Care Teams and Workforce Guide

Although the importance of teamwork has been well established in primary care for many years, there is a perennial imperative to improve and deepen teamwork. Effective teamwork in healthcare requires not just professional competence on the part of individual team members, but competence in the knowledge, skills and abilities to function effectively together as a team.^[1] For organizations interested in going deeper with team development, there are a variety of evidence-based methods for enhancing teamwork, which can range from addressing intrapersonal and interpersonal team dynamics to enhancing the space in which teams work and collaborate. Organizations may also want to consider a systematic approach to promoting joy in work by addressing the minor daily irritants and larger scale organizational changes that drive team dissatisfaction and burnout.

Before selecting a particular intervention to enhance primary care teamwork, articulate your goals and target audience so that you can select an intervention appropriately. Consider the following four types of evidence-based team development interventions:

1. Team Training

This is a team development intervention that uses a formal curriculum and training approach to enhance team competencies and processes. There are many team training curricula, but for an approach that is specifically designed for enhancing healthcare teamwork, consider the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program created by the Agency for Healthcare Research and Quality. Effective team training is targeted towards identified areas for teamwork development with opportunities to learn new information and skills, as well as opportunities to practice and receive feedback in an environment of psychological safety.

2. Leadership Training

Leadership training can improve both the capabilities of participating leaders, as well as the satisfaction of the people who report to them. Leadership training addresses the knowledge, skills and abilities of professionals to behave effectively in formal leadership roles and to foster desired team outcomes. Like team training, effective leadership training is grounded in identified needs and priority outcomes, and includes a mix of knowledge and skill transfer with an opportunity to practice giving and receiving feedback on new skills and behaviors.

3. Team Building

Team building addresses the ability of team members to effectively resolve the problems they encounter, and generally includes four primary components. These components include goal setting, managing interpersonal relationships, role clarity and problem solving. Team building interventions help teams develop shared mental models with particular effects demonstrated by goal setting and role clarification. Effective team building deepens trust, enabling team members to cope with both uncertainty and vulnerability, which leads to better team coordination and performance. Both team trust and the ability to manage and resolve conflict are critical to effective team functioning. The Institute for Excellence in Health and Social Systems provides training and resources on relational coordination for teams that want additional support.

4. Team Debriefing

This is an approach that facilitates team members to reflect together on a recent experience with an orientation towards learning. Debriefing involves the team discussing the event, identifying issues and improvement opportunities, celebrating successes, and developing a plan for future performance. Team debriefing also promotes shared mental models and clear understanding of team roles and responsibilities, strengths, priorities and challenges. Effective team debriefing requires an environment of trust and psychological safety, a structured and facilitated approach, inclusive conversation, and reflection on both positive and negative aspects of team performance to promote learning and behavior change.^[2]

Although evidence-based interventions are available to improve team functioning, difficult organizational conditions will seriously hamper the effectiveness of teams.^[3] Many healthcare organizations and workforce members have been under unprecedented stress in recent years, due to the intense challenges and demands of the COVID-19 pandemic. Although many healthcare organizations were already seeking interventions to address employee burnout, the need for enhancing joy in work has only grown.

The Institute for Healthcare Improvement (IHI) has created a robust framework and set of tools for organizations interested in investing in employee well-being and joy in work. IHI recommends that leaders start with four key steps:

1. Ask staff what matters to them.
2. Identify unique impediments to joy in work in the local context.
3. Commit to a systems approach to making joy in work a shared responsibility at all levels of the organization.
4. Use improvement science to test approaches to improving joy in work in your organization.^[4]

While improving joy in work can sound like an aspirational goal, systematically addressing the obstacles to employee well-being and engagement are essential for creating the conditions wherein teams can thrive.

In addition to investing in team development and systematic interventions to address burnout, team-based care can be enhanced by effective space design.^[5] Although basic team space redesign, such as colocation to improve visibility and communication, can improve team functioning, these interventions have little effect on patient satisfaction.^[6] If you are interested in space design that both enhances teamwork and patient experience, consider adopting principles of trauma-informed design to improve your medical office space. Recommendations for trauma-informed space design include:

• Reduce and remove known adverse stimuli and environmental stresses, including flickering lights, ambient noises, odors and visual complexity.
• Create spaces with clear sightlines to promote a feeling of calmness and safety, and avoid the typical maze-like layout of many healthcare settings.
• Seek to actively engage individuals in a dynamic, multisensory environment that relies on cool colors, culturally relevant art and decor, and neat and tidy spaces.
• Support self-reliance with adequate, clear and consistent signage.
• Provide and promote connection to the natural world by incorporating natural light, plants that are easy to care for, and water features, if appropriate.
• Offer both private and social spaces, and create opportunities for separation and privacy for those in distress.
• Reinforce a sense of personal identity and choice with modular furniture that can be rearranged, dimmable light fixtures, and adjustable window coverings.^[7][8]

The adoption of a trauma-informed approach has to include consideration of the workforce experience and wellbeing. Investing in trauma-informed team space design can promote psychological and physical safety and calm for staff, as well as patients.