Registrar’s Message: The value of high functioning teams in health care

Dina Baras CPSA, Messenger 9 Comments

One of the benefits of being the “New Guy” is that you get to spend time meeting people and listening to their views. For my first month as CPSA Registrar this is exactly what I’ve done. What has struck me the most is the keen desire everyone has to improve health care for all Albertans.

As part of my orientation, I have been able to speak with senior leadership from Alberta Health, Alberta Health Services, a variety of other health professions, CPSA staff and individual care providers. Everyone agrees providing health care in a developed society is a complex endeavour and no one expects there to be a magic solution to fix it. Everyone does, however, realize we need to do something to improve care while controlling escalating costs.

From those I have spoken to so far, it’s clear our front line care providers work hard every day to improve the health and the care of Albertans, but the day-to-day struggles are not getting easier. Over the next few months, I will talk about a few things I believe the CPSA and physicians in general should consider to help improve the care provided in Alberta. This article focuses on recognizing the value of high functioning teams.

I told myself when I started that I would try to avoid using military analogies in my new job, but I find myself compelled to fall back on my experience to talk about the importance of high functioning teams. Over the past 27 years I have had the tremendous fortune to be a part of some incredible teams, whether that was the Canadian Armed Forces Air Demonstration Team, the Snowbirds, or everyone that was a part of saving lives in Afghanistan. The key to their success was recognizing each individual’s value and how the final outcome hinged on how well the group performed as a team. Everyone began by learning the skills of their trade, but very soon we were brought into small teams to work together and eventually those teams adapted into larger and larger groups as required. Working together as a small team was essential, but knowing you were still part of a larger team with a common goal was just as important.

Fundamentally, everyone working in health care has the same goal: to provide safe, high quality health care. We have individuals, small teams and some larger organizations working well together, but as a rule of thumb we could all improve how well we connect with each other and function as high performing teams. Health care is, without question, a team-based activity. We must understand and appreciate each person’s or organization’s contribution to the team. Our success in improving health care will be dependent on how well we work together.

Every physician practising medicine in Alberta is a member of a team whether they believe it or not. This is not dissimilar to a fighter pilot, who may appear to be working independently on a mission but is supported by many others. Maintainers, air controllers, decision makers, intelligence officers, doctors and lawyers all play a pivotal role in the success or failure of the mission.

The CPSA is also a part of the health leadership team in Alberta, and we look forward to working with other strategic health care organizations, professional colleges and associations to improve the care provided to Albertans.

-Dr. Scott McLeod

9 Comments on Registrar’s Message: The value of high functioning teams in health care

Noel Hershfield said : Subscribe Aug 13, 2017 at 11:31 PM

nothing new here.Could not practice without the assistance of my colleagues in Family ptactice,and other specialties,nurses,pharmacists etc.So what else is new? How about a place for doctors that have been illegally dismissed from practice by their colleagues ? I have knowledge of at least a dozen,of which I am one,who have been handled by their leaders!THAT would be something new!Patients first is a great ideology!How about us?Where do we fit in?

Noel Hershfield said : Subscribe Aug 12, 2017 at 1:06 PM

And that is a valid email address.  Welcome to Alberta.  The teamwork idea certainly good if you're working in a hospital or an ICU or in trauma etc.  I also work in a team situation in the clinic and always have.  I once wrote an article in a publication called the Alberta Doctors Digest about 20 years ago and calculated that a patient with an uncomplicated heart attack admitted to hospital, involved 137 so-called healthcare providers!  If you didn't notice we are no longer doctors, we are healthcare providers.  Always thought we were sickness care providers! 

Ever since I started practicing this province in 1966 there's always been strategies to improve healthcare.  Now we are considered to be stewards of medicine.  We are responsible for the high cost of medicine and it's up to us to reduce it.  I just recently finished A Medical Knowledge self-assessment medical knowledge program that is put out by the American college of physicians.  In the preface to every single volume and there are nine, dealing with various subspecialties etc. it says that we should now be providing high value care (HCV) and there are now hundred  and 30 suggestions how to provide high-value care.  For instance they claim  now been proven that such maneuvers as acupuncture, massage, meditation, and other so called alternative practices given by another group of healthcare providers such as acupuncturists, massage therapists etc. is just as good as surgery for the back and the knee.  They also state categorically that 85 to 90% of the diagnosis is based on a careful history and physical examination and I certainly agree with that. 

One of the problems with the team concept is that patients, especially those admitted to hospital with serious disease, do not know who saw them.  I ask every single patient in my office who has been who their doctor was while they were in hospital.  None of them knew the names of their caregiver.  Even their surgeons!  How could they possibly remember hundred and 37 people?  I don't know if the team concept is going to make this better or worse.  We shall see

In the last issue of the Alberta doctors digest it was all about the electronic medical record .  An interesting series of articles appeared in the American literature in the last two years discussing the effect of the EMR on the individual physician.  Not very scintillating reading!  One thing for certain, in my experience, is how many patients tell me that I'm one of the few doctors they saw have experienced over the past 5 years who  had  eye  contact with the patient !most of them said that when they saw their Dr. he has had his back to them while he  or she  was manipulating and entering and receiving data from the EMR.  I've experienced this myself when I was hospitalized in Southern California.  The doctors there walk around with laptop computers and believe it or not I don't even know the names of the many doctors at saw me..  The first time I recognizetheir names was when they sent me a bill for their services!

I won't delay you any further but there is something else that you need to know  that I will send you a letter because I'm not ready for this particular problem which is significant, to appear on a public communication.

 I would also like to know that recently  I was sad approached by the college of physicians and surgeons  for evaluation of my practice .  I sent them my not inconsiderable  CV but they want 20 charts pulled randomly from my office to be scrutinized  by an internist  in another district .  I have personally  in the past  been asked to monitor certain doctors in the province and have done so but the only way you can do that adequately in my opinion is to see the doctor and action  in his office are is clinic .  it's an interesting exercise.  .


Good luck in your endeavors

N  B Hershfield FRCP

Clinical Professor Medicine (HON)

The University Of Calgary

 

 

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Scott McLeod said : Subscribe Aug 14, 2017 at 9:29 AM

Comment *Good Morning Dr Hershfield. Thank you for taking the time to send in your thoughts. You have touched on several issues here that are important to consider. Over the next few months I will be posting articles that address some them. I encourage you to keep reading the Messenger. Scott

Scott McLeod said : Subscribe Aug 10, 2017 at 4:17 PM

Good Afternoon Dr Hoffman. Thanks for the welcome and for taking the time to read the Messenger. I look forward to seeing other posts from you in the future.

Scott

Paul MARNER said : Subscribe Aug 10, 2017 at 12:55 PM

We, the front line physicians, are overwhelmed by bureaucracy, guidelines, algorithms, codes of conduct (in many different ways) and the constant threat of litigation and examination by the CPSA due to 'complaints' (mostly vexaceous).

We are restricted more and more by rules and regulations that interfere with our ability to practise the full range of our education in medicine. Most of us, who have been practising for a number of years have developed special skills, not always identifiable by examination or learned in particular classes or courses. I refer in part to the ART of medicine and the intuitive understanding of the people we come across. Likewise we abandon those activities that we do not find useful or as interesting.

Lastly, the College has developed a reputation for being the 'Big Brother' who is to be feared and who can do no wrong. The fact that this image exists is quite unnerving. Letters from the CPSA  starting "This letter is not related to a complaint", or words to that effect. One would hope that all the above could be corrected by empathy and understanding.

I am glad to be exiting (slowly) the medical field after many years, feeling that my learned experience is not wanted and my academic ability has diminished to cause concern for possible CPSA censure. FYI - Medical school began in 1957. I do not feel comfortable competing with Dr. Google!

Best wishes in your new position. We always hope for someone better to hold your position; someone who will not blindly follow the political line and will do what is correct for patients and those who endeavour to care for them.

Sincerely

Paul Marner

Scott McLeod said : Subscribe Aug 10, 2017 at 4:05 PM

Dear Dr Marner, Thank you very much for taking the time to not only read The Messenger but provide us with your feedback and commentary. There is no question that life in the trenches of health care is not easy and the College recognizes this. We will take your comments to heart as we move forward. I wish you all the best as you near the end of your career in medicine. Scott

Janis Miyasaki said : Subscribe Aug 10, 2017 at 11:45 AM

I agree that as physicians we are members of a team - in the ambulatory setting, hospital and Emergency Department.  Our group (Parkinson and Movement Disorders Program at the Kaye Edmonton Clinic, UA) has taken advantage of the AHS AIW program to improve our work - but it is an ongoing process.  As a result, we have standardized the patient evaluation to improve our detection of cognitive impairment and non-motor symptoms and our staff have conducted in service education for ward nursing staff to improve Parkinson patient safety.  

I would encourage physicians to take advantage of the AHS Physician Learning Institute courses to improve leadership skills - the rest of Canada pays a hefty sum for these course - Alberta physicians have the opportunity to attend these courses sponsored by  AHS since AHS believes that every physician is a leader.  We are truly fortunate. 

 

Scott McLeod said : Subscribe Aug 10, 2017 at 4:11 PM

Dear Dr Miyasaki, Thank you very much for your comments. I just wanted to support your comments about taking advantage of training available through the Physician Learning Institute. These are great opportunities for personal and professional development no matter what type of practice you have or role you play in the greater health system. Scott

Harold Hoffman said : Subscribe Aug 10, 2017 at 10:14 AM

Welcome aboard!!  I like your military examples.

I do some work with Veterans Affairs Canada, so I have a minor understanding of your previous work.

 

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