mario
The L2 Global Harmonization Team on large molecule specific assay operation for protein bioanalysis in support of pharmacokinetics focused on the following topics: setting up a balanced validation design, specificity testing, selectivity testing, dilutional linearity, hook effect, parallelism, and testing of robustness and ruggedness. The team additionally considered the impact of lipemia, hemolysis, and the presence of endogenous analyte on selectivity assessments as well as the occurrence o...
Keitshokile Dintle Mogobe
Full Text Available Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs, and 39 HIV professional care team members (PCTMs. SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.
Full Text Available Marco Gasparetto,1 Imerio Angriman,2 Graziella Guariso1 1Department of Women and Children's Health, Paediatric Gastroenterology Unit, Padua University Hospital, Padova, Italy; 2Department of Surgery, Gastroenterology and Oncology, Padua University, Padova, Italy Background: Stricture formation is a common complication of Crohn's disease (CD, occurring in approximately one-third of all patients with this condition. Our aim was to summarize the available epidemiology data on strictures in patients with CD, to outline the principal evidence on diagnostic imaging, and to provide an overview of the current knowledge on treatment strategies, including surgical and endoscopic options. Overall, the unifying theme of this narrative review is the multidisciplinary approach in the clinical management of patients with stricturing CD. Methods: A Medline search was performed, using “Inflammatory Bowel Disease”, “stricture”, “Crohn's Disease”, “Ulcerative Colitis”, “endoscopic balloon dilatation” and “strictureplasty” as keywords. A selection of clinical cohort studies and systematic reviews were reviewed. Results: Strictures in CD are described as either inflammatory or fibrotic. They can occur de novo, at sites of bowel anastomosis or in the ileal pouch. CD-related strictures generally show a poor response to medical therapies, and surgical bowel resection or surgical strictureplasty are often required. Over the last three decades, the potential role of endoscopic balloon dilatation has grown in importance, and nowadays this technique is a valid option, complementary to surgery. Conclusion: Patients with stricturing CD require complex clinical management, which benefits from a multidisciplinary approach: gastroenterologists, pediatricians, radiologists, surgeons, specialist nurses, and dieticians are among the health care providers involved in supporting these patients throughout diagnosis, prevention of complications, and treatment
Kiefer, Sarah M.; Ellerbrock, Cheryl R.
This qualitative case study analyzed how one interdisciplinary team within a large middle school fostered a responsive adolescent-centered community for eighth-grade team students. Data were collected during the spring semester of the 2009 school year via observations, individual interviews, and focus group interviews with nine participants,…
Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R
In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation. PMID:27305428
Jennifer Weller; Robert Frengley; Jane Torrie; Webster, Craig S.; Susan Tomlinson; Kaylene Henderson
Objectives: To conduct an in-depth exploration of the self-reported long-term change in attitudes and performance after a full-day multidisciplinary simulation-based course focussed on team management of emergency events in the Critical Care Unit. To address the current lack of knowledge of factors which can lead to improved teamwork performance and their measurement through identification of measurable markers of behaviour and attitude change. Methods: A purposive sample of course participan...
Chang, Ya-Fen; Chen, Chia-Chen; Chang, Pei-Yu
Nowadays, users/patients may gain desired medical services on-line because of the rapid development of computer network technologies. Conventional healthcare services are provided by a single server. However, care team collaboration by integrating services is the key to improve financial and clinical performance. How a user/patient accesses desired medical services provided by multiple servers becomes a challenge to realize care team collaboration. User authentication plays an important role to protect resources or services from being accessed by unauthorized users. In this paper, we first discuss the perceived security drawbacks of pervasive smart-card-based remote user authentication schemes. Then, we propose a novel dynamic-ID-based user authentication scheme based on elliptic curve cryptosystem (ECC) for multi-server environment with smart cards. The proposed scheme ensures user anonymity and computational efficiency and complies with essential requirements of a secure smart-card-based authentication scheme for multi-server environment to enable care team collaboration. PMID:23355184
Full Text Available Abstract Background There is evidence to suggest that delivery of diabetes self-management support by diabetes educators in primary care may improve patient care processes and patient clinical outcomes; however, the evaluation of such a model in primary care is nonexistent in Canada. This article describes the design for the evaluation of the implementation of Mobile Diabetes Education Teams (MDETs in primary care settings in Canada. Methods/design This study will use a non-blinded, cluster-randomized controlled trial stepped wedge design to evaluate the Mobile Diabetes Education Teams' intervention in improving patient clinical and care process outcomes. A total of 1,200 patient charts at participating primary care sites will be reviewed for data extraction. Eligible patients will be those aged ≥18, who have type 2 diabetes and a hemoglobin A1c (HbA1c of ≥8%. Clusters (that is, primary care sites will be randomized to the intervention and control group using a block randomization procedure within practice size as the blocking factor. A stepped wedge design will be used to sequentially roll out the intervention so that all clusters eventually receive the intervention. The time at which each cluster begins the intervention is randomized to one of the four roll out periods (0, 6, 12, and 18 months. Clusters that are randomized into the intervention later will act as the control for those receiving the intervention earlier. The primary outcome measure will be the difference in the proportion of patients who achieve the recommended HbA1c target of ≤7% between intervention and control groups. Qualitative work (in-depth interviews with primary care physicians, MDET educators and patients; and MDET educators’ field notes and debriefing sessions will be undertaken to assess the implementation process and effectiveness of the MDET intervention. Trial registration ClinicalTrials.gov NCT01553266
Joint ownership is a standard operating procedure for many oil and gas companies and has led to the development of standardized operating agreements. Under the terms of these agreements, one party assumes responsibility for operating and developing the joint interests for the benefit of all working parties. The standard of care imposed upon an operator towards non-operators regarding jointly owned oil and gas operations, is discussed, with an emphasis on whether such an operator is liable to fellow participants for acts fo gross negligence or wilful misconduct. The starting point in the analysis is the proposition that the standard of care for an operation of joint interests may be specified and agreed to by the joint owners in their contracts governing their relationship. A discussion is included of two different standards of care by the courts, whether Alberta courts are finding the gross negligence or wilful standard applicable, and the need for more fundamental change to the industry standard form agreement before the gross negligence/wilful misconduct standard will be applied by Alberta courts. The examination is conducted for the most part with reference to the standard forms of joint operating proceedures in widespread use, the Canadian Association of Petroleum Landman forms of Operating Procedure