Are we teams?

a-truh-byoo-shuh n

the ascribing of a work (as of literature or art) to a particular author or artist. There is a steady push for healthcare delivery by teams because of the increasing complexity of patients, their needs and the system providing their care. “Our challenge …. is not whether we will deliver care in teams, but rather how well we will deliver care in teams.”


But here is my dilemma, if care is team based then why is attribution ascribed to the individual? 


Failure of a SCIP measure… who is the attending surgeon? Readmission for heart failure … who is the attending physician? Reduction of length of stay … here is a bonus to the gain sharing physician. There is a fundamental disconnect between the behavior we want to encourage and the “nudges” we employ to facilitate that behavior.

Work groups have members with specialized knowledge and skills resulting in specific roles who interact, make decisions and have a work product, in this case, the care outcome for an individual patient. This is a collection of individuals working in unison and its performance is a function of what its members do as individuals. Teams, on the other hand, produce a work product through their collective action, their joint contribution. These are groups “come together to share information, perspective and insights; to make decisions that help each person do his or her job better; and to reinforce individual performance standards…” As a thought experiment consider this in your clinical work, hospital and office, hospital cohort and office partners

Am I a member of a work groups or team?

AHRQ’s TeamSTEPPS program defined a number of team types including “Core” teams involved in direct patient and continuity care, think physicians, nurses, discharge planners, physical and respiratory therapists, pharmacists. Other teams include teams involved in operational management (transport, material management), contingency teams (rapid response teams), support teams for the facility/environment and the core team and of course, administrative teams that establish tone, vision, expectation and accountability. Work groups and teams can be transient or permanent, real or virtual, located together or geographically dispersed.

My interest lies with core teams that are assigned to “critical delivery points’ places where the cost and value of the company’s products and services are most directly determined.” My interim conclusion is that I work on a team consisting of work groups members and increasingly the disconnect in attribution forces me to act as an individual. 

“No group ever becomes a team until it can hold itself accountable as a team.”

Maybe we should look at our workgroup or team behavior and outcomes as a social network. 

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