As I briefly mentioned, values also deeply relate to students' ability to effectively execute the fundamental health skills. For example:. So how do we teach students values? Let me share my process of course feel free to adapt it to fit the needs of your students. I start by sharing the definition of values with students. After sharing the definition, students make a list of of the most important things in their life.
Next, students take the list and become a detective. As a detective, I ask them to look at each item on their list and to define possible core values related. Now, this process can be a little bit confusing, so I often share the following example:.
Then, students choose the value s they feel most connected to for each item on their list. The values that are defined as most important are a students' core values. It's important to note to students that it's normal for some values to shift and evolve throughout life.
That is all part of growing up and experiencing a full life. Once students have defined their core values, I have them make a visual representation of the goals. Then, we either put this up in the classroom or if they have a binder, they can stick it their. I like students to create a visual so it becomes a simple reminder of what their values are and helps keeps them accountable. It also is a great tool for when students are not acting according to the values and they need a little redirection.
And I wholeheartedly believe that the more aware we are of our values and the critical role they play in determining our well-being, the more we can take control and ownership of our well-being. Focusing on values challenging students to identify, define, and live by theirs!
We've got you covered! Get instant access to five free health lesson plans for in-person or digital instruction. Fundamentally, mutual trust enables these by setting the foundation for good communication, which is the focus of the following principle. As with each of these principles, mutual trust and effective communication are tightly linked and mutually supportive.
In the preoperative surgery unit at Nellis Air Force Base, the team established continuous note charting in the electronic medical record. The preoperative nurse, surgeon, anesthesiologist, and others use one running note to chart their observations and plans, maximizing the utility of their collaborative work.
The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings. If the team members are unable to provide information and understanding to each other actively, accurately, and quickly, subsequent actions may be ineffective or even harmful.
In the digital age, team communication is not limited to in-person communication, such as in team meetings. The framing and content of that communication is the core of effective communication. Effective communication should be considered an attribute and guiding principle of the team, not solely an individual behavior.
Effective communication requires incorporation of all of the values underlying effective teams: honesty, discipline, creativity, humility, and curiosity. Effective communication also comprises a set of teachable skills that can be developed by each member of the team and by the team as a whole.
The teams we interviewed employed a number of strategies and skills for developing and employing effective communication. First, setting a high standard for, and ensuring, consistent, clear, professional communication among team members is a core function of a high-performing team.
The guide outlines individual and team communication practices that support effective teamwork. They should tend toward discussing verifiable observations rather than personal opinion. Team members should listen actively to each other and show a willingness to learn from others. The need for these strategies is highlighted by the fact that many of the teams we interviewed indicated that allowing everyone an equal voice in the room is a core practice.
At Park Nicollet, interprofessional care is facilitated when all are encouraged to attend team meetings and encouraged to ask questions and share ideas equally. Second, effective communicators are deep listeners—actively listening to the contributions of others on the team, including the patient and family. Team members may need to help each other improve this skill either through team exercises or individual conversations.
Patients and families often participate more as listeners on the team; their contributions may need to be facilitated through the active listening of other team members. Team members may need to coach each other, including patients and families, in succinct and clear contributions.
Team members should recognize that questions are a valuable way to clarify and to learn from each other. Whatever option patients and families choose, the plan of care and daily work are defined by the goals and concerns expressed by the patient and family.
Active listening—with confirmation of information transfer —is fundamental to the rounds. Pediatric interns who present the events of the past 24 hours to the team are taught to confirm the report with the patient and family. Finally, team communication requires continual reflection, evaluation, and improvement. Recognizing signs of tension and unspoken conflict can serve as a trigger to reexamine the communication patterns of the team. Both individual and team communication skills are teachable and learnable.
One or more individual team member may act as a coach for patients and families not accustomed to or comfortable with active team membership and communication. Fundamentals of effective team communication include the active membership of the patient and family and the willingness and capability of team members to be clear and direct and communicate without technical jargon.
Information sharing is the goal of communication, and all team members need to recognize that this includes both technical and affective information. As an example of this last factor, at MD Anderson Cancer Center, patients can access their full medical records and communicate virtually with team members through the myMDAnderson Web portal.
The uptake of this service has been enormous and patient and provider satisfaction with the service is high. These are used to track and improve performance immediately and over time. High-functioning teams, by definition, have embraced or at least integrated the principles of team-based care noted above. The high-functioning team has agreed upon shared goals for delivery of patient-centered care.
Clear roles and responsibilities have been shared across the team and team members have committed to shared accountability. High-functioning teams recognize the importance of trust in all interactions, and actively work to build and maintain a respectful and trusting environment. Once they employ these principles, how do teams know they are high-functioning? How can teams that are initially forming assess their progress? How can teams that have been disrupted or lost some functionality understand what efforts are needed to regain it?
And, how can teams know that they are improving care and outcomes while controlling costs to the best of their ability? Measurement of team effectiveness is not a new science. Other industries which employ highly educated, strongly motivated professionals with complimentary or overlapping responsibilities in high-pressure, high-risk situations like aviation, nuclear power, and the armed services have developed a significant body of literature on measuring the effectiveness of teamwork.
Only recently, with higher levels of attention given to patient safety and high-quality care, has health care begun explicitly to create and measure team-based health care delivery. The teams we interviewed considered three types of processes and outcomes: patient outcomes, patient care processes that lead to improved patient outcomes, and value outcomes. Improved patient outcomes provide one of the most important measures of any type of health care, and the number of validated measures has grown exponentially in recent years.
Patient outcome measures should and do vary between teams, reflecting the patients and populations served, as well as the unique strengths, challenges, and improvement initiatives of the team. For the hospital-based teams we interviewed, readmission to the hospital within 30 days was commonly cited as a relevant measure. Safety measures were also cited as important outcomes for patients. In some cases, teams track process measures that are linked to improved patient outcomes.
The Vermont Blueprint for Health has adopted a comprehensive approach to patient outcomes by committing to achieve recognition of each of its Advanced Primary Care Practices as NCQA patient-centered medical homes, among other requirements. Finally, teams assess their outcomes by integrating quality and cost data. Increased capacity for delivering care, using the skillsets of diverse individuals in communicating effectively to the patient, caregivers, and the rest of the team, may decrease the cost of health care.
Currently, many measures that are tied to clinician performance refer to the work of a single clinician, typically a physician. In addition to more traditional process and outcome measures, and reflecting a current national quality trend, all teams interviewed said that they measure satisfaction—formally or informally—of the patients and families they serve as well as that of the other team members. Satisfaction reflects the relational components of care, including rapport, respectful communication, and trust.
Still, patient satisfaction is used as a proxy for, and if well-designed may truly reflect, patient-centeredness and patient engagement in care. Thank you. Many teams we interviewed also emphasized the importance of measuring satisfaction among other team members as a way of tracking team function.
The El Rio Community Health Center has implemented degree evaluations which include measures of employee satisfaction. At the University of Pennsylvania, in addition to patient and cost outcomes, a critical measure of success is the satisfaction of team members, which is linked to staff retention—a critical element for team functioning. In addition to measuring the satisfaction of patients and other team members which are indirect measures of team functioning , engaging in routine, frequent, meaningful evaluation of team function per se allows team members to improve their skills to fulfill the other principles of team-based care.
A number of tools have been developed to directly assess the functionality of teams. Two measures mentioned by teams we interviewed include the Team Development Measure teammeasure.
Valentine and colleagues have produced a review of team measurement tools applicable to health care; a summary table of these tools, reproduced with permission, is available in the Appendix. In summary, measurement of team-based care should include both measures of the processes and outcomes that derive from team functioning and measures of team functioning itself.
There is a deficiency in the availability of validated measures with strong theoretical underpinnings for team-based health care. Improved measurement will enable teams to grow in their capacity to fulfill the principles, facilitate the spread, improve the research, and refine evaluation of the high-value elements of team-based care. To examine the implications of the principles and values of team-based health care outlined here, members of the Best Practices Innovation Collaborative met on February 28, Participants at the meeting provided feedback about the principles and values described here and considered the timeliness of the framework, including bridges to ongoing activities in related sectors.
From those discussions, four themes emerged to guide the immediate activities of those working to accelerate high-value team-based health care:. The requirement that patients and families be at the center of care is espoused by most health care reform and improvement processes, including the patient-centered medical home, care coordination, interprofessional education, and more. Ensuring that patients and families are active members of the health care team is the next critical step toward high-value health care.
Mitchell and colleagues describe a social compact between health professionals, patients, and society intended to strengthen the connections between patient-centered care and team-based care, with a call for patients to be active members of health care teams. Patients are often ill-prepared to participate on health care teams and health professionals are often ill-equipped to practice collaboratively with patients for many reasons—imbalance of power in relationships, poor communication, non-intuitive systems, payment structures that reward volume over value, lack of workforce preparation, and more.
The solution to many of these problems requires restructuring the culture and practices of health care, including promoting transparency of information in an understandable fashion, orientation of people to health care team practices, predictability, and development and spread of readily-available tools for knowledge sharing, self-care, and patient-clinician—team communication.
High-quality team-based health care is costly to implement. As described by those we interviewed, teams are complex systems that require substantial investment to function at their highest capacity. Thus, the use of teams should be targeted to situations in which the transactional costs of team care are outweighed by the benefits in terms of health outcomes.
Targeting is an ongoing process in which the needs of the patient and family are assessed repeatedly, with the expectation that needs are personal and will change over time and based on the situation. Figure 1 presents a schematic of the relationship between complexity of patient needs and the complexity of the corresponding team-based care.
Team-based care and activities related to teams are increasing in many health care sectors. Building bridges between these activities can help ensure synergy and efficiency. Here, we highlight connections between team-based care and three areas in particular: interprofessional education and workforce development, health informatics, and care coordination.
Health education groups in the United States and abroad have called for improved interprofessional education in the preclinical and clinical settings. In the group released a report on the core competencies of interprofessional education to stimulate effective team-based practice.
These core competencies harmonize with the principles outlined in this paper and are critical for guiding the education, evaluation, and certification of health education programs and members of the modern health care workforce. We believe that the values and principles described in this paper supplement the core competencies and should be used to guide selection of candidates for the health professions, their training, their licensure and certification, and their ongoing evaluation by employers, patients, and society.
Many team training tools currently exist in practice to help health professionals—and, ideally, patients and families—continue to develop and maintain values and skills to support their teamwork. The explosion of digital capacity and stimulation of infrastructure development through policy have created opportunities for promotion and facilitation of team-based care.
Health informatics has the capacity to support the work of teams e. For example, an electronic health record designed with teams in mind can enable team charting, and informatics-driven simulation training systems can provide a safe, effective means of improving teamwork, particularly for rare or high-stakes situations. Furthermore, informatics can help teams make sense of vast amounts of data that can be captured to maximize continuous learning, monitor population health, and promote safety and quality without overwhelming team members.
High-functioning teams and their organizations must consider the transformative impact of Web-based, digital, and mobile technology on health and health care delivery. Technological innovations such as telehealth monitoring devices, behavior sensing mobile applications, and diagnostic tools on smartphones are already engaging patients and practitioners in new ways and expanding the continuum of care beyond traditional settings.
The Internet is democratizing medical knowledge by providing unprecedented access to health-related content, research, and patient-to-patient communities such as CureTogether and PatientsLikeMe. Doing this will help you make thoughtful decisions about your life — both in specific situations and for larger and longer term life decisions check out some examples below. This can, at times, lead to challenging situations or decision points.
Before we give you a few examples of situations where values matter, try writing down five values that are important to you personally, then think of and write down three values important to your family and finally think of a group you are part of you can be a New Yorker, Texan, Episcopalian, American and think of three values you feel are important to this group.
It is Monday afternoon and school is done. You have a math test on Thursday. You feel pretty confident but this is a big test. How much do you value academic success and planning ahead? How much do you value spending time with your friends, improving your basketball game, getting exercise every day? How much weight or importance do you give these values and whatever other factors you need to consider will probably lead to your decision.
We typically make these kinds of decisions intuitively — but if you stop to think about it, most of us are actually automatically weighing the various values in these situations.
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