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Creating Interprofessional Understanding for a Better Health in Indonesia

Interprofessional Teamwork in Health Care

Department of Bioethics, School of Medicine Faculty of Medicine and Health Sciences Universitas Jenderal Soedirman

Amalia Muhaimin

Objectives: Definition of team Examples of a team Definition of teamwork Effective teamwork Problems and barriers in effective teamwork Possible and alternative solutions Interprofessional healthcare team/teamwork Interprofessional education
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Can we work as a team?

What is a team?
Five characteristics: 1. Teams consist of two or more individuals. 2. Team members have specific roles, specific tasks, interact/coordinate to achieve a common goal 3. Teams make decisions 4. Teams possess specialized knowledge and skills; often function under conditions of high workload 5. Teams differ from small groups teams embody a collective action arising out of task interdependency.

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Examples: military command-and-control teams, aircraft flight crews police SWAT teams fire/rescue teams management teams health care settings: medical emergency teams intensive care units labor and delivery unit, neonatal care units operating room teams etc.
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What is teamwork?

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Teamwork...
team inputs team processes team outputs Team inputs: characteristics of the task, elements of the context, and attitudes brought by its members Team processes: interactions and coordination among team members to achieve specific goals. Team outputs: products derived from the teams collective efforts Teamwork occurs in the process phase, during which designated members interact and collaborate to achieve the desired outcomes.
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Can healthcare personnels work as a team??

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Survey/studies...
In 1999: IOM (Institute of Medicine) report: medical errors cause 44,000 98,000 deaths annually!! automobile accidents (43,458) breast cancer (42,297) AIDS (16,516) airplane accidents (.......)

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Medical errors are often related to teamwork and communication!!!

PATIENT SAFETY

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Empirical Studies

How about Indonesia??

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Ethical problems encountered by physicians and nurses (A.Muhaimin, D.W.Lestari, M.Ferine; 2010)
Issue 1 2 3 4 5 6 Regulation/system Patients family Communication Teamwork Scarce resources Confidentiality* % 68 48 37 36 36 10 Case Lack of drug supply, payment / insurance Consent / refusal of treatment Delivering bad news Disagreement with colleagues Lack of facilities and/or human resources HIV
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Problems in Teamwork (Muhaimin et al., 2010)

Conflict with colleagues (between doctors, OR between nurses) Conflict with other profession (between doctors AND nurses)

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Problems in Teamwork...
Conflict with colleagues (between doctors OR nurses): Difficult to build a good (cohesive) teamwork, especially when working with other discipline/expertise (specialist) Communication barriers, hesitancy to question/criticize concerns of offending, fear of conflict (open conflict) Arrogances/egotism between expertise gray area of disease ex. Oncology Rare conflict between nurses why?? ...
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Conflict with other profession (with doctors/nurses): Rare conflict between nurses only take orders from doctors strong hierarchical system Disagreements between nurses and doctors are often unopened (?), case not often and not perceived as a conflict

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Problem solving: Keep problem to oneself Consult to colleague in other expertise written (in medical record), not directly face to face Choose certain (favorable) colleague to consult less problem, no subspecialties yet (Muhaimin et al., 2010)

How can we achieve an effective teamwork?

Effective team performance requires a willingness on the part of team members to cooperate in the service of a shared goal, such as the goal of improving patient safety and the creation of a treatment environment free from medical errors. Moreover, effective teamwork depends on effective communications within the team, along with adequate organizational resources and support.

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What is IPE??

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Interprofessional Education (IPE)

The process by which a group of students or workers from the health-related occupations with different backgrounds learn together during certain periods of their education, with interaction as the important goal, to collaborate in providing promotive, preventive, curative, rehabilitative, and other health-related services. (World Health Organization)

Overall Goal

to improve patient and provider satisfaction and improve patient outcomes.

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Goals of interprofessional teamwork

Socializing health care providers in working together, in shared problem solving and decision making, towards enhancing the benefit for patients, and other recipients of services; Developing mutual understanding of, and respect for, the contributions of various disciplines; Instilling the requisite competencies for collaborative practice.

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Conclusion
Research Needs: 1. A medical team performance model 2. Teamwork process and outcome measures, relative to medicine 3. More efficient practices for evaluating medical team training programs 4. Team performance diagnostics 5. Simulation-based training applications
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Reference
Baker et al. 2005. Medical Teamwork and Patient Safety The Evidence-based Relation. American Institutes for Research, University of Central Florida, University of Miami Center for Patient Safety. Available at: http://www.ahrq.gov/research/findings/finalreports/medteam/medteamwork.pdf Muhaimin et al. 2012. Communication Barriers in Care at the End of Life. Asian Bioethics Review. June 2012, Vol. 4; 2. Muhaimin et al. 2010. Ethical Dilemmas Encountered by Physician and Nurses. Unpublished.

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