Teamwork vital to improving patient outcomes

14 Oct 2015

Written philosophies, regular team meetings, respect and hard work are all essential ingredients that make up a successful diabetes team, Bruce King has told ISPADAPEG delegates.

Speaking at a session on Teams, Teamwork and Targets Dr King, a paediatric endocrinologist at John Hunter Hospital in Newcastle told delegates that for patients to achieve good outcomes they needed to be managed by teams where all members gave consistent advice to patients.

When teams give conflicting advice patients don’t know who to believe as they don’t have a clear message, he told delegates.

“They really have to decide what they are going to do for themselves … the management is left to the patients,” he said.

When information is repeated there is an improved retention of information, making the person more likely to change their behavior.

For example the Hvidoere study of 21 international diabetes centres showed substantial differences in patient outcomes across centres.

When the researchers looked for differences between the best and worst performing centres they discovered the use of analog insulin, the insulin regime, pumps, staffing ratio, education and materials, and the types of patients did not seem to impact patient outcomes.

However the centres with the lowest HbA1c had teams who set lower targets that were agreed between team members and the children and their parents.

“The teams consistency in being able to state what the glycaemic targets were was a reflection of the teamwork that was occurring within these teams,” said Dr King.

Having blood glucose and diabetes targets are not enough, teams need to work on all aspects of diabetes management for patients to have good outcomes, he said.

“What really helps in teamwork are meetings, written philosophies, guidelines and protocols, coordinated management plans and respect,” he said.

The John Hunter Children’s Hospital uses three forums for team members to meet, including a weekly meeting that establishes their targets and goals.

“What happens in reality is that someone will come along with a goal or idea or a new bit of research and we’ll sit down as a group and discuss it,”explained Dr King.

“These are the worst meetings we have, everyone tries to get out of them because they are such hard work… But they are extremely effective” he told delegates.

Case discussions and ward rounds allow team members to align themselves with what other team members are thinking or saying.

And personal meetings are used to clarify what people are thinking and get rid of any misunderstandings.

The JHCH also has written philosophies that they give to patients – one for those on multiple daily injections and one for people on pumps.

They are given to patients on the first day and are essentially a guideline for how patients should be managing their diabetes

The fact that you’ve got a team, or a big team or a small team doesn’t actually mean that you have teamwork, Dr King concluded.

“Team work occurs when team members work together to produce effective outcomes and this involves planning, implementation and evaluation,” he said.

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