CanMEDs Collaborator
Health Care Professionals

Who are the members of the health care team?

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John Nguyen, 2005

 

A team can be defined as:

A collection of individuals who are interdependent in their tasks, who share responsibility for outcomes, who see themselves and who are see by others as an intact social entity embedded in one or more larger social systems and who manage their relationships across organizational borders. [1] 

In health care, the most common types of teams are:

  • project teams (e.g. quality improvement teams)

  • care delivery teams by patient population (e.g. geriatric teams), disease type (e.g. stroke team), patient care setting (e.g. long term care)

 

 

The Oncology Team

Image
Barry Springle, 2005

 

The care of patients with cancer is an example of  multidisciplinary and interprofessional teams.  The cancer clinic and the inpatient unit on Connell 10  have teams of professionals devoted to the care of patients with cancer. 

 

The following link will take you to an animation where you will hear from various professionals about their contribution to the cancer care team.

Oncology Team montage

 

 

 

There are a number of health care professionals represented in these video clips. They all contribute to the overall care of our patients with cancer.

1.

Which health care professional is missing from these video clips?

2.

Why do you think oncologists were not represented in this series of video clips?

 

 

 

 

The video clips show how members of the cancer care team bring together a breadth of  expertise and experience to assist the patient.

 

 

The team approach can be likened to a relay where the baton is passed to the professional that is best capable to deal with the active issue.  (At times, it can feel like a hot potato as well, especially when no one wants to take on responsibility like Friday afternoons!).

 

 

Finding the right health care professional

 We can’t work together unless we understand the scopes of practice of all members of the team.

 

 

 

 

1.

Who are the different members of a health care team? List as many as you can.

2.

Describe what a physiotherapist does?

3.

Describe how a dietitian contributes to the health care team.

4.

How many years of training does it take to become a pharmacist?

5.

Describe the ways that an occupational therapist assessment can help with discharge planning.

 

Unless services are available by self-referral (e.g. self-referral is available by the Arthritis Society in the community), a physician is expected to initiate a consult to the other members of the health care team for necessary services. In an environment of restricted human resources, physicians are often asked to authorize the need for another team members expertise.

Review the following scenarios and choose the health care professional that can best assist your patient. More than one answer may be correct.

1.You are following a 72 year old woman admitted for congestive heart failure. She is ready for discharge in the next few days but she tells you that she is unable perform self-care in the bathroom. Who can help in this situation?
Occupation therapist
Physiotherapist
Social Worker
Family Physician
2.A 60 year old woman who has just recovered from a prolonged ICU admission for pneumonia and acute renal failure is ready to go home. She is quite deconditioned and you feel that she may require a wheelchair once at home. Who do you consult to arrange this?
Physiotherapist
Social Worker
Family Physician
Occupational Therapist
3.A 48 year old man has been admitted to hospital for investigation of a left sided lung mass. He is also having difficulty with eating food and has lost a significant amount of weight. Which Health Professional can help?
Social Worker
Dietitian
Speech-Language Pathologist
Pharmacist
4.A 70 year old woman is admitted with recurrent falls. You are the resident following this patient and after much discussion she has decided to go to a retirement home. She currently lives with her daughter who wants her to stay with her as the retirement home is costly. The daughter states that she needs her mother's money to help with the upkeep of her home. Who would you consult to help resolve this issue?
Physiotherapist
Social worker
Psychiatrist
Occupational therapist

 

 

Teams

  • are not always immediately functional

  • require effort and commitment of the members

  • are not all the same, what works for one team may not work for another

  • need to be safe and have ways of discussing difficult topics

Team Development

In 1965 Bruce Tuckman published a paper proposing a predictable set of stages through which a team will pass while developing

1. Forming - the coming together of a group

2. Storming - the articulation and sorting of various needs, wishes and goals

3. Norming - coming to a an agreed way of being/working together

4. Performing - working together as a well functioning team

5. Adjourning/mourning - not about the function of the team, but an acknowledgment that the experience of being in a team affects us

Much has been written on this, but it is important to know that teams are organic, they grow and change and develop over time.

 

 

Roles in groups

Just like there are many leadership styles there are also many roles that people play in teams.  The role you play will change over time and in different situations.  As a resident, your knowledge and expertise will also change over time which will add to the variety of roles you may play.  Changing roles can be stressful at times and it is important to recognize when you feel overwhelmed or inexperienced.  Understanding the various roles at play in group situations may help one’s acceptance of others.

 

 

 

 

 

Team leader versus Team member 

In a healthy collaborative environment, it is likely that leadership is fluid and dynamic, that all members of the team will have an opportunity to provide leadership.  Depending on the circumstances, one team member may need or be expected to take on a more prominent role.  For example, in a situation when a patient requires nursing home placement, it is often more appropriate for the social worker to take on more of a leadership role. It is not unusual for physicians to be looked to as leaders and we are trained to fill this role.  Other factors such as gender, cultural norms, power structure/imbalance and history all contribute to this.  These issues are complex and can effect a teams function. 

 

When physicians are taking the role of leader it is good to think about how this came to be - Was it discussed? Will leadership rotate? Are we as involved when someone else is taking the lead? 

 

 

 

 

Physicians, even residents and medical students, can be expected to function as a health care team leader. There are benefits and pitfalls to be "the leader".

1.

Describe a situation where it is helpful to have an identified "leader".

2.

Describe a situation you have been in where having a "leader" was unhelpful. Why?

 

The history of a physician being at the top of the health care professional hierarchy can influence the attitudes of the other members of a health care team.  One should be aware that there may be difficulties in the team because of resentment stemming from the historical dominance of a physician in the health care setting.  Often, these resentments manifest towards students and residents in medicine rather than towards attending physicians. 

 

1.

Have you ever felt that you were being treated unreasonably because of another health care professional's negative attitude towards physicians? If yes, describe the situation and outcome.

 

 

 

 

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1. Cohen & Bailey: Journal of Management 23(4) 238-290

All references for this section