The Fundamentals of Creating Cohesive

Multidisciplinary Teams in the Medical Home

Kenneth W. Phelps, Ph.D.Assistant Clinical Professor

Department of Neuropsychiatry and Behavioral ScienceUniversity of South Carolina School of Medicine

Keeley J. Pratt, Ph.D.Post‐doctoral Fellow in Personalized MedicineObesity Signature Program, RTI International

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #B4BOctober 29, 201110:30AM

Faculty DisclosureWe have not had any relevant financial

relationships during the past 12 months.

Need/Practice Gap• More settings are adopting the use of integrated

teams; however, most training programs have not adjusted to educate providers on how to work in settings where intense collaboration exists.

• The resulting dilemma is that providers are often trained in silos, but have no real practice on how to effectively integrate their skill sets.

• The presenters hope to address how providers can create effective, cohesive teams, as well as problem-solve common issues.

Objectives1. Identify the necessity to use multidisciplinary

teams in the patient centered medical home (PCMH).

2. Examine challenges when practicing on multidisciplinary care teams that arise from dissimilar education / training experiences.

3. List strategies to troubleshoot barriers to effective multidisciplinary care.

4. Describe methods for evaluation of collaborative team-based care. 

Experience with teams…

• All of us can relate to being on a “team”o Sports teams (football, soccer, volleyball)o Education teams (school projects, IEP, PTO, board)o Extracurricular teams (glee club, band, fraternity)o Business or executive teamso Family, marriage, or relational teamso Healthcare teams o Others

“For a group of individuals to be transformed into a team, they must have a purpose that is

distinctive, specific to the group and promotes member buy-in to a whole that becomes greater than

simply collecting individual contribution toward the same

objective.”

Kohn and O’Connell, 2007, p. 45-46

“6 Habits of Highly Effective Teams”

Kohn and O’Connell, 2007

Strengthening emotional capacity to

improve team relationships

Expanding team self-awareness

Practicing empathy and respectfulness

Establishing and regulating team

normsThinking laterally

Entrusting team members with

appropriate roles

Why use multi-disciplinary teams?

• Effectiveness of care• Efficiency of delivery• Targeting of BPS needs• Multiple expertise• Mutual learning• Limits oversight and mistakes• Increases professionalism

Effective Primary Care Teams

An effective team may have the…• “capacity to function at a level that enhances the

individual contributions of their members and team effectiveness.”

Themes of primary care team effectiveness:1. Understanding and respecting team members’ roles2. Recognizing that teams require work3. Understanding primary health care 4. Working together: practical know-how for sharing care5. Communication***

Sargeant et al., 2008

Key Elements of Team Building

• Defined Goalso Overall organizational mission statemento Specific, measurable, operational objectives

• Systems (Clinical, Administrative, Financial)• Division of Labor• Training and Cross-training• Communication Structure and Processes

Bodenheimer, 2007 for California Health Foundation

PCMH Team Soup: Most Important

Ingredient?CommunicationFlexibility

Collective MentalityFlat HierarchyShared Vision

Dependability of MembersAddressing Multiple Systems

Etcetera

Common Team Challenges in PCMH

• Languages of care• Unclear roles• Conflicting

personalities• Minimal cohesiveness• No common goals

• Alliances• Triangulation• Boundaries• Indistinct team

leader• Absent patient

and/or family

Narratives of Problematic Healthcare

Teams

Troubleshooting Strategies

1. Give & Take Education2. One Cohesive Treatment Plan3. Reflective Listening 4. Role Statements5. Outside Consultation6. Evaluation

Give & Take Education• Appreciate each person’s unique skill set

and overall contribution to the team• Prioritizing what information should be

included in discussion • Round robin effect vs. lead/follow• Speaker-listener review

*Consider use of personality inventories (True Colors, Myers Briggs, etc.) to highlight differences in approaches to the team and each person’s strengths.

One Cohesive Treatment Plan

• Mission Statement = primary objectives• Vision Statement = values

• Cohesive Treatment Planso Biopsychosocial frameworko System for designation and f/uo Location, location, location

Reflective Listening & Role Statements

• Refresher on I-statementso Replacing the “I” with your professional role

• Team-statements during meetings

• VCR Approacho Validateo Clarify/challengeo Request

Hardy and Laszloffy, 2005

Seeking Outside Consultation

• When is it necessary?• How to find someone?• What is the anticipated end product?

o Assess functional performance of teamo Provide environment where feedback is the normo Assist with problem solving, resolving conflict and

enhancing cohesiveness

Evaluation• Process Groups• Observational Data

o Live observation by 3rd partyo Video or audio record

• Formal Questionnaires o Providerso Patient or family

• Frequency of re-evaluation/appraisal

References• Bodenheimer, T. (2007) Building Teams in Primary Care:

Lessons Learned. California Healthcare Foundation. • Kohn, S. E., & O’Connell, V. D. (2007). 6 Habits of Highly

Effective Teams. Pompton Plains, NJ: The Career Press. • Sargeant, J., Loney, E., & Murphy, G. (2008). Effective

Interprofessional Teams: “Contact is Not Enough” to Build a Team. Journal of Continuing Education in the Health Professions, 28, 228-234.

• Hardy, K. & Laszloffy, T. (2005). Teens who hurt: Clinical interventions to break the cycle. Guilford Publshing.

Questions

Contact Information• Kenny Phelps, Ph.D.

Kenneth.phelps@uscmed.sc.edu (803) 434-4221

• Keeley Pratt, Ph.D.Keeley.pratt@gmail.com(317) 902-7233