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Healthcare Team Members Importance and their Roles

Healthcare Team Members Importance and their Roles -Members of a Healthcare Team in nursing foundation Importance of Nurses in the Healthcare Team

Healthcare is a complex and challenging field that requires a multidisciplinary approach to ensure optimal patient outcomes. The healthcare team plays a crucial role in providing patient-centered care, and effective communication and collaboration among team members are key components of success. In this article, we will explore the concept of a healthcare team, the importance of collaboration and communication, the different types of healthcare teams, and strategies for promoting effective teamwork.

Table of Contents

Definition of Health Care Team

A healthcare team is a group of healthcare professionals from different specialties who work together to provide patient-centered care. The team may include doctors, nurses, pharmacists , physical therapists, occupational therapists, social workers, and other healthcare professionals who work together to provide comprehensive care to patients.

Members of a Healthcare Team

When it comes to receiving quality healthcare, patients rely on a team of professionals to provide them with the necessary care and attention they need. The members of a healthcare team work together to provide the best possible care to patients, and each member plays a critical role in ensuring that patients receive the care they need. we will explore the different members of a healthcare team and their roles in patient care.

1. Physicians

Physicians are often the first point of contact for patients when they seek medical care. They are responsible for diagnosing and treating illnesses and injuries, prescribing medication, and ordering tests and other diagnostic procedures. They work with other members of the healthcare team to develop treatment plans and provide ongoing care to patients.

Nurses are an essential part of the healthcare team, providing patients with care and attention throughout their stay in the hospital. They work with physicians to administer medication, monitor patients’ vital signs, and provide emotional support to patients and their families.

3. Pharmacists

Pharmacists are responsible for dispensing medications and ensuring that patients receive the correct medications and dosages. They work closely with physicians and nurses to provide medication therapy management and ensure that patients understand how to take their medications correctly.

4. Physical Therapists

Physical therapists are responsible for helping patients regain their strength and mobility after an illness or injury. They work with patients to develop personalized treatment plans to help them achieve their goals and regain their independence.

5. Occupational Therapists

Occupational therapists help patients regain their ability to perform daily tasks, such as bathing, dressing, and cooking. They work with patients to develop personalized treatment plans to help them regain their independence and improve their quality of life.

6. Speech Therapists

Speech therapists work with patients who have difficulty speaking or swallowing due to an injury or illness. They help patients regain their ability to speak and swallow by developing personalized treatment plans.

7. Medical Social Workers

Medical social workers provide patients and their families with emotional support and assistance with navigating the healthcare system. They work with patients to identify their needs and connect them with community resources and services.

8. Dietitians

Dietitians play a critical role in patient care by developing personalized nutrition plans for patients. They work with patients to ensure that they receive the right nutrition to support their recovery and overall health.

9. Respiratory Therapists

Respiratory therapists are responsible for helping patients with breathing difficulties due to an illness or injury. They work with patients to develop personalized treatment plans to improve their breathing and overall health.

10. Diagnostic Professionals

Diagnostic professionals include radiologists, sonographers, and laboratory technicians. They are responsible for performing diagnostic tests and providing accurate results to physicians to aid in diagnosis and treatment plans.

11. Administrative Professionals

Administrative professionals include medical billers, coders, and receptionists. They play an important role in ensuring that the healthcare facility runs smoothly and that patients receive the best care possible.

The Importance of Nurses in Healthcare Team

The healthcare system is complex and requires a team of professionals to work together to ensure that patients receive the care they need. Each healthcare team member brings a unique set of skills and knowledge to the table, and when they work together, they can provide patients with the best possible care.

Providing Compassionate and Evidence-Based Care

Nurses are responsible for providing compassionate care to patients, which is an essential component of healing. They must be able to communicate effectively with patients and their families, listen to their concerns, and provide emotional support. Additionally, nurses must use evidence-based practice to provide the best possible care to their patients. This involves staying up-to-date on the latest research and using it to inform their clinical practice.

Managing Complex Medical Situations

Nurses are often the first healthcare professionals to assess patients and develop care plans. They are responsible for monitoring vital signs, administering medications, and managing complex medical situations. This includes recognizing and responding to changes in a patient’s condition and intervening as needed to prevent further deterioration.

Collaborating with Other Healthcare Professionals

Nurses work closely with other healthcare professionals, including doctors, pharmacists, and therapists, to provide comprehensive care to patients. They are responsible for communicating patient information, providing updates on treatment plans, and ensuring that all members of the healthcare team are working together effectively.

Collaboration and communication among healthcare team members are essential to providing high-quality patient care. Healthcare organizations must invest in strategies to promote effective teamwork, such as fostering a culture of collaboration and communication, utilizing technology to facilitate communication and collaboration, and providing ongoing education and training on effective teamwork. By working together, healthcare teams can improve patient outcomes, enhance patient safety, and reduce healthcare costs.

What is a healthcare team?

A healthcare team is a group of healthcare professionals from different specialties who work together to provide patient-centered care.

What are the benefits of effective collaboration and communication in healthcare teams?

Effective collaboration and communication can improve patient outcomes, enhance patient safety, and reduce healthcare costs.

What are some strategies for promoting effective teamwork in healthcare?

Strategies for promoting effective teamwork include fostering a culture of collaboration and communication, encouraging open communication among team members, utilizing technology to facilitate communication and collaboration, establishing clear roles and responsibilities for each team member, providing ongoing education and training on effective teamwork, and addressing conflicts in a timely and constructive manner.

What is the role of technology in facilitating communication and collaboration among healthcare team members?

Technology can play a significant role in facilitating communication and collaboration among healthcare team members. Tools such as electronic health records, telemedicine, and mobile apps can enhance communication and collaboration, improve access to patient information, and streamline workflows.

How can conflicts be addressed within a healthcare team?

Conflicts within a healthcare team can be addressed by promoting open communication, active listening, and mutual respect. Healthcare organizations can establish conflict resolution policies and provide training on techniques to help team members effectively address and resolve conflicts.

Why is teamwork important in healthcare?

Teamwork is essential in healthcare because it allows for better coordination and communication among healthcare professionals, which leads to better patient outcomes. By working together, healthcare professionals can provide patients with more personalized and efficient care.

How do healthcare teams collaborate?

Healthcare teams collaborate by sharing information, communicating effectively, and working together to develop treatment plans that meet the needs of the patient. They may use technology, such as electronic health records, to share patient information and collaborate more efficiently.

Can patients choose their healthcare team?

Patients may have some input in choosing their healthcare team, but ultimately, the team is determined by the healthcare facility and the patient’s specific needs. Patients can, however, request to work with certain healthcare professionals if they have a preference.

What is the role of a patient in a healthcare team?

The patient plays a critical role in the healthcare team by actively participating in their own care and communicating their needs and concerns to the healthcare professionals. By working together, patients and healthcare professionals can develop treatment plans that are tailored to the patient’s specific needs and preferences.

Please note that this article is for informational purposes only and should not substitute professional medical advice.

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Core Principles & Values of Effective Team-Based Health Care

This paper is the product of individuals who worked to identify basic principles and expectations for the coordinated contributions of various participants in the care process. It is intended to provide common reference points to guide coordinated collaboration among health professionals, patients, and families—ultimately helping to accelerate interprofessional team-based care. The authors are participants drawn from the Best Practices Innovation Collaborative of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care. The Collaborative is inclusive—without walls—and its participants are drawn from professional organizations representing clinicians on the front lines of health care delivery; members of government agencies that are either actively involved in patient care or with programs and policies centrally concerned with the identification and application of best clinical services; and others involved in the evolution of the health care workforce and the health professions.

Teams in health care take many forms, for example, there are disaster response teams; teams that perform emergency operations; hospital teams caring for acutely ill patients; teams that care for people at home; office-based care teams; geographically disparate teams that care for ambulatory patients; teams limited to one clinician and patient; and teams that include the patient and loved ones, as well as a number of supporting health professionals. Teams in health care can therefore be large or small, centralized or dispersed, virtual or face-to-face—while their tasks can be focused and brief or broad and lengthy. This extreme heterogeneity in tasks, patient types, and settings is a challenge to defining optimal team-based health care, including specific guidance on the best structure and functions for teams. Still, regardless of their specific tasks, patients, and settings, effective teams throughout health care are guided by basic principles that can be measured, compared, learned, and replicated. This paper identifies and describes a set of core principles, the purpose of which is to help enable health professionals, researchers, policy makers, administrators, and patients to achieve appropriate, high-value team-based health care.

The Evolution of Teams in Health Care

Health care has not always been recognized as a team sport, as we have recently come to think of it. In the “good old days,” people were cared for by one all-knowing doctor who lived in the community, visited the home, and was available to attend to needs at any time of day or night. If nursing care was needed, it was often provided by family members, or in the case of a family of means, by a private-duty nurse who “lived in.” Although this conveyed elements of teamwork, health care has changed enormously since then and the pace has quickened even more dramatically in the past 20 years. The rapidity of change will continue to accelerate as both clinicians and patients integrate new technologies into their management of wellness, illness, and complicated aging. The clinician operating in isolation is now seen as undesirable in health care—a lone ranger, a cowboy, an individual who works long and hard to provide the care needed, but whose dependence on solitary resources and perspective may put the patient at risk. [1,2]

A driving force behind health care practitioners’ transition from being soloists to members of an orchestra is the complexity of modern health care, which is evolving at a breakneck pace. The U.S. National Guideline Clearinghouse now lists over 2,700 clinical practice guidelines, and, each year, the results of more than 25,000 new clinical trials are published. [3] No single person can absorb and use all this information. In order to benefit from the detailed information and specific knowledge needed for his or her health care, the typical Medicare beneficiary visits two primary care clinicians and five specialists per year, as well as providers of diagnostic, pharmacy, and other services. [4] This figure is several times larger for people with multiple chronic conditions. [5] The implication of these dynamics is enormous. By one estimate, primary care physicians caring for Medicare patients are linked in the care of their patients to, on average, 229 other physicians yearly, [6] to say nothing of the vital relationships between physicians, nurses, physician assistants, advanced practice nurses, pharmacists, social workers, dieticians, technicians, administrators, and many more members of the team. With the geometric rise in complexity in health care, which shows no signs of reversal, the number of connections among health care providers and patients will likely continue to increase and become more complicated. Data already suggest that referrals from primary care providers to specialists rose dramatically from 1999 to 2009. [7]

Given this complexity of information and interpersonal connections, it is not only difficult for one clinician to provide care in isolation but also potentially harmful. As multiple clinicians provide care to the same patient or family, clinicians become a team—a group working with at least one common aim: the best possible care—whether or not they acknowledge this fact. Each clinician relies upon information and action from other members of the team. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented. Now, more than ever, there is an obligation to strive for perfection in the science and practice of interprofessional team-based health care.

Urgent Need for High-Functioning Teams

The incorporation of multiple perspectives in health care offers the benefit of diverse knowledge and experience; however, in practice, shared responsibility without high-quality teamwork can be fraught with peril. For example, “handoffs,” in which one clinician gives over to another the primary responsibility for care of a hospitalized patient, are associated with both avoidable adverse events and “near misses,” due in part to inadequacy of communication among clinicians. [8,9,10,11,12] In addition to the immediate risks for patients, lack of purposeful team care can also lead to unnecessary waste and cost. [13] Given the frequently uncoordinated state of care by groups of people who have not developed team skills, it is not surprising that some clinicians report that team care can be cumbersome and may increase medical errors. [14] By acknowledging the aspects of collaboration inherent in health care and striving to improve systems and skills, identification of best practices in interdisciplinary team-based care holds the potential to address some of these dangers, and might help to control costs. [15,16] Identifying best practices through rigorous study and comparison remains a challenge, and data on optimal processes for team-based care are elusive at least partly due to lack of agreement about the core elements of team-based care. Once the underlying principles are defined, researchers will be able to more easily compare team-based care models, payers will be able to identify and promote effective practices, and the essential elements for promoting and spreading team-based care will be evident.

The State of Play

The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective health care delivery system. As a result, a number of models have been developed and implemented to coordinate the activities of health care providers. Building on foundations established by earlier reports from the IOM [17] and the Pew Health Professions Commission, [18] team-based care has gained additional momentum in recent years in the form of legislative support through the Patient Protection and Affordable Care Act of 2010 and the emergence of substantial interprofessional policy and practice development organizations, such as the Patient-Centered Primary Care Collaborative and the Interprofessional Education Collaborative (IPEC).

In addition to national initiatives, there are many deeply considered, well-executed initiatives in team-based care in pockets across the United States. High-functioning teams have been formed in a variety of practice environments, including both primary and acute care settings. [1,19,20,21,22,23,24] Teams have also been formed to serve specific patients or patient populations, for example, chronic care teams, hospital rapid response teams, and hospice teams. [25,26,27]

Analyses of the quality and cost of team-based care do not yet provide a comprehensive, incontrovertible picture of success. Still, two reviews indicate that team-based care can result in improvements in both health care quality and health outcomes, and one review indicates that costs may be better controlled, particularly in transitional care models. [16,28] Research on team-based care has been hindered by lack of common definitions. While common elements, success factors, and outcome measures are beginning to be described in a variety of team-based care scenarios, a widely-accepted framework does not yet exist to understand, compare, teach, and implement team-based care across settings and disciplines.

Fundamental to the success of any model for team-based care is the skill and reliability with which team members work together. Team function has been described in one conceptualization as a spectrum running from parallel practice, in which clinicians mostly work separately, to integrative care, in which the interdisciplinary team approach is pervasive and nonhierarchical and utilizes consensus building, with many variations along the way. [29] It is likely that the appropriate team structure varies by situation, as determined by the needs of the patient, the availability of staff and other resources, and more. A unifying set of principles must not only acknowledge this variation but embrace as formative the underlying situation-defined needs and capacities.

Despite the pervasiveness of people working together in health care, the explicit uptake of interprofessional team-based care has been limited. At the most basic level, establishing and maintaining high-functioning teams takes work. In economic terms, if the transaction costs of team functioning outweigh the benefit to team members, there is little incentive to embark on the journey toward formal team-based care. [30 Some of the specific costs that may be restraining forces include lack of experience and expertise, cultural silos, deficient infrastructure, and inadequate or absent reimbursement. [31] These barriers were outlined in a 2011 conference convened by the Health Resources and Services Administration, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, and the ABIM Foundation in collaboration with IPEC. The publication of the proceedings, Team-Based Competencies: Building a Shared Foundation for Education and Clinical Practice, identified key barriers to change, including the absence of role models and reimbursement, resistance to change, and logistical barriers.

Despite these barriers, teams are built and maintained. Researchers have identified facilitators of team-based care, or factors that constitute and promote good teams and teamwork. For instance, Grumbach and Bodenheimer found that key facilitators include having measurable outcomes, clinical and administrative systems, division of labor, training of all team members, effective communication, and leadership. [1,30] IPEC has focused on effective interprofessional work and has defined four domains of core competencies: values/ethics, roles/responsibilities, communication, and teamwork/team-based care. [32]

Our aim is to build from this prior work to identify a set of core principles underlying team-based care across settings, as well as the essential values that are common to the members of high-functioning teams throughout health care. By doing so, we hope to help reduce barriers to team-based care, while supporting the facilitators of effective teamwork in health care.

The authors are individuals knowledgeable about team-based care who participated in an interprofessional work group that was drawn from the IOM’s Best Practices Innovation Collaborative. To achieve the goal of identifying basic principles and values for interprofessional team-based care, we first synthesized the factors previously identified in various health care contexts, then took these distilled principles to the field to understand how well they represent team-based care in action. We held monthly conference calls between October 2011 and June 2012 with frequent e-mail collaboration in the intervals. We then reviewed the health professions’ and “gray” literature and discussed common elements. Using this information, we drafted a definition of team-based care and a sample set of principles and values critical to team-based care. To test the applicability and validity of the principles and values, and to understand their on-the-ground actualization, we performed “reality check” interviews with members of team-based health care practices. Teams with various compositions, practice settings, and patient profiles were identified around the country through the literature review and the input of experts. A draft of the team-based care definition, principles, and values was sent to teams in advance of a telephone interview. We then interviewed members of the teams by telephone during January 2012 using a semi-structured approach. Based upon the results of the interviews, we refined the team-based care principles and values, identified key themes, and added illustrative examples.

A Proposed Definition of Team-Based Health Care

To inform a proposed definition of team-based care, we reviewed the literature and reflected on the definitions and factors identified in prior work. Elements found across the definitions we reviewed include the patient and family as team members, more than one clinician, mutual identification of the preferred goal, close coordination across settings, and clear communication and feedback channels. Ultimately, we chose to adapt the definition developed through a detailed literature review and consensus process by Naylor and colleagues. [28] Although this definition was developed for use in the context of primary care for chronically ill adults, its core elements were easily adapted to apply to the work of teams across settings:

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care. [28]

In the process of considering and refining the principles of team-based care, we noted that while teams are groups, they are also made up of individuals. In addition to particular behaviors that facilitate the function of the team, we heard from the teams we interviewed that certain personal values are necessary for individuals to function well within the team. This harmonizes with the core competency domain of “values/ethics” put forward in IPEC’s Team-Based Competencies.

The following are five personal values that characterize the most effective members of high-functioning teams in health care.

Honesty: Team members put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continued improvement and for maintaining the mutual trust necessary for a high-functioning team.
Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems inconvenient. At the same time, team members are disciplined in seeking out and sharing new information to improve individual and team functioning, even when doing so may be uncomfortable. Such discipline allows teams to develop and stick to their standards and protocols even as they seek ways to improve.
Creativity: Team members are excited by the possibility of tackling new or emerging problems creatively. They see even errors and unanticipated bad outcomes as potential opportunities to learn and improve.
Humility: Team members recognize differences in training but do not believe that one type of training or perspective is uniformly superior to the training of others. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy. In this regard, as Atul Gawande has said, effective teamwork is a practical response to the recognition that each of us is imperfect and “no matter who you are, how experienced or smart, you will fail.” [2]
Curiosity: Team members are dedicated to reflecting upon the lessons learned in the course of their daily activities and using those insights for continuous improvement of their own work and the functioning of the team.

Principles of Team-Based Care

Each health care team is unique—it has its own purpose, size, setting, set of core members, and methods of communication. Despite these differences, we sought to identify core principles that embody “teamness.” After reviewing the literature and published accounts of team processes and design, five principles emerged: shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes. These principles are not intended to be considered in isolation—they are interwoven, and each is dependent on the others. Eleven teams across the nation considered the principles, verified and clarified the meaning of each, and described how each comes into play in their own team environments. Descriptions of the teams are listed throughout. The following section describes each of the principles in detail, provides examples from the teams we interviewed, and considers organizational factors to support development of teams that cultivate these five principles, as well as the values that support high-quality team-based health care. Arguably, the most important organizational factor supporting team-based health care is institutional leadership that fully and unequivocally embraces and supports these principles in word and action. [33]

Shared Goals

The team—including the patient and, where appropriate, family members or other support persons—works to establish shared goals that reflect patient and family priorities, and that can be clearly articulated, understood, and supported by all team members.

The foundation of successful and effective team-based health care is the entire team’s active adoption of a clearly articulated set of shared goals for both the patient’s care and the team’s work in providing that care. Although obvious to some extent, the explicit development and articulation of a set of shared goals, with the active involvement of the patient, other caregivers, and family members, does not happen easily or by chance. We found that teams shared several strategies and practices with regard to establishing shared roles.

First, the patient, caregivers within the family, and the family itself must be viewed and respected as integral members of the team. High-functioning teams in health care strive to organize their mission, goals, and performance seamlessly around the needs and perspective of patients and families. This element is central to the most forward-thinking team-based care and represents a central tenet of a social compact between health care professionals and society. [34] As an example, this commitment to patient involvement in the team is central to team training within the Department of Veterans Affairs (VA) patient-aligned care team, which emphasizes that without the veteran (the patient), the team has no mission or goal. Team members are taught to think of things from the veteran’s point of view and align the team’s concerns and actions with those of the veteran. This “patient-centered” attitude is embedded in many of the teams interviewed, including the University of Pennsylvania Transitional Care Model, in which team members acknowledge explicitly that the patient and family are the ones who truly “own” the plan of care. (As described by Berwick (2009), patient-centeredness reflects an “experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters—without exception—related to one’s person, circumstances, and relationships in health care.”)

Second, as part of integrating the patient into the team, high-functioning teams fully and actively embrace a shared commitment to the patient’s key role in goal setting. Many teams interviewed used their first meetings with the patient and family, or an initial “intake” interview, to begin the process of developing shared goals. The patient and family meeting is the tool employed by team members at Hospice of the Bluegrass, for example, to help team members develop a shared understanding of the full extent of the patient and family’s needs, which are then translated into stated goals of care. To engage in a full discussion, they noted, it is especially important for the team to be clear with the patient and family about all the types of needs the team is prepared to fulfill. Patients and families may not expect the full extent of services available. When such a comprehensive approach to patient needs is taken, though, patients and families are grateful to know that the team will collaborate with them to meet their needs to the extent possible.

Third, teams regularly evaluate their progress toward the shared goals and work together with patient and family members to refine and move toward achievement of these goals. At Cincinnati Children’s Hospital, this monitoring and updating takes place daily during patient- and family-centered rounds. Core elements of daily rounds include reviewing together the events of the past 24 hours, creating a daily assessment and plan of care, and reviewing and updating criteria for and progress toward hospital discharge. This process ensures that the team both reaffirms with regularity the applicability of the shared goals and offers an opportunity for clarification of intent and prevention of misunderstandings.

Organizational factors that enable development of shared goals include

Providing time, space, and support for meaningful, comprehensive information exchange between and among team members, particularly when a new team forms—for example, when a new patient/family begins to work with the team.
Facilitating establishment and maintenance of a written plan of care that is accessible and updatable by all team members.
Supporting teams’ capacity to monitor progress toward shared goals for the patient/family and the team.

The perspectives and experiences shared in the interviews strongly support the foundational nature of shared goals within the larger framework of team-based care principles. To achieve shared goals that are meaningful and robust, the patient and family must be integrally involved as members of the team in developing, refining, and updating the goals. While shared goals are the roadmap guiding the work of the team, the development and execution of these goals is dependent upon the other principles that follow. Clear roles, mutual trust, and effective communication among team members are essential for work to be done and goals to be met. Measurable processes and outcomes determine the level of success, help to refine goals over time, and guide improvement.

Clear Roles

There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team to take advantage of division of labor, thereby accomplishing more than the sum of its parts.

Members of health care teams often come from different backgrounds, with specific knowledge, skills and behaviors established by standards of practice within their respective disciplines. Additionally, the team and its members may be influenced by traditional, cultural, and organizational norms present in health care environments. For these reasons it is essential that team members develop a deep understanding of and respect for how discipline-specific roles and responsibilities can be maximized to support achievement of the team’s shared goals. Attaining this level of understanding and respect depends upon successful cultivation of the personal values necessary for participating in team-based care, noted above. Training and working in interdisciplinary settings where these values are foundational also allows the team to safely challenge the boundaries of traditional roles and responsibilities to meet the needs of the patient.

Integrating patients and families fully into the team represents a particular challenge that requires careful planning. Patients and families are unique members of the team in several ways. First, patients and families often do not have formal training in health care. Although different health professionals may, at times, speak “different languages,” if patients and families are to be full members of the team, they must understand their fellow team members. Second, a number of different patients and families typically come in and out of the team many times per day. This requires continual adaptation by other team members who must “shift gears” as they form and reform teams on a regular basis. Finally, just as clinicians must adapt to the various patients they encounter, so, too, must patients learn the rules and customs of each new health care team with which they interact. Processes that introduce—and reintroduce—the patient and family to the roles, expectations, and rules of the team are critical if they are to participate as full members of the team.

Managing a team is challenging and becomes especially so as the membership increases and includes some or all of the following disciplines: licensed physical and mental health professionals (e.g., nurses, physicians, nurse practitioners, physician assistants, social workers, psychologists, pharmacists, physical, occupational and speech therapists, and dieticians); personal care providers (e.g., certified nurse aides and home health aides); community providers (e.g., spiritual care, community-based support, and social media); and the patient, family, and others close to the patient. In addition, it is possible to have teams integrated into larger teams. An example of this is the medication management team at Park Nicollet, which collaborates with and is a part of the Health Care Home team. To establish clear roles that support “teamness,” the teams we interviewed engage a number of strategies and practices.

First, team members determine the roles and responsibilities expected of them based on the shared goals and needs of the patient and family. At Hospice of the Bluegrass, team members anticipate a broad spectrum of patient and family needs that may, to some extent, alter the way in which they perform their professional duties. Following the patient and family meeting, in which the team identifies needs and goals that range from treating pain to addressing food insecurity to engaging spiritual services, the team members then lay out how they will intervene to maximize resources. This maximization may include adding responsibilities to particular team members’ work. For example, if the services of a chaplain are primarily required, he or she may also take on the responsibility of bringing supplies to the home, or asking about the level of pain. Inherent in these shared responsibilities is the identification of needs that require the knowledge and skills of other team members.

Second, team members must engage in honest, ongoing discussions about the level of preparation and capacities of individual members to allow the team to maximize their potential for best utilization of skills, interests, and resources. This frankness allows the team to inventory the discipline-specific assets of team members and ensure that they are creatively aligned with the team’s shared goals. Once they have engaged in the process of matching patient goals to needed roles and planning for the best utilization of team resources, team members must have the autonomy to implement these plans. For example, at El Rio Community Health Center, the clinical pharmacist serves as the primary care provider for patients with diabetes and comorbid conditions, such as hypertension and hyperlipidemia, requiring complex medication management. This occurs through a medical staff–approved collaborative practice agreement in which the pharmacist provides appropriate diagnostic, educational, and therapeutic management services, including prescribing medication and ordering laboratory tests, based on national standards of care for diabetes. [35] The arrangement is sharply focused on the needs of the patient while maximizing the expertise of health professionals in the clinic.

Third, while roles and responsibilities must be clearly defined and explicitly assigned, team members must anticipate and embrace flexibility as needed. For example, a challenge faced by patient-aligned care teams in the VA is the absence of personnel. If no replacement exists for an absent team member, then the team can become dysfunctional. Thus, while clear roles must exist to enable accountability and creativity, effective communication and flexibility must be built into the fabric of the team to ensure that seamless coverage is available. Building in flexibility requires that team members understand to the greatest extent possible the background, skillsets, and responsibilities of their teammates.

Fourth, team members must seek the appropriate balance between roles and responsibilities that fall to individual team members and those that are better accomplished collaboratively. Given the high transaction costs of using a team, clear roles help facilitate decisions about the appropriate engagement of multiple team members in particular scenarios. For example, the BRIGHTEN (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking) program at Rush University in Chicago finds that occasionally issues arise at team meetings that do not concern all team members or that are best handled by one or two team members alone. To flag these items and facilitate the work that requires full team engagement, the team has a standing rule that issues involving one or two team members will be handled outside of team meetings.

Finally, all teams have certain roles and responsibilities that are routinely indicated to support the team’s functioning. These roles include team leadership, record keeping, and meeting facilitation, as well as other administrative tasks. Carrying out routine tasks requires the team to utilize their resources creatively while avoiding pretense and superiority in the process. Routine tasks should be assigned in a manner similar to patient care tasks—balancing patient need, team goals, and local resources. Teams should determine which member is most appropriate for the role, recognizing that some roles may be best rotated across the team.

The issue of team leadership has sometimes been contentious, especially when approached in the political or legal arenas, where questions about team leadership often become entangled in professional “scope of practice” issues. In particular, arguments have arisen around “independent practice” versus team-based care and, where care is team-based, whether all team functions must be “physician-led,” and what this would imply for other health professionals with regard to care management decision making. These debates are taking place in many states, with a number of potential solutions taking shape, and this paper does not aim to resolve them. However, our interviews produced two potentially helpful observations. First, these questions seem much less problematic in the field than they are in the political arena. Among the teams we interviewed, notions of “independent practice” were not relevant because no one member of the team was seen as practicing alone, and leadership questions were not sources of conflict; rather, when leadership issues were raised they were portrayed as matters for open discussion that led to mutually agreeable solutions. Second, this relative lack of conflict might be because these teams use the term “leadership” in a nuanced way.

There is widespread agreement that effective teams require a clear leader, and these teams recognize that leadership of a team in any particular task should be determined by the needs of the team and not by traditional hierarchy. For example, the Mount Sinai palliative care team identified the need to improve a weekly clinical care meeting. They identified the main goal for the meeting: addressing complex patient issues in a context that ensured that each team member had an equal voice. The team assessed the training and skillsets of all team members, and, based upon the goal, determined—somewhat surprisingly, yet successfully—that the chaplain was the best person to run the clinical care meeting. This example nicely illustrates that being an effective team leader for a particular task (like running a team meeting) can require a set of skills that are distinct from those required for making clinical decisions.

While the teams we interviewed acknowledged that physicians are clinically and often legally accountable for many team actions, the physicians on the teams we interviewed were not micromanagers; instead, they were collaborators who did not seek or exercise authority to override decisions best made by other team members with particular expertise, whether in social work, chaplaincy, or care coordination, etc.

Since roles on the team vary by both professional capability as well as function, patients and their caregivers must be fully informed about these roles. Each team member should communicate his or her role clearly and solicit input from others, especially the patient and family, so that all responsibilities are clearly defined and understood. For example, at Park Nicollet, clinical pharmacists and pharmacy residents are placed directly next to other care providers to answer any questions that arise in the course of clinical care, as well as to make it apparent that all care providers work together. Likewise, during rounds at Cincinnati Children’s Hospital, all members of the team introduce themselves to each patient and family by name and then describe how they contribute to the team in clear language. Roles and responsibilities are discussed verbally and written into the care plan. The team explicitly solicits all opinions, including those of the patient and family.

While team members’ expertise and skills should be tailored to the needs of the patient, it is also important to recognize when unintended or unforeseen consequences may occur. The experience and skills of team members are likely to overlap, with the potential for confusion or frustration about roles and responsibilities, possibly leading to misunderstandings and disruption in care to the patient. For example, within the Park Nicollet medication management group, multiple team members are skilled and experienced in aspects of diabetes care and management. Team members work together to identify clearly the roles and responsibilities for which they are best suited, ensuring that roles are discrete and that the experience is harmonized for patients. After roles and responsibilities are clarified, team members may, at times, find themselves in situations for which they feel ill-prepared or are not comfortable. To ensure that team members are empowered to seek support at any time, the team must foster an environment of continuous learning in which seeking advice or help is considered a strength and rewarded. In a high-functioning team environment, team members will hold significant responsibility and accountability. To foster success rather than stress, the team must establish transparent and measurable expectations related to roles and responsibilities, for each individual member and for the team as a whole.

Organizational factors that enable establishing and maintaining clear roles include

providing time, space, and support for interprofessional education and training, including explicit opportunities to practice the skills and hone the values that support teamwork.
facilitating communication among team members regarding their roles and responsibilities.
redesigning care processes and reimbursement to reflect individual and team capacities for the safe and effective provision of patient care needs.

Regardless of a team’s setting, size, or member characteristics, roles and responsibilities must be clear and accountability expected. Yet, despite the best of intentions, teams are not immune to the inherent norms of health care delivery systems. Even effective teams with clear roles and responsibilities may experience the emergence of silos of care, decreased teamwork, or delayed engagement of needed personnel or resources within their group. A team with well-articulated roles and responsibilities grounded in the values of honesty, discipline, creativity, humility, and curiosity fosters an environment where any team member feels safe bringing such concerns to the forefront for discussion, proactive improvement, and prevention.

Mutual Trust

Team members earn each other’s trust, creating strong norms of reciprocity and greater opportunities for shared achievement.

Trust is the current that flows through the team, allowing team members to rely upon each other personally and professionally and enabling the most efficient provision of health care services. Achieving a team with norms of mutual trust requires establishing trust, maintaining trust, and having provisions in place to address questions about or breaches in trust. When a strong trust fabric is woven, team members are able to work to their full potential through relying on the assessments and information they receive from other team members, as well as the knowledge that team members will follow through with responsibilities or will ask for help if needed. The BRIGHTEN team explained that actively developing trust in team members allows them to learn from and build on each other’s assessments and conclusions and permits nonduplication of work.

Establishing and maintaining trust requires that each team member hold true to the personal values of honesty, discipline, creativity, humility, and curiosity, which together support the creation of an environment of mutual continuous learning. The Mount Sinai palliative care team emphasized the importance of setting the stage for trust as early as the hiring process. Using shared values as the basis for selecting team members is critical to ensuring that the norms that support a trusting environment are upheld. This team finds that “shoehorning” someone into the team can be very harmful. The hiring process has been carefully amended to ensure that professional and personal values and skills will nurture, and be nurtured by, the team.

In a clinical setting, providing excellent patient care is the direct outcome of implementing personal values in the context of professional skill. At El Rio Community Health Center, a key element of building team members’ trust in each other is documenting the contribution of each team member and professional group to high-quality patient care and outcomes. Making these data transparent to the whole team generated better understanding of and appreciation for team members’ contributions, as well as the potential gains in efficiency and effectiveness possible through leveraging team members’ capacities in purposeful team-based care.

In addition to carrying outpatient care duties professionally, a critical element of trust is understanding and respecting the rules and culture of the team. Many teams said that a critical element to establishing trust among team members is ensuring that all voices on the team are heard equally. At Nellis Air Force Base, the ethos is that, regardless of military rank, everyone is expected to raise questions or concerns. To facilitate a safe and trusting environment in which more junior team members can speak up, incentives are aligned to encourage leaders to listen with open minds and address team members’ questions and concerns.

The importance of personal connections among team members as an instrument for building trust was endorsed by some teams. The BRIGHTEN team refers specifically to their “culture of cake,” in which team members’ significant events are celebrated at meetings, with cake. The cake does not derail the purpose of the meeting—the celebration is part and parcel of the work of the team, while at the same time, team members focus on their joint tasks. The Mount Sinai palliative care team has a monthly birthday celebration for members of their team at which there are no clinical or administrative tasks. Nellis Air Force Base has team- and community-building activities throughout the year—for example, picnics or bowling—so that individuals can get to know each other on a personal level.

Developing and maintaining trust with patients and families may require special consideration, as they may not have the longevity on the team or daily working relationship shared by other team members. Clinician members of the team can develop trust with patients and families by using effective communication to explain the process of developing shared goals and establishing clear roles. By being accountable and following through with these principles, patients and families will come to trust the values of other team members. Clinician members may benefit from learning skills formally to build trust with patients and families. Negotiation and conflict management skills may be particularly valuable. For example, at Cincinnati Children’s Hospital, team members are taught to make themselves “vulnerable” by stepping out of their traditional roles and looking through the eyes of the patient and family in order to find common ground as a starting point for mutual trust.

Organizational factors that facilitate development of mutual trust include

Providing time, space, and support for team members to get to know each other on a personal level.
Embedding in education and hiring processes the personal values that support high-functioning team-based care.
Developing resources and skills among team members for effective communication, including conflict resolution.

Mutual trust enables team members to set clear goals and achieve shared goals in a harmonious, efficient fashion. Fundamentally, mutual trust enables these by setting the foundation for good communication, which is the focus of the following principle. As with each of these principles, mutual trust and effective communication are tightly linked and mutually supportive. Thus, the signs of mutual trust in a team include not only elements of team function, such as equal participation and facilitative leadership style, but also outcomes such as successful quality improvement efforts and redesigned care processes in which team members build on each other’s work. In the preoperative surgery unit at Nellis Air Force Base, the team established continuous note charting in the electronic medical record. The preoperative nurse, surgeon, anesthesiologist, and others use one running note to chart their observations and plans, maximizing the utility of their collaborative work.

Effective Communication

The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings.

If the team members are unable to provide information and understanding to each other actively, accurately, and quickly, subsequent actions may be ineffective or even harmful. In the digital age, team communication is not limited to in-person communication, such as in team meetings. It incorporates all information channels—progress notes and electronic health records, telephone conversations, e-mail, text messages, faxes, and even “snail mail.” Many channels of communication may be employed by team members to achieve their purposes. The framing and content of that communication is the core of effective communication. Effective communication should be considered an attribute and guiding principle of the team, not solely an individual behavior. Effective communication requires incorporation of all of the values underlying effective teams: honesty, discipline, creativity, humility, and curiosity. Effective communication also comprises a set of teachable skills that can be developed by each member of the team and by the team as a whole. The teams we interviewed employed a number of strategies and skills for developing and employing effective communication.

First, setting a high standard for, and ensuring, consistent, clear, professional communication among team members is a core function of a high-performing team. The BRIGHTEN program employs the Rush University Medical Center Geriatric Interdisciplinary Team Training Program guide to the fundamentals of effective teamwork. The guide outlines individual and team communication practices that support effective teamwork. [36] For example, team members should speak clearly and directly in a succinct manner that avoids jargon, while drawing upon their professional knowledge. They should tend toward discussing verifiable observations rather than personal opinion. Team members should listen actively to each other and show a willingness to learn from others. The need for these strategies is highlighted by the fact that many of the teams we interviewed indicated that allowing everyone an equal voice in the room is a core practice. At Park Nicollet, interprofessional care is facilitated when all are encouraged to attend team meetings and encouraged to ask questions and share ideas equally. The skills outlined are also critical for the University of Pennsylvania Transitional Care Team, which works with the patient, family, inpatient care team, and outpatient providers to ensure that the patient’s care plan is followed while ensuring that all providers’ roles and responsibilities are honored.

Second, effective communicators are deep listeners—actively listening to the contributions of others on the team, including the patient and family. Individuals on the team need to be able to listen actively and model this for others on the team by clarifying or elaborating key ideas, reflecting thoughtfully on value-laden or controversial “hot-button” issues. Team members may need to help each other improve this skill either through team exercises or individual conversations. Patients and families often participate more as listeners on the team; their contributions may need to be facilitated through the active listening of other team members. Team members may need to coach each other, including patients and families, in succinct and clear contributions. Team members should recognize that questions are a valuable way to clarify and to learn from each other. Teams that perform patient- and family-centered rounds at Cincinnati Children’s Hospital engage listening at many levels. First and foremost, central to rounds is the elicitation, on the first day, of the patient and family’s preference for participation (or nonparticipation) in team rounds. Whatever option patients and families choose, the plan of care and daily work are defined by the goals and concerns expressed by the patient and family. Active listening—with confirmation of information transfer —is fundamental to the rounds. Pediatric interns who present the events of the past 24 hours to the team are taught to confirm the report with the patient and family. Since orders are entered into the computer during rounds, a final step is an official “read-back” of those orders, ensuring accuracy and preventing errors.

Finally, team communication requires continual reflection, evaluation, and improvement. Recognizing signs of tension and unspoken conflict can serve as a trigger to reexamine the communication patterns of the team.

Both individual and team communication skills are teachable and learnable. [37,38] Individuals should be able to use a wide range of effective communication techniques, recognize when their own or the team’s communications are not functioning well, and act as a facilitator. One or more individual team member may act as a coach for patients and families not accustomed to or comfortable with active team membership and communication. (For more information, visit http://www.ama-assn.org/resources/doc/ethics/research-ambulatory-patient-safety.pdf.) Fundamentals of effective team communication include the active membership of the patient and family and the willingness and capability of team members to be clear and direct and communicate without technical jargon. Information sharing is the goal of communication, and all team members need to recognize that this includes both technical and affective information.

Organizational factors that sustain effective communication include

providing ample time, space, and support for team members to meet—in-person and virtually—to discuss direct care as well as team processes.
ensuring that team members are trained in shared communication expectations and techniques.
utilizing digital capacity—including the electronic medical record, e-mail, Web portals, personal electronic devices, and more—to facilitate easy, continuous, seamless, transparent communication among team members, with a special focus on inclusion of patients and families.

As an example of this last factor, at MD Anderson Cancer Center, patients can access their full medical records and communicate virtually with team members through the myMDAnderson Web portal. The uptake of this service has been enormous and patient and provider satisfaction with the service is high.

Measurable Processes and Outcomes

The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team’s goals. These are used to track and improve performance immediately and over time.

High-functioning teams, by definition, have embraced or at least integrated the principles of team-based care noted above. The high-functioning team has agreed upon shared goals for delivery of patient-centered care. Clear roles and responsibilities have been shared across the team and team members have committed to shared accountability. High-functioning teams recognize the importance of trust in all interactions, and actively work to build and maintain a respectful and trusting environment. Effective communication is at the core of the team’s work and is apparent in all encounters among team members, patients, and other participants in the care process.

Once they employ these principles, how do teams know they are high-functioning? How can teams that are initially forming assess their progress? How can teams that have been disrupted or lost some functionality understand what efforts are needed to regain it? And, how can teams know that they are improving care and outcomes while controlling costs to the best of their ability? Only through rigorous, continuous, and deliberate measurement of the team’s processes and outcomes can potential barriers be identified and strategies developed to overcome them. Measurement of team effectiveness is not a new science. Other industries which employ highly educated, strongly motivated professionals with complimentary or overlapping responsibilities in high-pressure, high-risk situations like aviation, nuclear power, and the armed services have developed a significant body of literature on measuring the effectiveness of teamwork. Only recently, with higher levels of attention given to patient safety and high-quality care, has health care begun explicitly to create and measure team-based health care delivery.

Measures for team-based health care fall into two categories: processes/outcomes and team functioning. The teams we interviewed considered three types of processes and outcomes: patient outcomes, patient care processes that lead to improved patient outcomes, and value outcomes. Improved patient outcomes provide one of the most important measures of any type of health care, and the number of validated measures has grown exponentially in recent years. The National Quality Measures Clearinghouse currently lists thousands of clinical quality measures from the National Quality Forum (NQF), the Ambulatory Care Alliance, the Physician Consortium for Performance Improvement, the Joint Commission, the National Committee on Quality Assurance (NCQA), health professional organizations, federal agencies, insurers, and many more. Patient outcome measures should and do vary between teams, reflecting the patients and populations served, as well as the unique strengths, challenges, and improvement initiatives of the team. For the hospital-based teams we interviewed, readmission to the hospital within 30 days was commonly cited as a relevant measure. Safety measures were also cited as important outcomes for patients. In some cases, teams track process measures that are linked to improved patient outcomes. The Vermont Blueprint for Health has adopted a comprehensive approach to patient outcomes by committing to achieve recognition of each of its Advanced Primary Care Practices as NCQA patient-centered medical homes, among other requirements. Finally, teams assess their outcomes by integrating quality and cost data. Increased capacity for delivering care, using the skillsets of diverse individuals in communicating effectively to the patient, caregivers, and the rest of the team, may decrease the cost of health care. [28] Leaders at MD Anderson have developed a framework for integrating information about the health outcomes of their patients with the costs of the care provided, resulting in a reproducible, trackable analysis of the value of their team care model. [39] The MD Anderson approach is illustrative of how the impact of a team can be measured. Currently, many measures that are tied to clinician performance refer to the work of a single clinician, typically a physician. [40] This perception of one individual’s accountability for clinical outcomes possibly undermines the effectiveness of the team, or, at least, does not provide an incentive to accelerate team-based care.

In addition to more traditional process and outcome measures, and reflecting a current national quality trend, all teams interviewed said that they measure satisfaction—formally or informally—of the patients and families they serve as well as that of the other team members. Satisfaction reflects the relational components of care, including rapport, respectful communication, and trust. It is unclear whether the patient and family’s perception of care is related to clinical effectiveness. Still, patient satisfaction is used as a proxy for, and if well-designed may truly reflect, patient-centeredness and patient engagement in care. Members of the team at Cincinnati Children’s Hospital say they know they have succeeded when, on the day of discharge, the patient and family say: “You’ve answered all my questions, covered all the bases, taken good care of me, and treated me like an equal. Thank you.” Similarly, a favorite informal measure of satisfaction mentioned by Hospice of the Bluegrass is public commemoration of the services provided by the hospice team in the patient’s obituary. Many teams we interviewed also emphasized the importance of measuring satisfaction among other team members as a way of tracking team function. The El Rio Community Health Center has implemented 360-degree evaluations which include measures of employee satisfaction. At the University of Pennsylvania, in addition to patient and cost outcomes, a critical measure of success is the satisfaction of team members, which is linked to staff retention—a critical element for team functioning. The Vermont Blueprint has a qualitative component to its evaluation, including focus groups, individual interviews, and a planned statewide implementation of the Consumer Assessment of Healthcare Providers and Systems Patient-Centered Medical Home (CAHPS PCMH) survey in order to ascertain patient and practice experiences with team-based care.

In addition to measuring the satisfaction of patients and other team members (which are indirect measures of team functioning), engaging in routine, frequent, meaningful evaluation of team function per se allows team members to improve their skills to fulfill the other principles of team-based care. A number of tools have been developed to directly assess the functionality of teams. Two measures mentioned by teams we interviewed include the Team Development Measure (teammeasure.org) and TeamSTEPPS questionnaires. Valentine and colleagues have produced a review of team measurement tools applicable to health care; a summary table of these tools, reproduced with permission, is available in the Appendix. [41] Despite the availability of team measurement tools, there is room for improvement in measurement of teamwork, since current measures look at various aspects of teamwork, few of them are robustly validated, and many are not routinely applied to teams in practice.

Organizational factors that support measurement to improve team function and outcomes include

prioritizing continuous improvement in team function and outcomes and ensuring that electronic systems routinely provide data about the measures that matter to the teams providing care and can be immediately updated as indicated by frontline teams.
developing routine protocols for measurement of team function, aimed at continuous improvement of the processes of team-based care.
providing ample time, space, and support for team members to engage in meaningful evaluation of processes and outcomes together.

In summary, measurement of team-based care should include both measures of the processes and outcomes that derive from team functioning and measures of team functioning itself. There is a deficiency in the availability of validated measures with strong theoretical underpinnings for team-based health care. Improved measurement will enable teams to grow in their capacity to fulfill the principles, facilitate the spread, improve the research, and refine evaluation of the high-value elements of team-based care.

Implications of the Team-Based Health Care Principles and Values

To examine the implications of the principles and values of team-based health care outlined here, members of the Best Practices Innovation Collaborative met on February 28, 2012. Participants at the meeting provided feedback about the principles and values described here and considered the timeliness of the framework, including bridges to ongoing activities in related sectors. From those discussions, four themes emerged to guide the immediate activities of those working to accelerate high-value team-based health care:

Ensuring that the patient and family are at the center of the team requires careful planning and execution.
Targeting of team-based care—matching resources to patient and family needs—is essential to maximize value.
Building bridges to ongoing activities related to team-based care is critical to ensure efficiency.
Defining a coordinated research agenda for team-based care is necessary to achieve continuously improving, high-value team-based health care.

Making Patients and Families Active Members of the Team

The requirement that patients and families be at the center of care is espoused by most health care reform and improvement processes, including the patient-centered medical home, care coordination, interprofessional education, and more. Ensuring that patients and families are active members of the health care team is the next critical step toward high-value health care. Mitchell and colleagues describe a social compact between health professionals, patients, and society intended to strengthen the connections between patient-centered care and team-based care, with a call for patients to be active members of health care teams. [34] The codes of ethics of health professional societies have long argued that shared decision making is an ethical obligation, and that the legal and ethical notion of informed consent is built on the fundamental rights of patients to participate in decisions that affect their well-being. [42,43] Moreover, people who are involved in their own care have better health outcomes and typically make more cost-effective decisions. [44] In reality, the practice of putting patients and families on health care teams is daunting. Patients are often ill-prepared to participate on health care teams and health professionals are often ill-equipped to practice collaboratively with patients for many reasons—imbalance of power in relationships, poor communication, non-intuitive systems, payment structures that reward volume over value, lack of workforce preparation, and more. The solution to many of these problems requires restructuring the culture and practices of health care, including promoting transparency of information in an understandable fashion, orientation of people to health care team practices, predictability, and development and spread of readily-available tools for knowledge sharing, self-care, and patient-clinician–team communication. [37] There is also a role for measuring the performance of organizations in creating a practice environment that supports shared decision making. [45]

Targeting of Team-Based Care

High-quality team-based health care is costly to implement. As described by those we interviewed, teams are complex systems that require substantial investment to function at their highest capacity. Thus, the use of teams should be targeted to situations in which the transactional costs of team care are outweighed by the benefits in terms of health outcomes. Targeting is an ongoing process in which the needs of the patient and family are assessed repeatedly, with the expectation that needs are personal and will change over time and based on the situation. Health professionals must, as part of their professional responsibilities, ensure that assessments and reassessments are completed and call upon other health professionals and community services as indicated by patient/family needs. Figure 1 presents a schematic of the relationship between complexity of patient needs and the complexity of the corresponding team-based care. The exact composition of the team and services mobilized should be tailored according to patient/family needs and local resources.

Building Bridges to Activities Related to Team-Based Care

Team-based care and activities related to teams are increasing in many health care sectors. Building bridges between these activities can help ensure synergy and efficiency. Here, we highlight connections between team-based care and three areas in particular: interprofessional education and workforce development, health informatics, and care coordination.

Interprofessional Education

Health education groups in the United States and abroad have called for improved interprofessional education in the preclinical and clinical settings. A U.S. effort—the Interprofessional Education Collaborative—is led by a coalition of academic associations, foundations, and government agencies. In 2011 the group released a report on the core competencies of interprofessional education to stimulate effective team-based practice. These core competencies harmonize with the principles outlined in this paper and are critical for guiding the education, evaluation, and certification of health education programs and members of the modern health care workforce. We believe that the values and principles described in this paper supplement the core competencies and should be used to guide selection of candidates for the health professions, their training, their licensure and certification, and their ongoing evaluation by employers, patients, and society. Many team training tools currently exist in practice to help health professionals—and, ideally, patients and families—continue to develop and maintain values and skills to support their teamwork. One of the best-known programs, TeamSTEPPS, has recently expanded from the acute care to the ambulatory care setting.

Health Informatics and Technology

The explosion of digital capacity and stimulation of infrastructure development through policy have created opportunities for promotion and facilitation of team-based care. Health informatics has the capacity to support the work of teams (e.g., communication, process improvement, group training, shared work) while allowing required documentation within the regulatory and medico-legal environment. For example, an electronic health record designed with teams in mind can enable team charting, and informatics-driven simulation training systems can provide a safe, effective means of improving teamwork, particularly for rare or high-stakes situations. Furthermore, informatics can help teams make sense of vast amounts of data that can be captured to maximize continuous learning, monitor population health, and promote safety and quality without overwhelming team members.

High-functioning teams and their organizations must consider the transformative impact of Web-based, digital, and mobile technology on health and health care delivery. Technological innovations such as telehealth monitoring devices, behavior sensing mobile applications, and diagnostic tools on smartphones are already engaging patients and practitioners in new ways and expanding the continuum of care beyond traditional settings. The Internet is democratizing medical knowledge by providing unprecedented access to health-related content, research, and patient-to-patient communities such as CureTogether and PatientsLikeMe. The rapid emergence of innovative technologies, expanded access, and broad adoption is poised to disrupt how teams manage health and illness as well as how patient-centered care is delivered and received. [46]

Care Coordination

According to the NQF, “care coordination helps ensure a patient’s needs and preferences for care are understood, and that those needs and preferences are shared between providers, patients, and families as a patient moves from one health care setting to another. Care among many different providers must be well-coordinated to avoid waste, over-, under-, or misuse of prescribed medications, and conflicting plans of care.” [4,47] Additionally, the forthcoming IOM discussion paper “Communicating with Patients on Health Care Evidence” reports that 64 percent of people strongly agree (and 92 percent of people agree overall) that health care providers should work as a team to coordinate care and share health information. For patients with chronic conditions, 72 percent strongly agreed (and 97 percent agreed overall) that their care ought to be coordinated. These findings strongly support the conclusion that not only should care be coordinated to increase quality, but that patients already expect to receive coordinated care. [48]

Reviewing the myriad activities in the area of care coordination is beyond the scope of this paper; however, the links between team-based care and care coordination are clear. For example, care coordination starts with a written plan of care; team-based care requires an explicit statement of shared goals. These are integrally related activities; the patient’s goals should drive the development of the patient’s care plan. Fundamentally, we see the principles and values of high-functioning team-based care as central to the success—both in terms of efficiency and effectiveness—of care coordination. The NQF publication Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination: A Consensus Report (2010) outlines many of the specific steps that can help patients and clinicians achieve the principles of effective team-based care within the context of practicing care coordination. Many of the NQF-endorsed preferred practices are applicable to all settings in which team-based care is employed [49].

Defining a Research Agenda

To date, research on team-based care has largely focused on describing the successful elements of individual programs. Comparisons of team-based care programs and paradigms have been hampered by lack of common definitions, shared conceptualization of components, and a clear research agenda. The bulk of this paper attempts to frame the first two elements. Here, we outline suggestions for an approach to the third element—the research agenda. We suggest that the research agenda be divided into two broad categories: targeting team-based care and sustaining effective team-based care.

The first main purpose of research about team-based care is to determine the specific practices that achieve the best outcomes and cost savings for particular patients in a given setting. Simply stated, the research agenda should aim to perfect the science of targeting team-based care. The elements of team-based care to be studied include the who (team composition and roles), what (services provided), where (health care setting, home or community environment, transition between settings), and how (teamwork model employed, including methods of communication, conflict resolution, etc). The measured outcomes should be meaningful to patients and should include improved personal and community health, reduced costs, and the comparative effectiveness of team-based care elements for particular patients in particular settings.

As the science of targeting team-based care is perfected, the second purpose of the research agenda must be to consider elements critical to sustaining targeted team-based care. Areas for consideration include engagement of patients and families (what are the most effective and efficient ways to help patients and families become active participants in their care and as members of the team—including the role of personal technologies and informatics?); the health care workforce (how are the right people selected and trained?); practical tools for team-based care implementation and assessment (how can tools be matched to local needs and uptake of high-quality tools be promoted?); and more.

In conclusion, accelerating the implementation of effective team-based health care is possible using common touchstone principles and values that can be measured, compared, learned, and replicated. This paper provides guidance about the personal values and core principles of high-performing teams as well as the organizational support that is required to establish and sustain effective team-based care. Teams hold the potential to improve the value of health care, but to capture the full potential of team-based care, institutions, organizations, governments, and individuals must invest in the people and processes that lead to improved outcomes. To target expenditures and plan wisely for outcome-oriented team-based care, the top priorities should be the targeting of team-based care to situations in which it promotes the most efficiency and effectiveness and patient engagement (including shared decision making). Given the enthusiasm and activity in team-based care present today, immediate and deep investment in these areas holds profound potential for transformative change in U.S. health care.

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Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century . Washington, DC: The National Academies Press. https://doi.org/10.17226/10027
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AAFP, AAP, ACP, AOA. 2007. Joint principles of the patient-centered medical home. Washington, DC. Available at: https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf (accessed May 14, 2020).
Bodenheimer, T. 2011. Lessons from the trenches—a high-functioning primary care clinic. New England Journal of Medicine 365(1):5-8. https://doi.org/10.1056/NEJMp1104942
Bodenheimer, T., and B. Y. Laing. 2007. The teamlet model of primary care. Annals of Family Medicine 5(5):457-461. https://doi.org/10.1370/afm.731
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Naylor, M. D. 2004. Transitional care for older adults: A cost-effective model. LDI Issue Brief 9(6):1-4.
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Jones, D. A., M. A. DeVita, and R. Bellomo. 2011. Rapid-response teams. New England Journal of Medicine 365(2):139-146. https://doi.org/10.1056/NEJMra0910926
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Naylor, M. D., K. D. Coburn, E. T. Kurtzman, et al. Inter-professional team-based primary care for chronically ill adults: State of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; March 24-25, 2010.
Boon, H., M. Verhoef, D. O’Hara, and B. Findlay. 2004. From parallel practice to integrative health care: a conceptual framework. BMC Health Services Research 4(1):15. https://doi.org/10.1186/1472-6963-4-15
Bodenheimer, T. 2007. Building teams in primary care: Lessons learned. San Francisco: California HealthCare Foundation. Available at: https://www.chcf.org/wp-content/uploads/2017/12/PDF-BuildingTeamsInPrimaryCareLessons.pdf (accessed May 14, 2020).
Young, H. M., E. O. Siegel, W. C. McCormick, T. Fulmer, L. K. Harootyan, and D. A. Dorr. 2011. Interdisciplinary collaboration in geriatrics: Advancing health for older adults. Nursing Outlook 59(4):243-250. https://doi.org/10.1016/j.outlook.2011.05.006
The Interprofessional Education Collaborative. 2011. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC. Available at: https://www.aacom.org/docs/default-source/insideome/ccrpt05-10-11.pdf?sfvrsn=77937f97_2 (accessed May 14, 2020).
Cosgrove, D., M. Fisher, P. Gabow, G. Gotlieb, G. Halvorson, B. James, G. Kaplan, J. Perlin, R. Petzel, G. Steele, and J. Toussaint. 2012. A CEO Checklist for High-Value Health Care. NAM Perspectives. Discussion Paper, Washington, DC. https://doi.org/10.31478/201206e
Mitchell, P. H., L. W. Hall, and M. E. Gaines. 2012. A social compact for advancing team-based high-value health care. Health Affairs Blog. Available at: https://www.healthaffairs.org/do/10.1377/hblog20120504.019004/abs/ (accessed May 14, 2020).
Sandra Leal, J. G., R. N. Herrier, and A. Felix. 2004. Improving quality of care in diabetes through a comprehensive pharmacist-based disease management program. Diabetes Care 27(12):2983-2984. https://doi.org/10.2337/diacare.27.12.2983
Principles of successful teamwork and team competencies. 2008. Available at: http://www.pcpci.org/sites/default/files/webinar-related/Successful%20Teamwork%20Principles.pdf (accessed May 14, 2020).
Paget, L., P. Han, S. Nedza, P. Kurtz, E. Racine, S. Russell, J. Santa, M. J. Schumann, J. Simha, and I. Von Kohorn. 2011. Patient-Clinician Communication: Basic Principles and Expectations. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201106a
Levinson, W., C. S. Lesser, and R. M. Epstein. 2010. Developing physician communication skills for patient-centered care. Health Affairs (Millwood) 29(7):1310-1318. https://doi.org/10.1377/hlthaff.2009.0450.
Feeley, T. W., H. Albright, R. Walters, and T. W. Burke. 2010. A method for defining value in healthcare using cancer care as a model. Journal of Healthcare Management/American College of Healthcare Executives 55(6):399-411.
Bitton, A., and E. C. Schneider. 2011. Home is where the laboratory is: The PCMH as a laboratory for performance measure development. http://qualitymeasures.ahrq.gov/expert/printView.aspx?id=34158 (accessed February 14, 2012).
Valentine, M. A., I. M. Nembhard, and A. C. Edmondson. 2011. Measuring teamwork in health care settings: A review of survey instruments. Harvard Business Review. Boston, MA. https://doi.org/10.1097/MLR.0b013e31827feef6.
AMA. Opinion 8.08—Informed Consent. Code of medical ethics of the American Medical Association: Current opinions with annotations. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/codemedical-ethics/opinion808.page (accessed June 14, 2012).
Berg, J., P. Appelbaum, C. Lidz, and L. Parker. 2001. Informed consent: Legal theory and clinical practice. 2nd ed. New York: Oxford University Press.
Greene, J. 2012. Why does patient activation matter? An examination of the relationships between patient activation and health outcomes. Journal of General Internal Medicine 27(5):7. https://doi.org/10.1007/s11606-011-1931-2
Wynia, M., M. Johnson, T. McCoy, G. L. Passmore, and C. Osborn. 2010. Validation of an organizational communication climate assessment toolkit. American Journal of Medical Quality 25(6):8. https://doi.org/10.1177/1062860610368428
Topol, E. 2012. The creative destruction of medicine: How the digital revolution will create better health care. New York: Basic Books.
Care Coordination Practices & Measures. 2012. Available at: http://www.qualityforum.org/projects/care_coordination.aspx (accessed June 29, 2012).
Alston, C., L. Paget, G. Halvorson, B. Novelli, J. Guest, P. McCabe, K. Hoffman, C. Koepke, M. Simon, S. Sutton, S. Okun, P. Wicks, T. Undem, V. Rohrbach, and I. Von Kohorn. 2012. Communicating with Patients on Health Care Evidence. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201209d
National Quality Forum. 2012. Preferred practices and performance measures for measuring and reporting care coordination: A consensus report. Washington, DC. Available at: qualityforum.org/Publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_Reporting_Care_Coordination.aspx (accessed May 14, 2020).

https://doi.org/10.31478/201210c

Suggested Citation

Mitchell, P., M. Wynia, R. Golden, B. McNellis, S. Okun, C.E. Webb, V. Rohrbach, and I. Von Kohorn. 2012. Core principles & values of effective team-based health care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201210c

Author Information

Pamela H. Mitchell is Past-President of the American Academy of Nursing and the Robert G. and Jean A. Reid Dean in Nursing (Interim) at the University of Washington. Matthew K. Wynia is Director of The Institute for Ethics at the American Medical Association. Robyn Golden is Instructor and Director of Older Adult Programs at Rush University Medical Center. Bob McNellis is Vice President, Science and Public Health at the American Academy of Physician Assistants. Sally Okun is head of Health Data Integrity and Patient Safety at PatientsLikeMe. C. Edwin Webb is Associate Executive Director and Director, Government and Professional Affairs at American College of Clinical Pharmacy. Valerie Rohrbach is Senior Program Assistant at the Institute of Medicine. Isabelle Von Kohorn is Program Officer at the Institute of Medicine.

Acknowledgments

The authors are deeply grateful for the insights and assistance of health care teams at the following institutions: BRIGHTEN at Rush University; Cincinnati Children’s Family- and Patient-Centered Rounds; El Rio Community Health Center; Hospice of the Bluegrass; MD Anderson Cancer Center; Mike O’Callaghan Federal Medical Center; Mount Sinai Palliative Care Team; Park Nicollet; University of Pennsylvania Transitional Care Model; Veterans Affairs Patient-Aligned Care Teams; and Vermont Blueprint for Health.

The views expressed in this discussion paper are those of the authors and not necessarily of the authors’ organizations or of the Institute of Medicine. The paper is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council.

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Teamwork in Nursing: Team-Building Strategies for Better Patient Care

3 min read • July, 11 2023

Teamwork and collaboration in nursing are essential to ensure better patient care and improved outcomes. Through effective communication, shared objectives, delegation , empowerment, and continuous development, nurses can foster a collaborative and supportive environment that leads to greater patient satisfaction and boosts team morale.

Why Is Teamwork Important in Health Care?

A collaborative, cohesive nursing team provides the best patient care. Solid internal communication and mutual respect in the overall multidisciplinary delivery process strengthen your team. That positivity spills over into the patient experience.

The benefits of teamwork in a health care environment extend beyond the patient. The camaraderie that comes with a harmonious team helps nurses stay positive and focused when faced with challenges and work fatigue.

Team-Building Strategies in Nursing

Nurse leaders are responsible for the general health and well-being of their unit’s staff. They can actively promote nursing teamwork through inclusivity , demonstrating and applauding transparency, and creating opportunities for autonomy and ownership. There's no one-size-fits-all approach to team building, so try various strategies and see which ones resonate with your team.

Show Gratitude and Support

It's easy to overlook daily triumphs when things move fast and furious. As a nurse leader, encourage your team to pause and reflect on these small wins to foster a positive work environment . Building a culture of gratitude can yield positive benefits, including improved morale, higher self-esteem, and an increased capacity for dealing with adversity.

Share Ideas Openly

Open dialogue allows for innovation in a health care organization. Nurse leaders should encourage a culture of mutual respect and shared decision-making to empower team members to speak up with ideas or concerns. Nurses can apply the same active listening they use with patients to their teammates.

Prioritize Autonomy

Mutual trust in your colleagues’ abilities and competencies is critical to the health of any team. Nurse leaders should avoid micromanaging. This management style demoralizes employees and discourages proactivity. Instead, encourage an atmosphere of autonomy where nurses hold themselves responsible for their mistakes without fear of being penalized.

Start a Mentorship Program

Want to help sharpen your team’s retention and interpersonal communication proficiencies? A mentorship program gives them access to experienced colleagues’ insights, which inspires confidence, critical thinking skills , and personal development. Mentoring also allows nurse leaders to expand their knowledge, reignite their sense of purpose, and contribute to the development of the nursing profession.

Encourage Integrity

By nature, nurses are trustworthy and forthright and give their all to their patients. Nurse leaders can nurture these standards by leading by example, respecting each team member’s opinion, and rewarding honesty. A nursing team with demonstrated integrity translates to better patient relationships and an enhanced reputation for the organization.

Celebrate Diversity

Every nurse brings something unique to the table, and these differing perspectives — culture, background, and experiences — must be respected to create a sense of community within the team. Nurse leaders can organize diversity training sessions to ensure team members are considerate and sensitive to one another’s boundaries and abilities.

Develop a Growth Mindset

On an individual level, a growth mindset views skill and intelligence not as predetermined traits but as attributes you develop through persistence and dedication. This attitude also benefits teams, helping nurses reframe setbacks as opportunities for growth and change rather than finger-pointing or negativity.

Group of laughing medical practitioners laugh together at a table.

Nurture Team Communication

A strong team communicates effectively and frequently. Nurses must be able to collaborate and cooperate internally and across all health care disciplines. This unified approach benefits the organization and the patient since improved communication reduces the risk of medical mistakes due to misunderstandings.

The collaborative nature of coordinated health care delivery makes teamwork in nursing essential to providing excellent patient treatment and outcomes. By fostering a supportive environment, enhancing communication, and promoting transparency, nurses can learn from one another and grow professionally and personally.

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Leadership strategies for evolving health care executives, related articles, reinvigorate your health care system: build meta-leadership into your practices and thinking, approaching diversity, equity, and inclusion through a future-oriented lens, change management: why it's so important, and so challenging, in health care environments, how to build, manage, and maintain strong teams in the modern health care space.

Shot of a team of doctors having a meeting in a hospital

by Katherine J. Igoe

The working world post-COVID-19 looks a lot different, both in terms of how we work and what we do—which means that managers in leadership positions need to adapt to this new environment.

“Everything’s changed. There’s a tremendous amount of burnout in the industry. We’re on the other side of the Great Resignation. We’re seeing a lot of hybrid and fully remote work. And we’re obviously seeing a total shift in our work culture. So we need to be thinking about building strong teams in our new world,” says Louise Keogh Weed , program director of the Leadership Strategies for Evolving Health Care Executives program, instructor in the Department of Health Management at the Harvard T.H Chan School of Public Health, and the director of leadership training at the Harvard Medical School Center for Primary Care.

So how, exactly, can leaders build—and maintain—better teams in the modern age?

How a Health Care Team Needs “Norming” First

The first step, according to Keogh-Weed, is to create norms for the team (“norming”) by identifying ground rules for how its members will work together and interact. This is particularly important when a group operates in a Zoom environment instead of in person, since the remote aspect can lead to disconnection. One example of norming, in fact, is establishing Zoom etiquette, such as agreeing to keep one’s camera on unless absolutely necessary to indicate one’s transparency in meetings.

“Norming brings mutual agreement and interconnectedness into your group,” says Keogh-Weed. “And it essentially democratizes the responsibility for how the team will function because we’ve all agreed on how we want to work together. Anyone on the team can say, ‘We aren’t adhering to our norms right now.’ And to some extent, it removes the pressure on the leader, since we’ve created an interdependence.”

Health care organizations can be hierarchical and entrenched in a top-down method of leadership—so, building a functional team can often mean changing preexisting working dynamics. Norming can remove some of the rigidity out of this framework, allowing ideas to come from all members without fear of retaliation. In other words, says Keogh-Weed, “how are we creating spaces where people feel comfortable, where people feel like they can speak up or otherwise write out feedback? Norming allows us to indicate to everyone, ‘you’re safe in this space.'”

Optimizing a Team With Transparency, Processes, and Change Management

Obviously, a team can look different based on its functions and members, but (unless it’s already functioning well) norming will involve necessary change. As a result, members may bristle at being told to do things a new way or feel a sense of loss over changes in the group’s dynamics. This is a normal—and necessary—part of the process, explains Keogh-Weed. “By committing to transparency in these processes, by taking anything that’s implicit and making it explicit, we are telling people what it’s going to be like to work here. And people have a choice about whether they want to be on the team or not.”

After a manager creates norms and begins to build trust, Keogh-Weed notes that there are several questions they should keep in mind:

What processes are we using, and for what?
Who’s responsible for what, in the macro and micro sense?
How do I facilitate professional bonding for the group and establish trust between them?
How are we going to make decisions that concern the whole team?
How do we get and give feedback? How do we respond to it productively?
How do we respond and adapt when something’s not working?
How do we increase transparency around processes, roles, and responsibilities?
How do I manage at the individual and team level?

Committing to the process will also mean evolving norms throughout the team’s evolutions—when people leave or are hired, when new best practices are put in place, and so on. Keogh-Weed explains that these evolutions can look like mini change management cycles and that the leader can actually bring the team together in that cycle, such as involving them in the interview process when a new employee is brought on board, for example.

Moving Forward With the Team in Mind

Ultimately, leaders hoping to do this work must focus on controlling what they can control while leading from a grounded, vulnerable place that enables feedback and growth. This process also allows the team to become more than the sum of its parts: a system in its own right, changeable while still functional and strong. Members can do their work effectively, speak up when they need to, and feel empowered to make decisions that benefit the whole. “When we create transparent processes and expectations and roles and responsibilities, we all know exactly how we’re engaging—exactly how we’re showing up for other people,” says Keogh-Weed.

Harvard T.H. Chan School of Public Health offers Leadership Strategies for Evolving Health Care Executives , an on-site program designed to develop skills in conflict resolution, operational analysis, employee management, and quality management to achieve individual and organizational goals.

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3.1 Roles and Responsibilities of Health Care Professionals

Ipec competency 1: values/ethics for interprofessional practice.

The coordination and delivery of safe, quality patient care demands reliable teamwork and collaboration across the organizational and community boundaries. Clients often have multiple visits across multiple providers working in different organizations. Communication failures between health care settings, departments, and team members is the leading cause of patient harm (Rosen et al., 2018). The health care system is becoming increasingly complex requiring collaboration among diverse health care team members.

The goal of good interprofessional collaboration is improved patient outcomes, as well as increased job satisfaction of health care team professionals. Patients receiving care with poor teamwork are almost five times as likely to experience complications or death. Hospitals in which staff report higher levels of teamwork have lower rates of workplace injuries and illness, fewer incidents of workplace harassment and violence, and lower turnover (Rosen et al., 2018).

Valuing and understanding the roles of team members are important steps toward establishing good interprofessional teamwork. Another step is learning how to effectively communicate with interprofessional team members.

IPEC Competency 2: Roles/Responsibilities

The second IPEC competency relates to the roles and responsibilities of health care professionals and states, “Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations” (Interprofessional Education Collaborative, n.d.).

See the following box for the components of this competency. It is important to understand the roles and responsibilities of the other health care team members; recognize one’s limitations in skills, knowledge, and abilities; and ask for assistance when needed to provide quality, patient-centered care.

Components of IPEC’s Roles/Responsibilities Competency (Interprofessional Education Collaborative, 2022.)

Communicate one’s roles and responsibilities clearly to patients, families, community members, and other professionals.
Recognize one’s limitations in skills, knowledge, and abilities.
Engage with diverse professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific health and health care needs of patients and populations.
Explain the roles and responsibilities of other providers and the manner in which the team works together to provide care, promote health, and prevent disease.
Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable.
Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.
Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning.
Engage in continuous professional and interprofessional development to enhance team performance and collaboration.
Use unique and complementary abilities of all members of the team to optimize health and patient care.
Describe how professionals in health and other fields can collaborate and integrate clinical care and public health interventions to optimize population health.

Nurses communicate with several individuals during their work. For example, during inpatient care, nurses may communicate with patients and their family members; pharmacists and pharmacy technicians; providers from different specialties; physical, speech, and occupational therapists; dietary aides; respiratory therapists; chaplains; social workers; case managers; nursing supervisors, charge nurses, and other staff nurses; assistive personnel; nursing students; nursing instructors; security guards; laboratory personnel; radiology and ultrasound technicians; and surgical team members. Providing holistic, quality, safe, and effective care means every team member taking care of patients must work collaboratively and understand the knowledge, skills, and scope of practice of the other team members. Table 3.4 provides examples of the roles and responsibilities of common health care team members that nurses frequently work with when providing patient care. To fully understand the roles and responsibilities of the multiple members of the complex health care delivery system, it is beneficial to spend time shadowing those within these roles.

Learn more about the roles and responsibilities of individual health care team members by completing the activity below.

Next: 3.2 interprofessional communication.

Leading Change in Health Systems: Strategies for RN-BSN Students Copyright © 2023 by Kathy Andresen DNP, MPH, RN, CNE is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Team-Based Care Toolkit

This toolkit shares best practices and real-life examples of successful team-based clinical care models that include internal medicine physicians working with Nurse Practitioners (NPs) and Physician Assistants (PAs) and other members of the clinical care team. The resources below can help you foster productive and purposeful internal medicine teams.

Why should we practice in teams, what is team-based care, steps to optimal team-based care framework.

Learn More About NP’s and PA’s

Case Studies and Real-life Models of Team-Based Care

Adding an np or pa to your practice, utilize and train existing team members, partnering in team-based care with patients, change management and sustainable teams, 5 quick wins for team-based care.

High functioning clinical teams are essential for the delivery of high value healthcare and have been associated with:

Decreased workloads
Increased efficiency
Improved quality of care
Improved patient outcomes
Decreased clinician burnout/turnover

Source: Implementing Optimal Team-Based Care to Reduce Clinician Burnout – from the National Academy of Medicine

A team-based model of care strives to meet patient needs and preferences by actively engaging patients as full participants in their care, while encouraging and supporting all health care professionals to function to the full extent of their education, certification, and licensure.

Actively engaging patients as full participants in their care, while encouraging and supporting all health care professionals to function to the full extent of their education, certification, and licensure.

Health care teams are defined as two or more health care professionals who work collaboratively with patients and their caregivers to accomplish shared goals. For example, an internist and an NP working together to transition a patient with diabetes to insulin therapy.
A health care team may involve a wide range of team members in various settings. For example, a small ambulatory health care team may include an internist and medical assistant working together to improve the rates of influenza vaccination in their practice. A large inpatient team might include a nurse case manager, social worker, clinical pharmacist, physician assistant, several medical residents, several medical students, an attending physician and unit nurse manager meeting daily to run the list of patients on a floor.
Potential members include physicians, nurse practitioners and physician assistants, medical assistants, pharmacists, social workers, trainees, patients and their families, and others identified as persons necessary to help achieve shared goals.

Access these resources to help you define the team and understand general principals behind team-based care:

Cambridge Health Alliance Model of Team-Based Care Implementation Guide and Toolkit - The Cambridge Health Alliance Model of Team-Based Care Implementation Guide and Toolkit provides information and resources on team-based care, the role of each team member, and sample huddle strategies.
Creating Patient-centered Team-based Primary Care – A proposed blueprint for patient-centered team-based care and strategies to provide patient-centered team-based care.
Foster mutual trust and physical and psychological safety
Clarify roles and expectations
Practice effective communication
Track a set of shared measurable goals

Access these resources to help build this framework and ensure clinical and administrative systems support team members in their defined work:

IOM Core Principles & Values of Effective Team-Based Health Care – This discussion paper presents basic principles and personal values that characterize interprofessional team-based care. Developed by individual participants from the IOM’s Best Practices Innovation Collaborative, the authors identified key findings from health care literature, and used interviews with eleven teams located across the United States to clarify how these factors shape effective team-based care.
Team-Based Care – This module from the AMA Steps Forward explores how to improve patient care and team engagement through collaboration and streamlined processes. It will help you define elements that constitute the model of team-based care, describe how to implement team-based care in your practice, and identify benefits of implementing team-based care in your practice.
Advancing Team Culture: Workforce Effectiveness During COVID-19 and Beyond – This playbook from Vizient sheds light on significant developments in clinical teamwork during 2020 and shares proven strategies for fostering effective teams.
Implementing High-Quality Primary Care: Rebuilding the Foundation of Healthcare – Chapter 6 of this report from the National Academy of Medicine, entitled “Designing Interprofessional Teams and Preparing the Future Primary Care Workforce”, focuses on key design elements of interprofessional teams and highlights the roles that extended care team members can play in delivering high-quality primary care.

Learn More About NPs and PAs

The term 'Advanced Practice Providers' refers to both Physician Assistants and Nurse Practitioners.

An improved understanding of the various roles, training requirements, and scope of work may help internists who are interested in building, expanding, or improving team-based care in their practices. The term “Advanced Practice Providers” refers to both Physician Assistants and Nurse Practitioners. NPs and PAs have very different requirements for both basic science education and clinical experience. In addition, their scope of practice and integration into the healthcare workforce varies significantly by state.

The resources below may help you with your decision to add an NP or PA to your team or more effectively incorporate the APP’s on your team:

NPs vs PAs; What’s the Difference? - This short article summarizes how NPs and PAs are alike and how they are different. It covers differences in the focus of their education, certification and licensure, and in state law mandating physician involvement in practice. It even includes a handy set of key questions to ask prior to hiring an APP.
PAs & NPs: Similarities and Differences – This infographic presents the similarities and differences between NPs and PAs in an easy-to-read infographic.
Physician Assistant Scope of Practice - This state law chart from the AMA outlines several aspects of state laws regulating physician assistant practice including prescriptive authority, requirements for collaborative or supervisory arrangements, regulation, and scope of practice determination.
PA Scope of Practice – This resource from the AAPA explains more about the scope of practice of PAs.
Nurse Practitioner Practice Authority – This state law chart from the AMA outlines nurse practitioner practice authority by state.
PAs and Team Practice - This resource from the AAPA highlights the important role of PAs in team practice.

Real-life examples of successful team-based care in Internal Medicine showcase ways in which team-based care involving nurse practitioners, physician assistants, pharmacists, and others are working together with patients and caregivers in both inpatient and outpatient settings.

Webinar Video Recording of the Virginia Mason Kirkland Medical Center case study
Watch this 3-minute video that describes how they have implemented effective team based primary care at Emory Patient Centered Primary Care.
Team-Based Care – This TCPi Team-Based Care power pack highlights Union Square Family Health Center, a Family Medicine site of the Cambridge Health Alliance in Boston, MA and how they successfully implemented a team-based care model as a sustainable solution to overwork.
Video on Interdisciplinary Rounds – This video features a patient care team at Christiana Care's Wilmington Hospital intensive care unit that demonstrates the patient and family centered care practice of interdisciplinary rounds at the bedside.
Leveraging Advanced Practice Providers during a Crisis: Lessons Learned from Top Healthcare Systems – This white paper from the American College of Healthcare Executives shares crisis strategies from APP leadership across the nation during the COVID-19 pandemic and showcases the innovative ways APPs met unprecedented demands.
Integrating Advanced Practice Providers into value based care strategies: One organization’s journey to achieve success through interprofessional collaboration – This case study from the Journal of Interprofessional Education and Practice showcases an urban academic pediatric hospital that enhanced the use of Advanced Practice Providers (APPs) to optimize care.

During the hiring process, defining team members’ roles can help you empower your team. Oversight and management of a team of advance practice providers is also essential to a highly functioning team.

These job descriptions and other hiring resources can help you facilitate decisions about which patients see which team members, and the best ways to optimize outcomes while having everyone work at the top of their scope.

The Business Case for Hiring a Nurse Practitioner – this article outlines estimated expenses, potential revenue generation and potential profits to expect after the addition of an NP to your practice.
Sample APRN Job Description – Sample APRN job description for an outpatient internal medicine clinic.
Sample Physician Assistant Job Description – Sample PA job description for an inpatient setting.
Sample Core and Specialty Privileges for PAs – Resource from the AAPA.
PAs: Credentialing, Privileging, and Assessing Competency (FPPE & OPPE) – Resource from the AAPA.
Third-Party Reimbursement for PAs – Resource from the AAPA.
Strategies for Recruiting NPs and PAs - In this article from the ACP Hospitalist , two hospitalists share their program’s model for outreach, screening, and interviews.

Hiring new staff is not always necessary to make the most of team-based care. By compensating and valuing the team you already have in place, you can decrease staff turnover and make more a more successful practice.

Remember the importance of the front desk staff and their role on the team
Medical assistants are often overlooked but crucial members of the team
Engage all team members in workflow redesign to get buy in and assure that the new process makes sense
Some examples: standing orders for influenza vaccination during flu season increase rates of vaccination without need for physician involvement; MA’s and LPN’s take patient portal review shifts to decrease response time and clinician burden; uptrain MA’s to scribe encounters in the EHR so that clinicians can focus on patient centered communication and clinical decision making
Clarify roles

Patients, families, and other caregivers need a clear understanding of the roles of the interprofessional care team with explanations of which role will serve which purpose in their care. The health care team should provide information to patients, families, and other caregivers so they can make informed healthcare decisions in partnership with their care team.

The following resources can help patients understand the different roles that make up the interprofessional health care team and how they might interact with each:

Who’s Who on the Healthcare Team: An Interdisciplinary Approach - This article provides a brief introduction to the educational background and role of the different professionals a patient might typically encounter in a hospital.
Your Health Care Team - This article provides a brief description of the roles of the different professionals a patient might typically encounter in a hospital.
Your PA Can Handle It – This patient-facing resource explains more about the physician assistant role on the healthcare team.

Physicians, clinicians, non-clinical staff and patients may have some difficulty adapting to team-based care models. Change management principles may ease adoption by stakeholders and help sustain the team and its members over the long term. Ongoing, structured communication and feedback are essential to optimize team performance and help to sustain teams over time. Relatedness and the ability for team members to enjoy each other’s company at work should be nurtured and encouraged. High functioning teams have been associated with reduced clinician burnout and improved patient outcomes.

These resources address how team-based care can reduce burnout and how to sustain team-based care models in the long term.

ACP’s Well-being and Professional Fulfillment Resources – These resources from ACP can help physicians and their teams reduce burnout and find ways to enhance professional satisfaction and wellbeing.
Team-based Care and Flexible, Adaptable Leadership - This menu of recommendations can help you get started with developing a plan for effective team-based communication and leadership in your practice.
Physician Assistant Burnout Resources – These resources from the AAPA help support the well-being and professional satisfaction of physician assistants.
Mini but Mighty Appreciative Inquiry – Appreciative Inquiry is an organizational development model that takes a positive approach to systems change. This webinar, developed by Kerri Palamara, MD, FACP, Director of the Center for Physician Well-being at Massachusetts General Hospital and Physician Coaching Services Lead for ACP, and presented by North Carolina Well-being Champion Marion McCrary, MD, FACP, guides you through using the AI approach in your practice and teaching others to do the same.

To put the Steps to Optimal Team-Base Care into action, here are five easy-to-implement examples that any care team can put into place:

1. Hang pictures of team members on the wall 2. Invite patients/families to join the clinical team

Both help foster mutual trust and physical and psychological safety

3. Hang a ribbon from each staff person’s badge that states their role 4. Include team members and their roles into the new patient visit

Both help clarify roles and expectations

5. Start each clinical session with a short team huddle

Emphasizes the practice of effective communication

These ideas help to enhance team-based care by optimizing the team you already have, and working with intention to involve everyone consistently on the care team.

What is Teamwork in Nursing? (With Examples, Importance, & How to Improve)

Are you a nurse searching for ways to build strong relationships, improve patient care, and promote a good work environment? If so, the key to making this happen is teamwork. Perhaps you know teamwork is essential but find yourself asking, "Where can I start, and what are some ways to know how to improve teamwork in nursing?” In this article, I will share some insight from my nursing career, including 15 expert tips to improve teamwork in nursing. As you read further, you will find reasons why teamwork is so important in nursing and learn the consequences of lack of teamwork. I’ll also share some sample scenarios using teamwork in nursing with examples of poor teamwork and good teamwork.

What is Teamwork in Nursing?

5 reasons why teamwork is so important in nursing, 1. teamwork in nursing results in better patient care, which improves patient outcomes., 2. teamwork and collaboration in nursing help build strong professional relationships., 3. when nurses work together as a team, there is a reduced risk to patient safety., 4. the increased efficiency in patient care due to effective teamwork in nursing leads to lower healthcare costs., 5. teamwork in nursing promotes efficiency in patient care, conducive to a healing environment for patients, and job satisfaction for nurses., what are the 7 key elements of good teamwork in nursing, 1. communication:, 2. collaboration:, 3. coordination:, 4. accountability:, 5. integrity:, 6. sharing ideas with one another:, 7. being supportive of others:, examples of poor teamwork vs. good teamwork in nursing, 1. scenario: demonstrating leadership in teamwork, poor teamwork:, good teamwork:, 2. scenario: collaborative teamwork to reduce patient anxiety, 3. scenario: unusually heavy patient load, how to improve teamwork in nursing, 1. learn effective communication skills., 2. give credit to others for a job well done., 3. avoid trying to micro-manage other team members., 4. two ears, one mouth., 5. volunteer to be a mentor., 6. adopt and promote a patient-centered mindset., 7. grow your skills., 8. be willing to be the first person to promote teamwork between yourself and your colleagues., 9. embrace the diversity that makes up your team., 10. understand the role and responsibilities of each team member., 11. practice integrity., 12. encourage others to grow and expand their professional skills., 13. be willing to accept change., 14. make personal connections with your team members., 15. promote a holistic approach to patient care., 4 consequences of poor teamwork in nursing, 1. increased stress in the workplace:, 2. increased risk of errors in patient care:, 3. conflict among team members:, 4. poor management of time and resources:, useful resources to improve teamwork in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of teamwork impact my nursing career, 2. usually, how long does it take for a nurse to improve their teamwork skills, 3. do all types of nurses require good teamwork skills, 4. are nurses with good teamwork skills happier.

Session 2. Teamwork and Communication in Health Care

Chapter 6. Case-Based Learning

At a glance.

	Teamwork and Communication in Health Care
	Pharmacy, Nursing, Speech-Language Pathology and Audiology
	Clinical skills
	Domain: Teams and Teamwork Describe the process of team development and the roles and practices of effective teams. Reflect on individual and team performance for individual, as well as team, performance improvement.
	Domain: Interprofessional Collaborative Practice Exchange meaningful information among health care providers to identify and implement appropriate, high quality care for patients, based on comprehensive evaluations and options available within the local health delivery and referral system.
	Understand the terminology and concepts of interprofessional education and collaborative practice. Consider how collaborative practice can increase provision of comprehensive oral health services.

Instructor’s Guide

Overview for instructors. The purpose of this didactic session is to introduce students to the concepts of interprofessional education and collaborative practice. Instructors will use two case studies to highlight the specific teamwork and communication skills individuals need to work effectively on an interprofessional health care team. Each case study uses little to no medical or dental terminology to embed oral health. As a result, this session is ideal for pre-licensure health sciences students with no clinical training.

Materials provided in this toolkit.

Pre- and Post-Session Assessment Questionnaire
Instructor’s Copy, Case Study: Jill
Instructor’s Copy, Case Study: Mr. Jones
Case Study: Jill
Case Study: Mr. Jones

Instructor Preparation.

Download slides 30–34 and the accompanying speaker notes from Smiles for Life Course 1: The Relationship of Oral to Systemic Health

Note: You must register as an educator before you can download individual slides and speaker notes. Slide numbers viewed through the web interface for Smiles for Life differ from the numbers on the downloaded slides. Slide numbers in this toolkit correspond to slides in the third edition of Smiles for Life in their downloaded format.

Ask a faculty member from each of the participating programs to locate or draft a short description of the roles and responsibilities for his or her respective profession. Compile these descriptions into one Word document and make it available to your students through email, your preferred learning management system, or your website.
Pre-Session Assignment: Teamwork and Communication in Health Care

Note : The survey portion of the Pre- and Post-Session Assessment Questionnaire is taken from the TeamSTEPPS ® Teamwork Attitudes Questionnaire , which looks at five core components of teamwork. TeamSTEPPS was developed jointly by the Department of Defense and the Agency for Healthcare Research and Quality to improve the quality and safety of patient care. To learn more about the system, which includes a full curriculum and other resources, visit TeamSTEPPS .

Complete the Pre- and Post-Session Assignment: Teamwork and Communication in Health Care .
Review the roles and responsibilities document provided by the instructor.
Pre-assessment (2–5 minutes)
Introduction (5 minutes)
Discussion of the pre-session assignment (10 minutes)
Smiles for Life Course 1: The Relationship of Oral to Systemic Health PowerPoint slides 30–34 (10 minutes)
Case study for Jill (10 minutes)
Case study for Mr. Jones (10 minutes)
Wrap-up (5 minutes)
Post-assessment (2–5 minutes)

Instructor’s Notes

This session will take approximately one hour, depending on the number of participants.

Pre-assessment (2–5 minutes). Ask students to complete the pre-session portion of the Pre- and Post-Session Assessment Questionnaire as they arrive.

Introduction (5 minutes). Review the learning objectives and purpose of the session. Ask students to identify themselves by hand as you note the professions represented in class. Then, ask a student volunteer from each profession to read the roles and responsibilities for his or her profession aloud.

Discussion of pre-session assignment (10 minutes). The purpose of this assignment is to provide students with a real-world example of substandard health care delivery.

Ask student volunteers to share their answers to the questions in the Pre-Session Assignment: Teamwork and Communication in Health Care . Use the following notes to enhance discussion for each question.

The purpose of this question is to prompt students to think about their personal experiences with teamwork. Allow a few students to share their answers.
The purpose of this question is to prompt students to identify specific examples of effective or ineffective teamwork.
This question should prompt students to reflect on the consequences of poor health care delivery (i.e., what happens when teamwork, collaboration, and good communication are absent).
This question asks students to contemplate what went wrong with Deamonte’s health care delivery.

If necessary, guide students toward an understanding of the ways better communication and teamwork could have resulted in the more timely care needed to save Deamonte’s life.

Smiles for Life Course 1: The Relationship of Oral to Systemic Health PowerPoint slides 30–34 (10 minutes). This portion of Smiles for Life Course 1: The Relationship of Oral to Systemic Health introduces the concepts of interprofessional education and collaborative practice. Take time to read the definition of each and point out that the purpose of this didactic session is to prepare students for collaborative practice.

Case study for Jill (10 minutes). Break students into interprofessional teams of five or six. If possible, place one student from each profession on each team.

Instruct students to read Jill’s case study silently, then answer the questions as a team. One student should take notes and be prepared to discuss the team’s answers.

Use the following notes to enhance discussion generated by the questions.

Yes. Although Jill’s school nurse could have taken action earlier, the dentist, physician, and school nurse communicated in a positive manner that reflects collaborative practice.
Yes. All U.S. states and territories have laws that mandate the reporting of suspected abuse by specified individuals. These typically include physicians, nurses, and other health professionals. The need to be alert to nonmedical issues also highlights a potentially overlooked aspect of patient-centered care delivery. All health care providers should be concerned about a patient’s overall health and wellbeing, including those conditions whose treatment extends beyond the provider’s training.
Jill’s health care team exhibited effective communication, mutual respect, and concern for comprehensive care.
The physician addressed Jill’s oral health concerns and provided a dental referral. This illustrates patient-centered, comprehensive care.
The dentist followed up with Jill’s physician and also consulted with her school nurse. This illustrates effective communication and collaboration.
Participate in interprofessional education opportunities such as this one.
Learn about the roles and responsibilities of other health care providers.
Contact local health care providers once in practice to facilitate collaboration.

Case study for Mr. Jones (10 minutes).

Option 1 Ask students to form new teams with at least one person from each profession present on each team. Teams should designate one person to take notes and report on team findings. After the students have formed teams, direct them to read the case study for Mr. Jones silently, then answer the questions as a team.

Option 2 Ask students to remain with their present teams but designate a new person to take notes and report findings. Direct students to read the case study for Mr. Jones silently, then answer the questions as a team.

The primary care provider (PCP) prescribed oral medication—a poor choice for patients with difficulty swallowing—and failed to refer Mr. Jones to a dentist for further evaluation.
The speech language pathologist (SLP) did not perform an adequate oral examination, even after noticing Mr. Jones’s bad breath and food accumulation.
The pharmacist filled the prescription for oral antibiotics in pill form without questioning the patient’s ability to swallow, even though the pharmacist recognized his facial paralysis and difficulty speaking.
Mr. Jones’s health care team members did not communicate or collaborate with one another regarding his health care delivery.
The PCP could have spoken to the SLP over the phone and explained that he prescribed Mr. Jones antibiotics and pain medication for an infected tooth. This may have prompted the SLP to point out the need for liquid antibiotics to ensure patient compliance. It may also have prompted the SLP to follow up with Mr. Jones regarding his oral condition at his appointment.
Even without a call from the PCP, the SLP could have performed a comprehensive oral examination as part of Mr. Jones’s appointment and noted the infected tooth, which should have prompted an immediate dental referral.
The pharmacist could have questioned Mr. Jones about his facial paralysis and ability to swallow. This would have prompted a change in prescription from pill to liquid form, enabling Mr. Jones to take the oral antibiotics more easily.
Yes, the PCP could have referred Mr. Jones to a dental provider when the oral antibiotics were prescribed.
Yes, cost and unnecessary pain and stress for the patient.

Wrap-up (5 minutes).

To facilitate a wrap-up discussion, ask students the following questions.

Did working with students from other professions highlight aspects of health care delivery that you had not considered before?
How will you apply what you learned today about teamwork and communication in health care to your education and in practice?

To close the session, summarize the following points for your students.

Patient-centered health care requires all health care providers to communicate and collaborate effectively.
A lack of communication and teamwork has been shown to negatively impact patient health outcomes.
Patient health and safety is at risk when health care providers do not work together.

Post-assessment (2–5 minutes). Ask students to complete the post-session portion of the Pre- and Post-Session Assessment Questionnaire before they leave. Impress upon them the value of their feedback in helping you hone the session for future students.

< Previous Page: Session 1. Team-Based Care

First Published: 10/2015 Last updated: 03/2016

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1.4 Health Care Settings & Team

Open Resources for Nursing (Open RN)

Health Care Settings

There are several levels of health care including primary, secondary, and tertiary care. Each of these levels focuses on different aspects of health care and is typically provided in different settings.

Primary Care

Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of health care include physician offices, public health clinics, school nursing, and community health nursing.

Secondary care

Secondary care occurs when a person has contracted an illness or injury and requires medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a small laceration or treat a strep throat infection to more complicated emergent care such as treating a head injury sustained in an automobile accident. Whatever the problem, the client needs medical and nursing attention to return to a state of health and wellness. Secondary care is provided in settings such as physician offices, clinics, urgent care facilities, or hospitals. Specialized units include areas such as critical care, burn units, neurosurgery, cardiac surgery, and transplant services.

Tertiary Care

Tertiary care addresses the long-term effects from chronic illnesses or conditions with the purpose to restore a client’s maximum physical and mental function. The goal of tertiary care is to achieve the highest level of functioning possible while managing the chronic illness. For example, a client who falls and fractures their hip will need secondary care to set the broken bones, but may need tertiary care to regain their strength and ability to walk even after the bones have healed. Clients with incurable diseases, such as dementia, may need specialized tertiary care to provide support they need for daily functioning. Tertiary care settings include rehabilitation units, assisted living facilities, adult day care, skilled nursing units, home care, and hospice centers.

Health Care Team

No matter the setting, quality health care requires a team of health care professionals collaboratively working together to deliver holistic, individualized care. Nursing students must be aware of the roles and contributions of various health care team members. The health care team consists of health care providers, nurses (licensed practical nurses, registered nurses, and advanced practice registered nurses), unlicensed assistive personnel, and a variety of interprofessional team members.

Health Care Providers

The Wisconsin Nurse Practice Act defines a health care provider as, “A physician, podiatrist, dentist, optometrist, or advanced practice nurse.” [1] Providers are responsible for ordering diagnostic tests such as blood work and X-rays, diagnosing a client’s medical condition, developing a medical treatment plan, and prescribing medications. In a hospital setting, the medical treatment plan developed by a provider is communicated in the “History and Physical” component of the client’s medical record with associated prescriptions (otherwise known as “orders”). Prescriptions or “orders” include diagnostic and laboratory tests, medications, and general parameters regarding the care that each client is to receive. Nurses should respectfully clarify prescriptions they have questions or concerns about to ensure safe client care. Providers typically visit hospitalized clients daily in what is referred to as “rounds.” It is helpful for nurses and nursing students to attend provider rounds for their assigned clients to be aware of and provide input regarding the current medical treatment plan, seek clarification, or ask questions. This helps to ensure that the provider, nurse, and client have a clear understanding of the goals of care and minimizes the need for follow-up phone calls.

There are three levels of nurses as defined by each state’s Nurse Practice Act: Licensed Practical Nurse/Vocational Nurse (LPN/LVN), Registered Nurse (RN), and Advanced Practice Registered Nurse (APRN).

Licensed Practical/Vocational Nurses

The National Council of State Boards of Nursing (NCSBN) defines a licensed practical nurse (LPN) as, “An individual who has completed a state-approved practical or vocational nursing program, passed the NCLEX-PN examination, and is licensed by a state board of nursing to provide client care.” [2] In some states, the term licensed vocational nurse (LVN) is used. LPNs/LVNs typically work under the supervision of a registered nurse, advanced practice registered nurse, or physician. [3] LPNs provide “basic nursing care” and work with stable and/or chronically ill populations. Basic nursing care is defined by the Wisconsin Nurse Practice Act as “care that can be performed following a defined nursing procedure with minimal modification in which the responses of the client to the nursing care are predictable.” [4] LPNs/LVNs typically collect client assessment information, administer medications, and perform nursing procedures according to their scope of practice in that state. The Open RN Nursing Skills, 2e textbook discusses the skills and procedures that LPNs frequently perform in Wisconsin. See the following box for additional details about the scope of practice of the Licensed Practical Nurse in Wisconsin.

Scope of Practice for Licensed Practical Nurses in Wisconsin [5]

“The Wisconsin Nurse Practice Act defines the scope of practice for Licensed Practical Nurses as the following: “In the performance of acts in basic patient situations, the LPN shall, under the general supervision of an RN or the direction of a provider:

(a) Accept only patient care assignments which the LPN is competent to perform.

(b) Provide basic nursing care.

(d) Consult with a provider in cases where an LPN knows or should know a delegated act may harm a patient.

(e) Perform the following other acts when applicable:

Assist with the collection of data.
Assist with the development and revision of a nursing care plan.
Reinforce the teaching provided by an RN provider and provide basic health care instruction.
Participate with other health team members in meeting basic patient needs.”

Registered Nurses

The NCSBN defines a Registered Nurse (RN) as “An individual who has graduated from a state-approved school of nursing, passed the NCLEX-RN examination and is licensed by a state board of nursing to provide client care.” [6] Registered Nurses (RNs) use the nursing process as a critical thinking model as they make decisions and use clinical judgment regarding client care. The nursing process is discussed in more detail in the “ Nursing Process ” chapter of this book. RNs may be delegated tasks from providers or may delegate tasks to LPNs and UAPs with supervision. See the following box for additional details about the scope of practice for Registered Nurses in the state of Wisconsin.

Scope of Practice for Registered Nurses in Wisconsin [7]

(1) “GENERAL NURSING PROCEDURES. An RN shall utilize the nursing process in the execution of general nursing procedures in the maintenance of health, prevention of illness or care of the ill. The nursing process consists of the steps of assessment, planning, intervention, and evaluation. This standard is met through performance of each of the following steps of the nursing process:

(a) Assessment. Assessment is the systematic and continual collection and analysis of data about the health status of a patient culminating in the formulation of a nursing diagnosis.

(b) Planning. Planning is developing a nursing plan of care for a patient, which includes goals and priorities derived from the nursing diagnosis.

(c) Intervention. Intervention is the nursing action to implement the plan of care by directly administering care or by directing and supervising nursing acts delegated to LPNs or less skilled assistants.

(d) Evaluation. Evaluation is the determination of a patient’s progress or lack of progress toward goal achievement, which may lead to modification of the nursing diagnosis.

(2) PERFORMANCE OF DELEGATED ACTS. In the performance of delegated acts, an RN shall do all of the following:

(a) Accept only those delegated acts for which there are protocols or written or verbal orders.

(b) Accept only those delegated acts for which the RN is competent to perform based on his or her nursing education, training or experience.

(d) Perform delegated acts under the general supervision or direction of provider.

(3) SUPERVISION AND DIRECTION OF DELEGATED ACTS. In the supervision and direction of delegated acts, an RN shall do all of the following:

(a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.

(b) Provide direction and assistance to those supervised.

(d) Evaluate the effectiveness of acts performed under supervision.”

Advanced Practice Registered Nurses

Advanced Practice Registered Nurses (APRN) are defined by the NCSBN as an RN who has a graduate degree and advanced knowledge. There are four categories of Advanced Practice Registered Nurses: Certified Nurse-Midwife (CNM), Clinical Nurse Specialist (CNS), Certified Nurse Practitioner (CNP), and Certified Registered Nurse Anesthetist (CRNA). APRNs can diagnose illnesses and prescribe treatments and medications. Additional information about advanced nursing degrees and roles is provided in the box below.

Advanced Practice Nursing Roles [8]

Nurse Practitioners: Nurse practitioners (NPs) work in a variety of settings and complete physical examinations, diagnose and treat common acute illness and manage chronic illness, order laboratory and diagnostic tests, prescribe medications and other therapies, provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance, and refer clients to other health professionals and specialists as needed. In many states, NPs can function independently and manage their own clinics, whereas in other states physician supervision is required. NP certifications include, but are not limited to, Family Practice, Adult-Gerontology Primary Care and Acute Care, and Psychiatric/Mental Health.

To read more about NP certification, visit Nursing World’s Our Certifications web page.

Clinical Nurse Specialists: Clinical Nurse Specialists (CNS) practice in a variety of health care environments and participate in mentoring other nurses, case management, research, designing and conducting quality improvement programs, and serving as educators and consultants. Specialty areas include, but are not limited to, Adult/Gerontology, Pediatrics, and Neonatal.

To read more about CNS certification, visit National Association of Clinical Nurse Specialist’s What is a CNS? web page.

Certified Registered Nurse Anesthetists: Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures, as well as provide airway management during medical emergencies. CRNAs deliver more than 65 percent of all anesthetics to clients in the United States. Practice settings include operating rooms, dental offices, and outpatient surgical centers.

To read more about CRNA certification, visit National Board of Certification & Recertification for Nurse Anesthetist’s website.

Certified Nurse Midwives: Certified Nurse Midwives provide gynecological exams, family planning advice, prenatal care, management of low-risk labor and delivery, and neonatal care. Practice settings include hospitals, birthing centers, community clinics, and client homes.

To read more about CNM certification, vi sit the American Midwifery Certification Board website.

Unlicensed Assistive Personnel

Unlicensed Assistive Personnel (UAP) are defined by the NCSBN as, “Any unlicensed person, regardless of title, who performs tasks delegated by a nurse. This includes certified nursing aides/assistants (CNAs), patient care assistants (PCAs), patient care technicians (PCTs), state tested nursing assistants (STNAs), nursing assistants-registered (NA/Rs), or certified medication aides/assistants (MA-Cs). Certification of UAPs varies between jurisdictions.” [9]

CNAs, PCAs, and PCTs in Wisconsin generally work in hospitals and long-term care facilities and assist clients with daily tasks such as bathing, dressing, feeding, and toileting. They may also collect client information such as vital signs, weight, and input/output as delegated by the nurse. The RN remains accountable that delegated tasks have been completed and documented by the UAP.

Interprofessional Team Members

Nurses, as the coordinator of a client’s care, continuously review the plan of care to ensure all contributions of the multidisciplinary team are moving the client toward expected outcomes and goals. The roles and contributions of interprofessional health care team members are further described in the following box.

Interprofessional Team Member Roles [10]

Dieticians: Dieticians assess, plan, implement, and evaluate interventions, including those relating to dietary needs of those clients who need regular or therapeutic diets. They also provide dietary education and work with other members of the health care team when a client has dietary needs secondary to physical disorders such as difficulty swallowing.

Occupational Therapists (OT): Occupational therapists assess, plan, implement, and evaluate interventions, including those that facilitate the client’s ability to achieve their highest possible level of independence in their activities of daily living such as bathing, grooming, eating, and dressing. They also provide clients with adaptive devices such as long shoehorns so the client can put their shoes on, sock pulls so they can independently pull on socks, adaptive silverware to facilitate independent eating, grabbers so the client can pick items up from the floor, and special devices to manipulate buttoning so the person can dress and button their clothing independently. OTs assess the home for safety and the need for assistive devices when the client is discharged home. They may recommend modifications to the home environment such as ramps, grab rails, and handrails to ensure safety and independence. OTs practice in all health care environments, including the home, hospital, and rehabilitation centers.

Pharmacists: Pharmacists ensure the safe prescribing and dispensing of medication and are a vital resource for nurses with questions or concerns about medications they are administering to clients. Pharmacists ensure that clients not only get the correct medication and dosing, but also have the guidance they need to use the medication safely and effectively.

Physical Therapists (PT): Physical therapists are licensed health care professionals who assess, plan, implement, and evaluate interventions, including those related to the client’s functional abilities in terms of their strength, mobility, balance, gait, coordination, and joint range of motion. They supervise prescribed exercise activities according to a client’s condition and also provide and teach clients how to use assistive aids like walkers and canes and how to perform exercise regimens. Physical therapists practice in all health care environments, including the home, hospital, and rehabilitation centers.

Podiatrists: Podiatrists provide care and services to clients who have foot problems. They often work with clients who have diabetes to clip toenails and provide foot care to prevent complications.

Prosthetists: Prosthetists design, fit, and supply the client with an artificial body part such as a leg or arm prosthesis. They adjust prosthesis to ensure proper fit, comfort, and functioning.

Psychologists and Psychiatrists: Psychologists and psychiatrists provide mental health and psychiatric services to clients with mental health disorders and provide psychological support to family members and significant others as indicated.

Respiratory Therapists: Respiratory therapists treat respiratory-related conditions in clients. Their specialized respiratory care includes managing oxygen therapy; drawing arterial blood gases; managing clients on specialized oxygenation devices such as mechanical ventilators, CPAP, and Bi-PAP machines; administering respiratory medications like inhalers and nebulizers; intubating clients; assisting with bronchoscopy and other respiratory-related diagnostic tests; performing pulmonary hygiene measures like chest physiotherapy; and serving an integral role in providing respiratory support.

Social Workers: Social workers counsel clients and provide psychological support, help set up community resources according to clients’ financial needs, and serve as part of the team that ensures continuity of care after the person is discharged.

Speech Therapists: Speech therapists assess, diagnose, and treat communication and swallowing disorders. For example, speech therapists help clients with a disorder called expressive aphasia . They also assist clients with using word boards and other electronic devices to facilitate communication. They assess clients with swallowing disorders called dysphagia and treat them in collaboration with other members of the health care team including nurses, dieticians, and health care providers.

Ancillary Department Members: Nurses also work with ancillary departments such as laboratory and radiology departments.

Clinical laboratory departments provide a wide range of laboratory procedures that aid health care providers to diagnose, treat, and manage clients. These laboratories are staffed by medical technologists who test biological specimens collected from clients. Examples of laboratory tests performed include blood tests, blood banking, cultures, urine tests, and histopathology (changes in tissues caused by disease). [11]
Radiology departments use imaging to assist providers in diagnosing and treating diseases seen within the body. They perform diagnostic tests such as X-rays, CTs, MRIs, nuclear medicine, PET scans, and ultrasound scans.

Chain of Command

Nurses rarely make client decisions in isolation, but instead consult with other nurses and interprofessional team members. Concerns and questions about client care are typically communicated according to that agency’s chain of command. In the military, chain of command refers to a hierarchy of reporting relationships – from the bottom to the top of an organization – regarding who must answer to whom. The chain of command not only establishes accountability, but also lays out lines of authority and decision-making power. The chain of command also applies to health care. For example, a registered nurse in a hospital may consult a “charge nurse,” who may consult the “nurse supervisor,” who may consult the “director of nursing,” who may consult the “vice president of nursing.” In a long-term care facility, a licensed practical/vocational nurse typically consults the registered nurse/charge nurse, who may consult with the director of nursing. Nursing students should always consult with their nursing instructor regarding questions or concerns about client care before “going up the chain of command.”

Nurse Specialties

Registered nurses can obtain several types of certifications as a nurse specialist. Certification is the formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty. See the following box for descriptions of common nurse specialties.

Common Nurse Specialties

Critical Care Nurses provide care to clients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses most often work in intensive care units of hospitals.

Public Health Nurses work to promote and protect the health of populations based on knowledge from nursing, social, and public health sciences. Public health nurses most often work in municipal and state health departments.

Home Health/Hospice Nurses provide a variety of nursing services for chronically ill clients and their caregivers in the home, including end-of-life care.

Occupational/Employee Health Nurses provide health screening, wellness programs and other health teaching, minor treatments, and disease/medication management services to people in the workplace. The focus is on promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards.

Oncology Nurses care for clients with various types of cancer, administering chemotherapy and providing follow-up care, teaching, and monitoring. Oncology nurses work in hospitals, outpatient clinics, and clients’ homes.

Perioperative/Operating Room Nurses provide preoperative and postoperative care to clients undergoing anesthesia or assist with surgical procedures by selecting and handling instruments, controlling bleeding, and suturing incisions. These nurses work in hospitals and outpatient surgical centers.

Rehabilitation Nurses care for clients with temporary and permanent disabilities within inpatient and outpatient settings such as clinics and home health care.

Psychiatric/Mental Health Nurses specialize in mental and behavioral health problems and provide nursing care to individuals with psychiatric disorders. Psychiatric nurses work in hospitals, outpatient clinics, and private offices.

School Nurses provide health assessment, intervention, and follow-up to maintain school compliance with health care policies and ensure the health and safety of staff and students. They administer medications and refer students for additional services when hearing, vision, and other issues become inhibitors to successful learning.

Telenursing refers to providing nursing care remotely using information and communication technology. Nursing care may include client education, support, health assessment and evaluation, and triage. While telenursing is not a specialty, it is provided in several specialty areas such as Critical Care and Emergency Departments. It is also provided in outpatient environments and encourages increased client interactions, especially in underserved rural areas. [12]

Other common specialty areas include a life span approach across health care settings and include maternal-child, neonatal, pediatric, and gerontological nursing. [13]

Wisconsin Administrative Code. (2024). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf ↵
NCSBN. https://www.ncsbn.org/ ↵
NCSBN. https://www.ncsbn.org/index.htm ↵
Wisconsin Administrative Code. (2024). Chapter N 6 standards of practice for registered nurses and licensed practical nurses . https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf ↵
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press. https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health ↵
Burke, A. (2020, January 15). Collaboration with interdisciplinary team: NCLEX-RN . RegisteredNursing.org. https://www.registerednursing.org/nclex/collaboration-interdisciplinary-team/#collaborating-healthcare-members-disciplines-providing-client-care ↵
This work is a derivative of StatPearls by Bayot and Naidoo and licensed under CC BY 4.0 ↵
Khraisat, O. M. A., Al-Bashaireh, A. M., & Alnazly, E. (2023). Telenursing implications for future education and practice: Nursing students' perspectives and knowledge from a course on child health. PLoS One, 18 (11), e0294711. https://doi.org/10.1371/journal.pone.0294711 . ↵
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health . National Academies Press. https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health ↵

Care that is provided to patients to promote wellness and prevent disease from occurring. This includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations.

Care that occurs when a person has contracted an illness or injury and is in need of medical care.

A type of care that deals with the long-term effects from chronic illness or condition, with the purpose to restore physical and mental function that may have been lost. The goal is to achieve the highest level of functioning possible with this chronic illness.

A physician, podiatrist, dentist, optometrist, or advanced practice nurse provider.

“An individual who has completed a state-approved practical or vocational nursing program, passed the NCLEX-PN examination, and is licensed by a state board of nursing to provide patient care.”

Care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.

An individual who has graduated from a state-approved school of nursing, passed the NCLEX-RN examination, and is licensed by a state board of nursing to provide patient care.

An RN who has a graduate degree and advanced knowledge. There are four categories of APRNs: certified nurse-midwife (CNM), clinical nurse specialist (CNS), certified nurse practitioner (CNP), or certified registered nurse anesthetist (CRNA). These nurses can diagnose illnesses and prescribe treatments and medications.

Any unlicensed person, regardless of title, who performs tasks delegated by a nurse. This includes certified nursing aides/assistants (CNAs), patient care assistants (PCAs), patient care technicians (PCTs), state tested nursing assistants (STNAs), nursing assistants-registered (NA/Rs) or certified medication aides/assistants (MA-Cs). Certification of UAPs varies between jurisdictions.

The impaired ability to form words and speak.

Impaired swallowing.

A hierarchy of reporting relationships in an agency that establishes accountability and lays out lines of authority and decision-making power.

The formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty.

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How One Major Healthcare Firm Became the Leader in Innovative AI Use

Paul Baier,
David DeLallo,
John J. Sviokla

Interviews with the Blue Cross Blue Shield of Michigan management team identified seven principles that guided their actions.

Blue Cross, Blue Shield of Michigan (BCBSM) has gone on a journey from being the least efficient user of technology in the Blue Cross system to the most efficient as measured on a technology cost per employee basis. Not only that but they have absorbed waves of new technology: cloud, new security protocols, extensive mobile support, more than 20 production AI applications and now generative AI (gen AI). Today, they also have three gen AI applications that they use and are planning on selling to other firms, all while complying with more than 700 regulatory bodies. Getting there meant undertaking a multi-year journey to renovate their core infrastructure to deal with the emerging complexity and member demands in their marketplace, while simultaneously increasing their agility. Interviews with the BCBSM management team identified seven principles that guided their actions.

Ask any organization about responsible AI and you’ll likely get an earful on frameworks, guidelines, and principles. There are many high-level white papers that give little practical advice or experience from market leading firms.

PB Paul Baier is CEO and Co-Founder of GAI Insights, an analyst firm dedicated to exploring practical applications of generative AI.
DD David DeLallo serves an AI analyst for GAI Insights, where his research focuses on human-computer interaction, AI ethics and the LLM vendor market. He also runs a tech-focused B2B content agency, David Loren, and previously led McKinsey & Company’s AI thought leadership program.
John J. Sviokla , Co-Founder of GAI Insights has been a senior consultant with PwC, Diamond, and was on the faculty of HBS for over decade. His passion is understanding how computability of reality changes organizations and competition and that’s what he researches, writes, and speaks about.

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Filing an appeal

If you disagree with a coverage or payment decision by Original Medicare , your Medicare Advantage or other Medicare health plan , or your Medicare drug plan you can file an appeal.

Before you start an appeal, ask your provider or supplier for any information that may help your case. If you’re in a Medicare Advantage plan, other health plan, or a drug plan, check your plan materials, or contact your plan, for details about your appeal rights. The plan must tell you, in writing, how to appeal. Generally, you can find your plan's contact information on your plan membership card.

You can file an appeal if Medicare or your plan refuses to:

Cover a health care service, supply, item, or drug you think Medicare should cover.
Pay for a health care service, supply, item, or drug you already got.
Change the amount you must pay for a health care service, supply, item, or drug.

You can also file an appeal if:

Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or drug you think you still need.
Your plan’s drug management program labels you as “at-risk” because you meet the Overutilization Monitoring System criteria. This means your plan limits your access to coverage for drugs like opioids and benzodiazepines.

What if I want to challenge a Local Coverage Determination?

How do appeals work?

The appeals process varies based on the kind of coverage you have. Generally, there are 5 levels of appeals. If you disagree with the decision made at any level of the process, you can usually go to the next level. At each level you'll get a decision letter with instructions on how to move to the next level of appeal.

Get specific information on how to file an appeal based on the kind of coverage you have:

Original Medicare Medicare health plans Medicare drug plans

Can someone help me file an appeal?

State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling. SHIPs are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare.

Representative: If you have a trusted family member or friend helping you with a complaint, you can appoint them as a representative. How do I appoint a representative?

Your right to a fast appeal

You also have the right to a fast appeal if you think your Medicare-covered services are ending too soon. This includes services you get from a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice.

Your provider will give you a written notice before your services end that tells you how to ask for a fast appeal. If they don’t give you this notice, ask for it. Learn more about how fast appeals work.

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A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours

Elizabeth mclaney.

1 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

2 University of Toronto, Toronto, Ontario, Canada.

3 University of Toronto, Toronto, Ontario, Canada.

Sara Morassaei

4 Queen’s University, Kingston, Ontario, Canada.

Leanne Hughes

Robyn davies.

5 Unity Health Toronto, Toronto, Ontario, Canada.

Mikki Campbell

Lisa di prospero.

Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.

Introduction

Interprofessional collaboration has become firmly established as an important component within education and healthcare. 1 There is emerging evidence that when interprofessional healthcare teams practice collaboratively it can enhance the delivery of person-centred care and lead to improved patient and health systems outcomes. 2 - 4 In an effort to train Healthcare Professionals (HCPs) and promote interprofessional collaboration, a number of competency frameworks have been developed. 5 - 8

While there are number of existing competency frameworks for interprofessional collaboration, the most widely referenced are framed as a set of individual competencies that define the attributes, knowledge, and skills of individual HCPs that are required for collaborative practice. 5 , 7 , 8 Many academic institutions and healthcare organizations have adopted interprofessional competency frameworks to put in place standards of practice and support the knowledge and skills of HCPs. 9 , 10 Organizations have also used competency frameworks to set performance indicators that can be used to evaluate HCPs in their ability to practice collaboratively. 11 - 13 There is an assumption with the adoption of individually framed competencies that if the set of competencies are enacted by each HCP then interprofessional collaboration and team performance will be optimal. 14 , 15 However, delivery of optimal care within an effective interprofessional team is based on the collective efforts of team members and is better accomplished through a number of shared responsibilities, interactive planning and collaborative decision-making. 16 , 17 Accordingly, the complex organization of acute care settings and the diverse group of HCPs that comprise the hospital environment warrant a team-based approach to improve care. 17 , 18 In addition, the assessment of collaborative practice using an interprofessional lens and based in team conversations reflects the delivery of real-world integrated care and may lead to the development of high-impact and innovative team capacity-building. Therefore, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. Given the growing importance of interprofessional collaboration, the limited team-based competency frameworks to guide hospitals in advancing interprofessional collaboration remain a gap.

To address this gap, an interprofessional working group at Sunnybrook Health Sciences Centre (Sunnybrook), an academic health sciences centre located in Toronto, Ontario and the largest trauma centre in Canada, recognized the need for the development of competencies that are framed as team competencies. While it remained important to maintain alignment with standard professional and clinical competencies, the Sunnybrook competency framework aimed to promote the idea of collective competence rather than individual capabilities. 19 The framework was intended for hospital-wide implementation and aimed to provide a common language for collaboration across settings, roles and professions and set consistent team expectations for collaborative practice.

The development of core competencies for interprofessional collaboration at Sunnybrook was part of a wider IPC strategy to become a system-wide leader in advancing a culture of interprofessionalism and foster the highest quality, compassionate and person-centred care. 20 A collaborative bottom-up approach was taken to the development and implementation of the framework to optimize acceptance and adoption of the competencies by the various clinical and non-clinical teams. The development and implementation of the core competencies is outlined below. Institutional ethics board review was not required for this development work as determined by the Sunnybrook Health Sciences Centre Research Ethics Office.

Working group and stakeholder consultation group

A 10-member IPC working group comprised of representatives from interprofessional education, professional practice, and organizational development and leadership was established. The IPC working group executed each step of the development process and led the stakeholder consultation process. A larger stakeholder consultation group was established which included clinical and non-clinical staff representing a variety of roles and expertise. The stakeholder consultation process included distribution of materials for review and feedback to directors of operation, patient care managers, nurse practitioners, health professions leaders, advanced practice nurses, clinical educators, and patient and student representation, as well as the Interprofessional Education Committee and the Education Advisory Committee.

Literature review and information extraction

A comprehensive literature search was conducted by a librarian through a reference interview to identify published and grey literature within the past 15 years with potential relevance to the development of hospital core competencies for interprofessional collaboration. The search was conducted using the Medline and Health Business Elite databases and a combination of keywords related to interprofessional collaboration. A total of 376 citations were identified. A screening and selection process was undertaken by the members of the IPC working group. A review of titles and abstracts eliminated 265 articles that were deemed not applicable to the development of interprofessional team competencies. The remaining 111 articles were retrieved for full-text review. The IPC working group members were assigned articles for detailed review, and each article was reviewed by at least two members. From these articles, 18 articles were selected for information extraction. Working group members were tasked with extracting reported enablers of interprofessional collaboration from the remaining articles.

Development of core competencies, definitions and associated behaviours

Through a process guided by principles of consensus building, 21 the IPC working group members grouped the list of evidence-based enablers by frequency and theme. This yielded 29 key enablers that were vetted for organizational relevance and alignment against hospital strategic plans. The key enablers underwent a second thematic grouping by the IPC working group who selected and synthesized the set of enablers based on their diverse expertise, knowledge, and experience to construct six core competencies. During the consultation period, the competencies were shared with the larger stakeholder group to seek feedback and confirm that core competencies aligned and resonated with the various clinical programs and health professional stakeholders. Additionally, a World Café model, which is a participatory approach for collecting large group feedback, was used to hold an interactive stakeholder event to further engage stakeholders. 22 The IPC working group used the feedback to further refine the core competencies and to develop the definitions and associated key behaviours that support interprofessional collaboration. The feedback was also used to develop an implementation plan for embedding the competencies across the organization. After a final circulation for review by key stakeholders, the core competencies for interprofessional team collaboration were approved by the Sunnybrook Interprofessional Collaboration Advisory Committee, the Interprofessional Steering Committee, executive sponsors, and the senior leadership team at the hospital.

Theoretical orientation for core competencies

The theoretical context and framing of the competencies were informed by the existing literature and evolved through discussions at working group meetings and through stakeholder consultation. The orientation of the framework was based on a pragmatic approach to maximize performance enhancement (as opposed to deficit-based), which means that one of the primary considerations when shaping the competencies was on what needed to be accomplished to advance interprofessional collaboration in the organization over the next few years. Lastly, the interprofessional team was defined as being inclusive of patients, families, clinical, non-clinical, and support services staff.

The Sunnybrook framework for interprofessional team collaboration ( Figure 1 ) is a set of six core competencies that have been worded purposefully as collective competencies and are designed for application to teams, as well as accompanying definitions for each and 19 associated behaviours.

An external file that holds a picture, illustration, etc.
Object name is 10.1177_08404704211063584-fig1.jpg

The Sunnybrook framework of the core competencies for interprofessional team collaboration. 20

The framework aims to support interprofessional collaboration which is placed at the centre of the figure. The competencies extend to the four domains which encircle interprofessional collaboration in the figure: (1) clinical and professional practice and care, (2) education, (3) research and quality improvement, and (4) approach to leadership. As part of the competency framework, interprofessional care is defined as “working together to deliver the highest quality of care”, while interprofessional education is defined as “learning about, from and with each other”. 1 Interprofessional research and quality improvement occurs when two or more professions come together to integrate expertise and scientific perspectives to answer a shared research question or address a quality issue. 23 The framework defines interprofessional leadership as drawing on the strengths and capacities of team members in all professions and roles. Interprofessional leadership recognizes the importance of multiple voices and perspectives to achieve organizational and cultural change in an environment of complexity. 24

The six core competencies, accompanying definitions for each, and associated behaviours for interprofessional team collaboration are presented in Table 1 .

The Sunnybrook core competencies for interprofessional team collaboration and associated behaviours

Interprofessional teams seek to achieve common understanding when communicating across roles and professions. They are attentive to actively providing information to and seeking information from team members and other teams to ensure a thorough understanding of the situation. They create processes and tools and select varied media/approaches to enhance the exchange of information within and across teams.

The team:

Develops processes for exchanging information in a specific and timely manner - within and across teams

Explicitly considers which members need to be involved in giving and receiving which pieces of information

Communicates using language that is common among roles and professions by avoiding jargon and acronyms, providing explanations and checking for understanding

Interprofessional teams respond to anticipated or occurring conflict situations with appropriate and skilled interventions in a timely manner by collaborating to create a range of solutions.

The team:

Identifies and proactively and effectively addresses team conflicts within and across teams

Listens open mindedly to differing opinions and ideas from diverse roles and professions

Discusses difficult team issues and arrives at mutually agreed upon solutions

Interprofessional teams decide collaboratively on plans. Team members come together to determine appropriate actions. Where necessary, teams decide who will make the final decision and who holds accountability for which tasks.

The team:

Creates and implements interprofessional care plans which reflect what is most important to patients and families/customers

Decides collaboratively on learning goals that are shared across roles and professions

Identifies and designates accountability for all aspects of the work particularly where there is role overlap

Interprofessional teams learn from their history and experiences. Team reflection is both process and performance oriented. Team members identify what they are doing well and what can be improved. They are attentive to optimizing how they interact with one another and the impact that their team function may have on patient care/collective work.

The team:

Dedicates time to ongoing team reflection

Develops processes and tools to support ongoing team reflection

Identifies successes and gaps regarding their collaborative work and celebrates or strategizes accordingly

Uses concepts of team development and team dynamics to appraise how they are doing collectively

Interprofessional teams ensure that members understand each other’s roles, scopes, and expertise. They explore interdependencies between their roles and optimize each member’s scope with consideration of repetition and redundancies.

The team:

Members are able to articulate their role and/or scope of practice to others on the team

Members actively seek understanding of the roles of others on their team

Members recognize their limitations and consult with one another appropriately based on knowledge, skills, roles, and scopes

Interprofessional teams create a climate of transparency, openness and willingness to collaborate. They maintain an inclusive approach and every team member’s perspective is valued.

The team:

Members speak with positive regard when discussing other roles and professions

Creates a safe environment for all members to speak up and advocate as necessary

Considers the values and ethics of the organization, regulatory bodies, and the individual members in team discussions

The six competencies include shared decision-making, interprofessional values and ethics, role clarification, communication, interprofessional conflict resolution, and reflection. Each competency and associated behaviour seeks to leverage the expertise of all team members and to create and achieve mutual goals. The phrasing of the associated behaviours refers to “the team” and provides actionable activities that together foster and create the right structures and supports for collaborative innovations and partnerships in practice, education, research and leadership at all levels of a healthcare organization.

Implementation of the competencies across hospital settings

Using a participatory approach and stakeholder feedback, several implementation strategies were generated to embed the competencies across hospital settings. The implementation strategy avoided a top-down approach and aimed to entrust ownership and promote uptake of the framework by both formal and informal clinical and non-clinical leaders. For example, staff from each clinical area became familiar with the competencies in small group sessions using an interactive game. Together with members of the interprofessional education committee, unit staff participated in the interactive game by rolling a die, discussing the competencies, and describing an example of how their team could enact whichever competency landed face up on the die to win a prize.

Another implementation strategy for embedding the interprofessional competencies throughout the organization was the addition of competencies to the organization’s onboarding and orientation program for new staff, as well as to the organizational leadership development program and student interprofessional education.

Application of the competencies by care teams and at organizational level

Each clinical and non-clinical team across Sunnybrook is unique in how they use the team-based interprofessional competencies. Most commonly, teams use the framework to evaluate and debrief on their collaborative practices. These team debriefs include both clinical and non-clinical unit staff, physicians, medical students, and other learners. Using the competencies and associated behaviours, teams assess their performance which can both facilitate an acknowledgement of their strengths and can lead to the development of workplans that identify opportunities for training, capacity-building, and improvement. Changes implemented by teams to improve team collaborative practices vary widely. For example, a team on a general internal medicine unit created protected time for team reflection after identifying the competency of reflection as an area of improvement. The team implemented monthly reflection sessions and team members were asked to share suggestions for topics of discussion through e-mail or a suggestion box on the unit. The reflection sessions are entirely team-driven with no individual facilitation. The team members openly reflect on difficult scenarios, identify struggles and stresses that are shared among the members, and provide support and generate solutions. The sessions are well-attended, with anecdotally collected positive feedback from team members who report feelings of camaraderie and community.

At an organizational level, the team competencies were used to align processes and adapt existing tools to endorse the framework and foster a culture of interprofessional collaboration. For instance, the competencies were used to create the assessment rubric for judging abstract submissions to an annual, organization-wide interprofessional collaboration showcase (ie, mini-conference). The competencies were also used to generate presenter guidelines for quarterly interprofessional grand rounds and to create an evaluation tool to assess whether the rounds supported awareness of each competency. As well, a “Team-based Interprofessional Teaching” award based on the competency framework was created to acknowledge an individual or team who is nominated for their collaborative, education best practices at an organization-wide level.

The Sunnybrook core competencies for interprofessional team collaboration set minimum expectations for teamwork and establish a shared vocabulary that can be used to describe interprofessional collaboration. The competencies emphasize building high performing teams and support collaboration among diverse teams and settings along the continuum of care. By creating recognizable behaviours among team members, the competencies become valuable both in the presence of collaborative practice, to label and build on successes; and in the absence of collaborative practice, to identify opportunities for improvement and provide a roadmap to achieve goals. These competencies can also support hospitals undergoing accreditation and that are subject to standards that require the effectiveness of team collaboration and functioning to be evaluated and opportunities for improvement to be identified. Furthermore, implementation of the framework can strengthen healthcare organizations to extend beyond these standards to support the delivery of high-quality care that can better anticipate and meet the needs of patients and their families.

Many existing interprofessional frameworks are structured as individual competencies and are intentionally broad to make them applicable to multiple settings, 5 , 7 but a one-size-fits-all approach has limitations especially when it comes to the complexity of a hospital setting. The Sunnybrook team-based competencies were designed with the unique context of the hospital in mind. The competencies and behaviours aim to maximize efficiency and usability by all members of the care team regardless of role and extending to both clinical and support service professions. Furthermore, development of the framework was evidence-informed, patient-oriented and involved a multi-stakeholder consensus building process. Notably, the stakeholder engagement included representatives from organizational development and leadership, as well as human resources, whose perspectives were instrumental in shaping the framework as behaviour-based competencies as opposed to value-based competencies. Behaviour-based competencies are actionable, applicable to all staff, and can be embedded in performance appraisals, which help support hospital-wide implementation of the framework. Also, the framework formally considers patients and families as part of the interprofessional team and as part of the organizational culture. Patient stakeholder recommendations suggested that the framework does not differentiate patients as a separate component, but instead integrates partnering with patients within each core competency.

There are also some limitations to the development of the Sunnybrook competency framework. The framework was not validated using validation methods after the development of the competency and behaviour items. While numerous stakeholder groups provided feedback on the set of competencies, the items were not tested to determine whether they represented a discrete construct (ie, collective team competence) or whether each item was mutually exclusive and non-overlapping components of a single construct. Therefore, it is possible that, for instance, working on building capacity within one competency would lead to improvement in another competency as well. Also, in order to make the Sunnybrook framework practical and easy to use by busy care teams, the large number of potential enablers of interprofessional collaboration was distilled down to a set of high-impact items that would be most effective in rapidly advancing collaborative practice. The resulting set of competencies is therefore narrower than some existing interprofessional competency frameworks that are more extensive, catch-all frameworks that include a broader set of competencies or sub-competencies. 5

While the clinical skills of individual team members are important, the framing of the competencies go beyond individual expertise and focus on collective competencies to build a culture of “we” that can optimize safety and performance. Models that guide high-performing teams such as the widely referenced inputs, processes, and outputs framework emphasize the importance of team processes, such as team communication and collective problem-solving, as critical mechanisms that influence performance and lead to positive outcomes. 25 For example, reflection is generally an individual practice of critical thinking used to evaluate and learn from experiences. 26 However, reflection as a core competency in this framework promotes team reflection on experiences to identify opportunities for change and improvement. The reflective behaviours enable “we” conversations that are process-oriented and focus on how interactions among team members can be improved to meet goals.

There are several potential avenues for the future application of this framework. Given that many hospitals have education strategic plans that focus on teaching and learning opportunities to enhance care, organizations can collect aggregate-level data from team assessments based on the set of competencies, which can be used to develop educational programming at a corporate level. As well, the competency-based data from team assessments could be used to assess the impact of advancing team competencies to practice collaboratively on quality of care and patient safety indicators such as patient satisfaction, as well as on staff satisfaction and well-being, and retention of the healthcare workforce. Lastly, future research assessing the patient and family perspective on team collaborative practices using the competency framework is needed to explore the impact on patient-centred care and patient-oriented priorities.

The Sunnybrook core competencies for interprofessional team collaboration provide a framework to guide hospitals toward advancing interprofessional collaboration among complex teams in order to enhance the delivery of person-centred care and improve patient and health systems outcomes. The framework was designed as a set of high impact team-based competencies and behaviours that can be easily referenced in complex, fast-paced team environments and widely implemented at all levels of the hospital.

Acknowledgements

We would like to thank the Sunnybrook Interprofessional Collaboration Advisory Committee, Interprofessional Collaboration Strategy Steering Committee, the Interprofessional Education Committee, the Interprofessional Quality Committee, and the Core Competency Working Group (Thuy Pham, Sandra Ellis, Anke Flohr, Suman Iqubal, Surjeet Rai-Lewis, Anna Bazylewicz, and Lawrence Jackson) for their contributions. We would also like to thank Maegan Oelsner for her assistance.

Sara Morassaei https://orcid.org/0000-0002-7121-727X

Mikki Campbell https://orcid.org/0000-0003-4374-9794

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OSF HealthCare welcomes new provider to Mendota

8/03/2024 - Mendota, Illinois

Brennan Reeder, PA

OSF HealthCare is excited to welcome Brennan Reeder, PA, as the newest addition to its primary care team. This will enhance service for Mendota and the surrounding communities.

Reeder will be providing primary care services at OSF HealthCare – OSF Medical Group , located at 1405 E 12th St, Suite 600 in Mendota, Illinois. With a medical degree from Concordia University of Wisconsin and board certification from the National Commission on Certification of Physician Assistants, Reeder brings a wealth of expertise and qualifications to the community, ensuring better access to quality care for patients.

To schedule an appointment with Brennan Reeder, PA, or any member of his dedicated care team, new and existing patients can call (815) 538-7200.

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Baptist Health Medical Group Primary Care Murray welcomes Allen Tinsley, MD

MURRAY, Ky. (KFVS) - Baptist Health Medical Group Primary Care Murray has announced the addition of Allen Tinsley, MD, to their team.

According to a release from Baptist Health, Dr. Tinsley will join Meghan Burcham, APRN, and Johnathan Bailey, APRN. His services include everything from well visits and disease prevention to health maintenance and care for urgent conditions.

Dr. Tinsley has earned his national board certification from the American Board of Internal Medicine, the American Board of Pediatrics, and the American Board of Addiction Medicine.

He received his medical degree from the University of Louisville School of Medicine and remained there completing an Internal Medicine & Pediatrics residency. He continued his education by pursuing a Primary Care-Child and Adolescent Psychiatry (PC-CAP) fellowship at the University of California Irvine School of Medicine.

Dr. Tinsley is accepting new patients. To schedule an appointment, you can call 270-415-7055.

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Team USA's Ariana Ramsey shocked by free health care at the Olympics

The rugby star received a pap smear, eye exam, a new pair of glasses and a dental appointment with x-rays — all for free, published august 9, 2024 • updated on august 9, 2024 at 8:50 pm.

After winning a historic bronze medal in women's rugby sevens last week, Ariana Ramsey has found a new reason to be at the Olympics : the free health care services.

In a series of TikTok videos, the rugby star documented her preventative care journey, including getting a Pap smear, eye exam, a new pair of glasses and a dental appointment with X-rays — all for free, courtesy of the Olympic Village.

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"Like, what?" Ramsey said in a TikTok after her optometry appointment. "Y'all, I'm truly amazed."

@ariana.ramsey I quite literally love it here. The way the Olympic village has free healthcare, but America doesn’t😣 oolympicsoolympicvillageoolympiantteamusarrugbyb #bronzemedalist ♬ original sound - Ari Ramsey

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The Village also offers specialized consultations in sports medicine, orthopedics, gynecology, cardiology and physiotherapy to athletes, free of charge, according to Chief Medical Officer Philippe Le Van . The organizing committee is covering the costs with help from volunteer health care professionals.

Free Village health care services have actually been offered since the 1932 Los Angeles Games , but it seems that few athletes were aware of the perk until recently. Other Olympians who saw Ramsey's videos DM'ed her expressing their surprise, the rugby player told Sports Illustrated , and clinic staffers thanked her for raising awareness about their services.

One of Ramsey's videos featuring volunteer health care workers has more than three million views on Instagram.

View this post on Instagram A post shared by Ariana Ramsey, OLY (@ariana.gabrielle)

The United States is the only high-income country without universal health care, according to a study by The Commonwealth Fund. It also ranked the U.S. last overall in providing accessible, affordable and high-quality health care and reported that 38% of American adults didn’t receive their recommended medical care in 2020 because it was too expensive.

Athletes — even those going to the Olympics — are no exception. While the U.S. Olympic and Paralympic Committee does have a health insurance policy, an individual athlete's eligibility is determined by their sport's governing body.

"Some of the most talented competitors under our flag go to sleep at night under the roof of a car or without sufficient food or adequate health insurance," a report by an independent commission appointed by Congress said.

The report found that more than 40% of U.S. athletes paid for health care out of pocket, averaging to about $9,200 per person. More than a quarter of athletes said they earned less than $15,000 per year.

“America needs to do better with their health care system," Ramsey said in a TikTok , "because there’s no way why me, an American girl, should be so amazed by free health care."

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Tim Walz, Who Spent Decades as an Enlisted Soldier, Brings Years of Work on Vets Issues to Dem Ticket

Minnesota Governor Tim Walz visits Minnesota National Guard

A retired Army National Guard noncommissioned officer who was once the top Democrat on the House Veterans Affairs Committee could become the next vice president.

Presumptive Democratic presidential nominee Vice President Kamala Harris announced Tuesday that Minnesota Gov. Tim Walz will be her running mate. That puts someone with an enlisted background on both presidential tickets after Republican nominee former President Donald Trump chose Marine veteran Sen. JD Vance of Ohio as his running mate.

Patrick Murphy, an Army veteran who was Walz' roommate when they were both freshmen in Congress, called Walz a "soldier's soldier."

Read Next: A Rocket Attack at an Iraqi Military Base Injures US Personnel, Officials Say

"The two largest federal agencies are DoD and the VA, so someone who has intimate knowledge of both is incredibly important," Murphy, who served as Army under secretary during the Obama administration, said in a phone interview with Military.com. "He was a field artilleryman who has tinnitus as diagnosed by the VA, so he understands the plight of our brother and sister veterans."

Walz enlisted in the Army National Guard in Nebraska in 1981 and retired honorably in 2005 as the top enlisted soldier for 1st Battalion, 125th Field Artillery Regiment, in the Minnesota National Guard, according to a copy of his records provided by the Minnesota Guard. He reached the rank of command sergeant major and served in that role, but he officially retired as a master sergeant for benefits purposes because he didn't finish a required training course, according to the records and a statement from the Minnesota Guard.

His Guard career included responding to natural disasters in the United States, as well as a deployment to Italy to support U.S. operations in Afghanistan, according to a 2018 article by Minnesota Public Radio . Walz earned several awards, including the Army Commendation Medal and two Army Achievement Medals, according to his military records. Working a civilian job as a high school teacher and football coach, the Nebraska native was also named that state's Citizen Soldier of the Year in 1989, according to official biographies.

During the 2022 Minnesota governor's race, Walz' opponent accused him of leaving the Guard when he did in order to avoid a deployment to Iraq, though Walz maintained he retired in order to focus on running for Congress, according to the Star Tribune newspaper .

Far-right commentators and media resurfaced those allegations and knocked him for never serving in combat -- something he has never claimed to do -- in contrast with Vance's deployment to Iraq as a combat correspondent.

"Looks like it is time to bring back Swift Boat Veterans for Truth. Oof. Walz is a really unforced error. He bailed on the military when they decided to send him to Iraq. JD Vance actually served," conservative talk radio host Erick Erickson posted on social media Tuesday.

Walz was first elected to the House of Representatives in 2006, becoming the highest-ranking retired enlisted soldier to serve in Congress.

His tenure in Congress included sitting on the House Veterans Affairs Committee, rising to be its ranking member in 2017.

"Walz' leadership on behalf of his fellow veterans when he was in the U.S. House of Representatives is notable at a time when our all-volunteer force continues to struggle to recruit," Allison Jaslow, CEO of Iraq and Afghanistan Veterans of America, said in a statement praising the choice of a veteran to be vice presidential nominee. "How we care for our veterans is as important to our national security as how we care for our troops, and Walz has a record to prove that he understands that imperative."

As the top Democrat on the committee, Walz was a chief adversary for the Trump administration's Department of Veterans Affairs . He battled with then-acting VA Secretary Peter O'Rourke in 2018 during a standoff over O'Rourke's handling of the inspector general's office, and pushed for an investigation into the influence of a trio of informal VA advisers who were members of Trump's Mar-a-Lago club. An investigation by House Democrats completed after Walz left Congress concluded that the so-called Mar-a-Lago trio "violated the law and sought to exert improper influence over government officials to further their own personal interests."

Walz also opposed the Mission Act, the bill that expanded veterans' access to VA-funded care by non-VA doctors that Trump considers one of his signature achievements. Walz said in statements at the time that, while he agreed the program for veterans to seek outside care needed to be fixed, he believed the Mission Act did not have sustainable funding. VA officials in recent years have said community care costs have ballooned following the Mission Act.

Walz supported another bill that Trump touts as a top achievement, the Department of Veterans Affairs Accountability and Whistleblower Protection Act, which sought to make it easier for the VA to fire employees accused of misconduct or poor performance. But the implementation of that law was later part of Walz' fight with O'Rourke . The law also faced legal challenges that prompted the Biden administration to stop using the expedited firing authorities granted by the bill.

Walz was also an early proponent of doing more for veterans exposed to toxins during their military service, sponsored a major veterans suicide prevention bill and advocated for the expansion of GI Bill benefits. And he repeatedly pushed the VA to study marijuana usage to treat PTSD and chronic pain, something that could come up in a future administration if the Department of Justice finalizes reclassifying marijuana into a category of drugs considered less dangerous.

Walz' time in Congress also included a stint on the House Armed Services Committee, a perch he used to advocate for benefits for members of the National Guard .

Walz consistently voted in support of the annual defense policy bill, as well as advocated for repealing the "Don't Ask, Don't Tell" policy that effectively banned gay and lesbian service members.

"He was my battle buddy in the fight to repeal 'Don't Ask, Don't Tell,' and it wouldn't have happened if we didn't have Command Sgt. Maj. Tim Walz helping lead the fight," Murphy said.

Since becoming governor of Minnesota in 2019, Walz' role as commander in chief of the Minnesota National Guard has come under a spotlight several times. In response to a request from the Minneapolis mayor, he activated the Guard in May 2020 to assist law enforcement when some protests over the Minneapolis police killing of George Floyd turned destructive. At the time, Minneapolis' mayor accused Walz of being too slow to order the deployment, a charge he denied.

"It is time to rebuild. Rebuild the city, rebuild our justice system, and rebuild the relationship between law enforcement and those they're charged to protect," Walz said in a statement when he announced the activation.

He also activated the Guard to protect the Minnesota state Capitol in January 2021 amid fears that Trump supporters could riot at state houses like they did at the U.S. Capitol that month. And he's used the Guard for missions that are more routine for the service, such as to help after heavy flooding earlier this summer .

As news broke Tuesday of Walz' selection, he quickly won praise from other Democratic veterans.

"Having a person who wore the uniform and who deployed around the world adds to the ticket someone who can connect with veterans and military families in a way that no one but a veteran can," Jon Soltz, chairman of liberal political action committee VoteVets, said in a statement.

-- Steve Beynon contributed to this story.

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Healthcare Team Members Importance and their Roles

Definition of Health Care Team

Members of a Healthcare Team

1. Physicians

3. Pharmacists

4. Physical Therapists

5. Occupational Therapists

6. Speech Therapists

7. Medical Social Workers

8. Dietitians

9. Respiratory Therapists

10. Diagnostic Professionals

11. Administrative Professionals

The Importance of Nurses in Healthcare Team

Providing Compassionate and Evidence-Based Care

Managing Complex Medical Situations

Collaborating with Other Healthcare Professionals

What is a healthcare team?

What are the benefits of effective collaboration and communication in healthcare teams?

What are some strategies for promoting effective teamwork in healthcare?

What is the role of technology in facilitating communication and collaboration among healthcare team members?

How can conflicts be addressed within a healthcare team?

Why is teamwork important in healthcare?

How do healthcare teams collaborate?

Can patients choose their healthcare team?

What is the role of a patient in a healthcare team?

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Core Principles & Values of Effective Team-Based Health Care

The Evolution of Teams in Health Care

Urgent Need for High-Functioning Teams

The State of Play

A Proposed Definition of Team-Based Health Care

Principles of Team-Based Care

Shared Goals

Clear Roles

Mutual Trust

Effective Communication

Measurable Processes and Outcomes

Implications of the Team-Based Health Care Principles and Values

Making Patients and Families Active Members of the Team

Targeting of Team-Based Care

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