Teamwork methods for accountable care: relational coordination and TeamSTEPPS®.

BACKGROUND To deliver greater value in the accountable care context, the Institute of Medicine argues for a culture of teamwork at multiple levels--across professional and organizational siloes and with patients and their families and communities. The logic of performance improvement is that data are needed to target interventions and to assess their impact. We argue that efforts to build teamwork will benefit from teamwork measures that provide diagnostic information regarding the current state and teamwork interventions that can respond to the opportunities identified in the current state. PURPOSE We identify teamwork measures and teamwork interventions that are validated and that can work across multiple levels of teamwork. We propose specific ways to combine them for optimal effectiveness. APPROACH We review measures of teamwork documented by Valentine, Nembhard, and Edmondson and select those that they identified as satisfying the four criteria for psychometric validation and as being unbounded and therefore able to measure teamwork across multiple levels. We then consider teamwork interventions that are widely used in the U.S. health care context, are well validated based on their association with outcomes, and are capable of working at multiple levels of teamwork. We select the top candidate in each category and propose ways to combine them for optimal effectiveness. FINDINGS We find relational coordination is a validated multilevel teamwork measure and TeamSTEPPS® is a validated multilevel teamwork intervention and propose specific ways for the relational coordination measure to enhance the TeamSTEPPS intervention. PRACTICAL IMPLICATIONS Health care systems and change agents seeking to respond to the challenges of accountable care can use TeamSTEPPS as a validated multilevel teamwork intervention methodology, enhanced by relational coordination as a validated multilevel teamwork measure with diagnostic capacity to pinpoint opportunities for improving teamwork along specific dimensions (e.g., shared knowledge, timely communication) and in specific role relationships (e.g., nurse/medical assistant, emergency unit/medical unit, primary care/specialty care).

[1]  David Otley,et al.  Performance Management: A Framework for Management Control Systems Research , 1999 .

[2]  Daniel T. Jones,et al.  Seeing the Whole Mapping the Extended Value Stream , 2002 .

[3]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[4]  D. P. Baker,et al.  Reducing medical error in the Military Health System: How can team training help? , 2006 .

[5]  A. Edmondson,et al.  Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy , 2012 .

[6]  R. Saunders,et al.  Best Care at Lower Cost: The Path to Continuously Learning Health Care in America , 2013 .

[7]  M. E. Warfield,et al.  Family well-being in a participant-directed autism waiver program: the role of relational coordination. , 2014, Journal of intellectual disability research : JIDR.

[8]  Ingrid M. Nembhard,et al.  Measuring Teamwork in Health Care Settings: A Review of Survey Instruments , 2014, Medical care.

[9]  Luci K. Leykum,et al.  The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams. , 2013, Health care management review.

[10]  Jody Hoffer Gittell,et al.  Coordination between formal providers and informal caregivers. , 2007, Health care management review.

[11]  C. Prahalad,et al.  Co-creation experiences: The next practice in value creation , 2004 .

[12]  Lucian Leape,et al.  Defining and Measuring Integrated Patient Care: Promoting the Next Frontier in Health Care Delivery , 2011, Medical care research and review : MCRR.

[13]  T. Manser.  Teamwork and patient safety in dynamic domains of healthcare: a review of the literature , 2009, Acta anaesthesiologica Scandinavica.

[14]  Jody Hoffer Gittell,et al.  The Southwest Airlines Way : Using the Power of Relationships to Achieve High Performance , 2002 .

[15]  John C. Morey,et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. , 2002, Health services research.

[16]  K. Volpp,et al.  Turning readmission reduction policies into results: some lessons from a multistate initiative to reduce readmissions. , 2013, Population health management.

[17]  J. Kohnen,et al.  Team Effectiveness and Decision Making in Organizations , 1997 .

[18]  Ronald D. Moen,et al.  The Improvement Guide: A Practical Approach to Enhancing Organizational Performance , 1996 .

[19]  Dana E. Sims,et al.  Is there a “Big Five” in Teamwork? , 2005 .

[20]  R. Kaplan,et al.  Using the balanced scorecard as a strategic management system , 1996 .

[21]  J. Cramm,et al.  Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs. , 2012, Health care management review.

[22]  Jody Hoffer Gittell,et al.  Relational Bureaucracy: Structuring Reciprocal Relationships into Roles , 2012 .

[23]  Jody Hoffer Gittell,et al.  Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects , 2002 .

[24]  M. Godfrey,et al.  Accelerating the rate of improvement in cystic fibrosis care: contributions and insights of the learning and leadership collaborative , 2014, BMJ quality & safety.

[25]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .

[26]  Eduardo Salas,et al.  Improving Patient Safety Through Teamwork and Team Training , 2012 .