This post was originally published on July 24th. Since this piece of our website was not working for all viewers, we're republishing some selected posts this week.
Working with the doctors and nurses I see every day is one of my favorite things about this work. I also observe a lot of folks working together, and the frustrations and successes I have been seeing made me want to look in the literature for other perspectives on medical collaboration. I found many articles, but two of them really struck me.
The first was about teamwork on inpatient medical units and the second discussed barriers to nurse-physician collaboration. They made some pretty stark observations about the ways healthcare providers are failing to work together effectively -- and why.
Sure, we're working in teams and we're trying hard. But working in a team is not the same as working together in a team.
These studies found 4 key barriers to medical collaboration:
- People aren't in the same place at the same time. This may sound obvious, but the fact that medical teams are working in different buildings, across organizations, and over different shifts creates a unique communications challenge. Communications systems that ignore this challenge (like video conferencing systems or pages in hospital hallways) ultimately fail.
- Common systems don't work. Healthcare providers report that the communications systems they're expected to use don't facilitate collaboration or coordination of care. Whether it's an EMR, a paging system, or telephone calls, providers are frustrated with the current options. They're old technologies that don't match the pace, aspirations, or reality of healthcare today.
- Coordination of care is basic, and not happening. You would think that the question, "who is taking care of this patient?" would be pretty basic. But providers report that coordination of care is taking up increasing amounts of their time and happening poorly. So poorly, in fact, that knowing who is taking care of a given patient is becoming a daily challenge.
- The "cockpit approach" doesn't work. Well, to be more specific, it does work -- 10% of the time. In a few specific situations, like in ERs and NICUs, applying learnings from airplane cockpits works (e.g., using checklists). But as Zwarenstien and Reeves point out, 90% of medicine takes place outside of this type of setting. The rest of medicine involves fluid teams, long-term and complex problems, and takes place in different locations and different times. That means that the cockpit construct doesn't help much, and these teams are left without a solution.
These barriers are familiar to me, both in our own hospital setting, and in the experience of many ClickCare users. The good news is that time and time again, I've seen creative, courageous nurses, aides, and physicians overcome these barriers, creating better patient care and a better provider experience.
What ClickCare's users taught me about breaking through to medical collaboration:
- Accept that this is your problem, even if it's not your fault. We may not have caused these difficulties in collaboration and communication, but we're suffering from them. The good news is that we've noticed ClickCare users getting a lot of satisfaction and stress-relief from collaboration. It wasn't their fault that it wasn't happening in the first place, but it did benefit them to make it happen.
- Experiment. There isn't a one-size-fits-all solution for collaboration, and so we have to experiment with figuring out what can work for us. The thing about experimentation, though, is that new efforts may not work right away. In the words of Seth Godin, "Anyone who says failure is not an option has also ruled out innovation."
- Choose a communications technology that works for you, even if not everyone is using it. As human beings, we have a tendency to wait for permission, to wait for standardization, to wait until we find out what everyone else is doing. But given the slow rate of change in the medical world, we have to take change into our own hands. Even if not everyone has adopted a new technology, it could easily be the right thing for us, for our organization, and for our patients.