It takes a team to deliver care of high quality
August 20, 2007

The hotel ballroom was packed with 400 doctors, 10 at each round table. My wife, also a physician, and I were attending a medical seminar.

Our facilitator, a pilot, asked us to write in our workbooks. "List all the members on your healthcare team ... the people who help you deliver the best possible care."

We had three minutes to do the exercise.

As I was jotting words like nurse, pharmacist and radiologist, my wife was working, separately. Our facilitator asked a few doctors to read from their lists, and most had what I had. I smiled and felt reassured.

In the past when doctors made home visits, often they worked in an autonomous and individualistic manner. A physician listened to the patient and made a decision as to the course of action. There was no healthcare team that followed him or followed up after the visits. There were limited numbers of diagnostic tests and therapeutic options.

Today, the model has changed. Teams are essential for effective and efficient delivery of healthcare. More importantly, physicians have to be part of a team and often need to lead the team. We have surgical teams, transplant teams, rehabilitation teams and medical office management teams.

In our hospital five years ago, we implemented an intensive care unit multidisciplinary team as part of a quality improvement initiative. A physician, patient's nurse, nurse manager, pharmacist, dietician, and social worker all conducted rounds exchanging ideas with a common purpose of providing patient-centered care.

We reaped rich rewards for this team approach to care. Our infection rates for ventilator-associated pneumonia and bloodstream infections fell by 50 percent and we had 20 percent reduction in cost per ICU patient. An individual physician or a nurse manager could not have done this alone.

Once we were done making a list of our healthcare team, our facilitator asked us: "How many people have 'patient' or 'family,' on their list, as part of their healthcare team?" Only about 10 doctors raised their hands. I was not one of them. I felt as if I had failed an exam.

The concept of healthcare team is evolving. Rightly so, patients and families are part of self-management care models. Some intensive care units have open-24 hours visitations and families making rounds with their ICU teams. A popular chronic care model successfully uses communication between informed interactive patients and prepared proactive providers as the core team.

The concept of teams has deep philosophical ties. In the Eastern religions there is a philosophy of "multiplicity of views" which encourages openness and respect for all perspectives in our search for a common goal.

It is best explained by the story of six blind men and an elephant. Each man touches a different part of an elephant's body -- the side, tusk, trunk, leg, ear or tail -- and insists that only he has the right answer. That is -- before him is a wall, spear, snake, tree, fan and a rope, respectively. The men fail to connect their perspectives or work together as a team and hence are unable to reach the truth.

At our medical seminar, of the 10 doctors who raised their hands, one of them was my wife. The words "patient and family" were on her list. "We jointly got the answer right." I whispered. "Teamwork."

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