The Antidote

Counterspin for Health Care and Health News

Thursday, March 08, 2007

Teamwork in health care - evidence-based?

Does teamwork in health care improve health outcomes? Nobody really knows.

Here's a 13-minute video by health journalist Ray Moynihan, who's a stickler for evidence, and filmmaker Miranda Burne. Moynihan is Australian and works a lot in the British Commonwealth, where evidence-based medicine is taken pretty seriously (see groups such as NICE and Cochrane). This film was funded by the Canadian Health Services Research Foundation, a policy group (though that's an oversimplification) that works with provider and government organizations to try and increase the uptake of research evidence into practice.

The film focuses on a program to integrate care for stroke victims. It raises some good questions: do you really need evidence when it's so obvious that an approach like team care is a good idea? My answer would be yes, if it's something that requires a lot of resources to bring about, and could have other hidden downsides. How do you get that evidence? Do you need a randomized trial? My answer: That's the best way, and you needn't rule out an RCT just because you are in a "complicated" setting with a lot of variability. Randomization takes care of a lot of that. Finally, shouldn't providers always work together as a team, just as a part of good practice, and what does "good practice" mean anyway? I'll leave that one open, but after reading some anecdotes recently about lack of coordination in hospital care, where patient charts became a sort of wastebasket for notes and lab slips that no one bothered to consult, I'd hazard that, yeah, some level of coordination probably makes sense.

What I would have liked to see more of in this film is an idea of what was meant by teamwork - is it just a series of case meetings like the one shown? How many such meetings were there? What sort of follow-up was there clinically? What does it actually mean to accumulate evidence on teamwork, and what outcomes would you look at?

Overall, though, the video is worth your 13 minutes, and provides food for thought.


At 9:04 PM, Blogger Greg P said...

Like so many things in health care, there are teams and there are teams. To put together a collection of people and call that a team isn't necessarily so.

To some extent, all health care is delivered by teams. Many of the preventable problems in health care delivery occur because the collection of people attempting to follow through with care do not work as a team. A team member not only knows what their particular role is but also understands the overall process and takes responsibility for that as well.

I've worked with a team in a rehab setting for over 20 years, and there is no question that my job is easier, the patients get better care because there is a to and fro exchange of information that is far superior to any amount of data or records that might be kept.

At 10:24 PM, Blogger Emily DeVoto, Ph.D., said...

Greg, thanks for your comment. Defining what constitutes a team is going to be a major challenge for establishing evidence.


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