Branching Paths Improving Health Care Services Discussion

Multiple resources exist to assist in implementing improved quality standards within a health care organization. You have already examined Six Sigma. Discuss two other resources that assist with this implementation. Provide an example from your professional experience when possible.

Essentials of Health Care Finance

Cleverley, W. O., & Cleverley, J. O. (2018). Essentials of health care finance (8th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284094633nal experience when possible.

Few industries match the scale of health care. In the United States alone, an estimated 85% of the population has at least 1 health care encounter annually and at least one quarter of these people experience 4 to 9 encounters annually. A single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are a public health issue. Health care delivery systems exemplify complex organizations operating under high stakes in dynamic policy and regulatory environments. The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries. In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the science and to highlight gaps in which studies can further illuminate our evidence-based understanding of teamwork and collaboration. Specifically, we highlight evidence concerning (a) the relationship between teamwork and multilevel outcomes, (b) effective teamwork behaviors, (c) competencies (i.e., knowledge, skills, and attitudes) underlying effective teamwork in the health professions, (d) teamwork interventions, (e) team performance measurement strategies, and (f) the critical role context plays in shaping teamwork and collaboration in practice. We also distill potential avenues for future research and highlight opportunities to understand the translation, dissemination, and implementation of evidence-based teamwork principles into practice.

Keywords: teamwork, health care, collaboration, health systems
In 1999, the Institute of Medicine issued a report that changed how health systems, providers, and researchers understand the occurrence of medical errors (Kohn, Corrigan, & Donaldson, 1999). Since the report’s release, the U.S. health care industry continues to undergo large-scale transformation to improve the value of care (Young, Olsen, & McGinnis, 2010). One factor, identified as a common contributor to medical errors, is the fragmented nature of how health care is delivered. Interventions and reforms vary but frequently include efforts to improve the coordination of care delivery (e.g., McDonald et al., 2014). Consequently, psychological research on how team members form cohesive social units, interdependently function, and adapt over time to achieve shared goals and manage complex work contributes to educational, technological, and work redesign interventions to improve care delivery, patient outcomes, and, ultimately, public health (Thomas, 2011).

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Why Study Health Care Teams?
Research on teams and teamwork processes within health care is important for two main reasons. First, the quality of teamwork is associated with the quality and safety of care delivery systems. This represents an opportunity for team researchers to contribute to solving large societal challenges. Second, the health care industry provides the means to develop and test theories on a large scale, across a wide range of team types. Each of these opportunities is elaborated on in the following two sections.

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The Importance of Teamwork to the Quality and Safety of Care Delivery
Academics, policymakers, and the public are increasingly aware of the magnitude of preventable patient harm in U.S. health care, which may exceed 250,000 deaths per year (Makary & Daniel, 2016). These harms include hospital-acquired infections (Klevens et al., 2007), patient falls (Miake-Lye, Hempel, Ganz, & Shekelle, 2013), diagnostic errors (Newman-Toker & Pronovost, 2009), and surgical errors (Howell, Panesar, Burns, Donaldson, & Darzi, 2014), among others (Pham et al., 2012). Each manifests through complex interactions in the sociotechnical care delivery system.

failures are both an independent cause of preventable patient harm and a cross-cutting contributing factor underlying other harms. Transitions of care (i.e., between care areas or shift changes) in acute care settings are leading opportunities for communication failures directly causing patient harm. They are high-risk interactions in which critical information about the patient’s status and plan of care can be miscommunicated, leading to delays in treatment or inappropriate therapies. These transitions are associated with approximately 28% of surgical adverse events (Gawande, Zinner, Studdert, & Brennan, 2003). Additionally, care team member interactions contribute to specific clinical harms. Poor communication of medication name, dose, route of delivery, and timing of administration between physicians, pharmacists, nurses, and patients can lead to medication errors (Keers, Williams, Cooke, & Ashcroft, 2013). Hierarchy (e.g., between professional roles, and over occupational tenure) can inhibit the assertive communication necessary for effective recovery from error (Sutcliffe, Lewton, & Rosenthal, 2004) such as violation of evidence-based treatment protocols.

The teamwork and communication challenges in health care manifest the problem of coordination neglect in organizational systems (Heath & Staudenmayer, 2000). Managing complex work usually involves breaking it into tasks and delegating components of the work. However, across industries, there is a strong tendency to emphasize the division of labor and ignore mechanisms of coordination and integration (Heath & Staudenmayer, 2000). Health care delivery is inherently interdependent and increasingly complex. No one individual can assure a patient receives the highest standard of care, nor can he or she protect the patient from all potential harms stemming from increasingly complex and powerful therapies. However, despite high levels of interdependence, health care has underinvested in structured and evidence-based practices for managing teams and coordinating care (Kohn et al., 1999).

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