Evolution and Validation of Practice Standards, Training, and Professional Development

iv.

Humility: Equal respect of all members, regardless of level of training or role – Not tied to

traditional hierarchical thinking in health care. Recognizes that all members of the team are

susceptible to mistakes.

Curiosity: Dedicated to reflection and continuous improvement

Five principles of team-based health care

Shared goals: Clearly articulated, understood, and supported goals are established by the team

that are consistent with the patient and family wishes. The patient and family are actively

involved in establishing the goals of care as members of the team.

ii.

Clear roles: Each team member’s functions, responsibilities, and accountabilities are clearly

established and understood by the team. Efficiency and logical division of labor are achieved.

Although autonomy is important, flexibility of roles and collaboration exist as needed.

iii.

Mutual trust: Establishing and maintaining trust, as well as openness to address questions about

or breaches of trust, are essential. Mutual trust permits individual team members to function to

their highest potential and rely on other team members to follow through on their commitments.

iv.

Effective communication: Tightly linked to mutual trust. The team has consistent channels for

candid and complete communication by all team members and in all situations.

Measurable processes and outcomes: The team develops and implements accurate and timely

measures of successes and failures and uses the results to track and improve performance.

Measures fall into two categories: Process/outcome measures and measures of team function.

This principle is typically the most challenging for a team to implement and sustain effectively.

Critical care teams – Gap analysis: When considering the core principles of team-based care, critical

care team members should evaluate their team structure and performance against these five principles.

Effective teams are much more than patient care rounds by a mix of health care professionals. Common

questions to consider when evaluating potential gaps should include:

Shared goals

Are the patient and family goals for critical care routinely incorporated into the care plan?

ii.

Are the patient and family viewed as active members of the team during the establishment of goals?

iii.

Are there clearly articulated and understood goals that are agreed on by all members of the

team during the provision of care to all ICU patients and the work of the team in the care of

that patient?

iv.

Is progress toward the goals routinely reevaluated in light of the changing course and evolving

perspective of the patient and family? Are goals adjusted or refined throughout the dynamic

course of the critical care admission as needed?

Are there adequate organizational resources and commitments to permit effective establishment

of shared goals in the treatment of ICU patients?

Clear roles

Are each team member’s functions, responsibilities, and accountabilities clearly defined? Can

each team member articulate and understand the role of the other team members?

ii.

Are the roles and responsibilities of each team member focused on the shared goals of the team

and patient?

iii.

Is there clear respect for the contributions of each team member from a nonhierarchical,

interdependent perspective?

iv.

Is each team member introduced (and reintroduced) to the patient and family, including a lay

description of each member’s role and responsibility?

Does each team member go about his or her responsibilities with a reasonable degree of

autonomy?

vi.

Is there a clear team leader? Does the leadership role vary according to individual circumstances,

problems, or environment?