As chair of the department of occupational therapy at Samuel Merritt College in Oakland, Calif., Kate Hayner, EdD, OTR/L, strives to help her students become the best occupational therapists they can be. Part of that is teaching them how to be good team members, particularly when they are working with the elderly, whose complex needs often require intervention by multiple disciplines.
"Teamwork is very important in any setting, but I think in the geriatric setting there are frequently so many disciplines involved in the care of the elderly individual that it's critical for really excellent care," she says. "You've heard the saying it takes a village to raise a child. In this case it takes an entire team to work closely together to best care for the elderly client."
Last spring, Hayner was part of a multidisciplinary group that taught a course titled "The Interdisciplinary Team: Improving the Care of Our Elders," a joint venture between Samuel Merritt College and the University of California, Berkeley. The faculty team comprised representatives from PT, nursing, medicine, and social work among others, and guest speakers included other disciplines, such as speech pathology, and even an elderly patient. Students in the class included majors in OT, PT, and chaplaincy.
The goal of the class was to provide an overview of the interdisciplinary team, including the roles each profession plays in patient care, to provide a framework for understanding the dynamics of good teamwork, and to lay the groundwork for how to be an effective team member. Part of the coursework involved having students observe interdisciplinary teams in action at different healthcare facilities.
"I think it's really important that students participate in interdisciplinary experiences, because I think it sets the tone for their entire career," notes Liz Macera, RN, PhD, NP-C, associate clinical professor in the department of physiological nursing at the University of California, San Francisco, who provided the nursing perspective in the course.
Macera decided to practice in geriatrics because she was intrigued by the complex problems of the elderly. "Instead of dealing with somebody with diabetes, you may have somebody who has diabetes and congestive heart failure and COPD. You're dealing with multiple problems that you have to balance." A team is the ideal way to mitigate those problems, she says: "Two minds are better than one."
During the course of her career, Macera has been on many interdisciplinary teams. "The better facilities were where people respected the knowledge of the people in the other professions and allowed some give and take in terms of the sphere of responsibility of taking care of the patient, within their scope of practice," she observes.
Turf wars can tank a team, notes Sharon Gorman, PT, MS, GCS (geriatric clinical specialist), an assistant professor at Samuel Merritt College who helped with the class. "I really think everyone has to understand that while their job is to protect what their practice is, you can't get mired down in it. It isn't all about me being a PT. It's really all about the patient. If you lose that patient focus you can get [into] all these turf wars with people that don't help anybody. That sometimes is troublesome," she says.
Ideally, the team should include representatives from all disciplines working with the patient.
"If you don't have all the members on the team with expertise in those areas looking at that patient from their particular lens of experience, it's really easy to miss something that could potentially help improve that person's quality of life," Gorman notes.
Crafting a Good Team
Part of the focus of the class was on characteristics of a good team. "One of them is focusing on the whole picture, which is what happens when you have a whole team together. You're not just looking in isolation at occupational therapy and what we would address," Hayner says.
But getting that big picture can be difficult. Part of the trouble with teamwork is getting the team together in the first place. Although it's ideal to be all-inclusive, gathering everyone at one time can be a logistical nightmare, Hayner admits. Conference calls may help with some scheduling difficulties.
But just bringing team members together isn't sufficient for good teamwork, she stresses. The team has to function well together and the ideas generated need to be carried out. The best teams she has worked on had a set meeting time that was enforced; clearly defined goals; mutual respect for all members; and a clearly designated leader who not only enforced start time, but also maintained an action list for follow-through on ideas generated at the meetings.
Defining the team's purpose can be critical to crafting an effective team, Gorman says. She suggests potential team members ask themselves, "What is the purpose of our meeting? Is it a meeting that we're going to talk discharge? Is it a meeting where we talk about progress? Is it a meeting where we talk about something not going well with the patient? Is it a combination, and do we have time periods for each of those?"
Another crucial component of a well-run team is managing conflicts. "Obviously there are going to be discussions and dialogue, but if there are conflicts, they should be managed well," Hayner says.
Understanding each other's roles in patient care and respecting each other's expertise can go a long way toward minimizing those conflicts, Macera points out. Conflicts often arise if members focus on their own agendas rather than the patients', which can lead to poor patient outcomes.
Despite potential troubles with teamwork, the payoff of a good team is invaluable, Hayner says: "I think when you have a very good interdisciplinary team approach, it provides for really good comprehensive care that can be very holistic and cost-effective."