Deciding on a team

"A care team is the right mix of people coming together with the right tools to deliver the right care for a defined population of patients."⁽¹⁾ 

If the focus of implementing self-management is across a whole team or service, assembling a team to lead and drive this process will be key. However, ideally such initiatives are most successful if built into ‘business as usual’, in terms of an already existing forum or meeting, such as a management team meeting, multidisciplinary review meeting etc.

On the other hand, putting together the ‘right’ leaders is a key ingredient to a successful quality improvement plan. The team should bring together individual leaders who offer a range of abilities such as appropriate skills, knowledge, expertise, peer respect and leadership.⁽²⁾ It is essential to select those who have the enthusiasm, commitment and time to make valuable contributions. Team size will vary based on the setting, from a large multidisciplinary team to a small team possibly consisting of just two people. A small team is absolutely fine but will rely on each person taking on a range of responsibilities.

Examples of possible team and leadership composition may be:

• For a private practice psychiatrist:
  
  • Psychiatrist
  • Clinic administrator

• For a multidisciplinary team within a private or public mental health service, leaders may be:
  
  • Team leader/manager
  • Psychiatrist
  • Senior nurse/nurse specialist
  • Admin support

• For a whole service, the focus of planning and implementing may be the service management team, and leaders will therefore include:
  
  • Service manager (or delegate)
  • Clinical director
  • Quality facilitator
  • Professional group clinical leaders (ie nursing, psychology, OT etc)

In this instance, it is likely to be important to also have a second tier of leadership within individual MDTs, to lead the team in its own local process of PDCA cycles.

The benefits of a self-management care team

Team care is central to improvement in health care practice and, if undertaken effectively, should achieve the following key targets:

• Ensures all of the needs are met in caring for the chronically ill
• Uses the least expensive and best trained staff to perform each task
• Maximises patient and staff satisfaction and retention
• Standardises care, improving both quality and efficiency. ⁽³⁾

In addition, the following benefits would also occur:

• Clear expectations and available tools
• Easy to understand and discuss processes of care
• Information is available when needed
• Everyone on the staff is valued and respected
• Feedback of performance and opportunities to grow
• Positive attitudes of co-workers.

References

1. Moore GL, Safford B. High functioning clinical teams are extremely efficient: how to get one and achieve advanced access. Institute for Healthcare Improvement, 2004. Available from http://www.improvingchroniccare.org/index.php?p=Critical_Tools&s=162
2. Agency for Healthcare Research and Quality. The CAHPS® Improvement Guide: Practical Strategies for Improving the Patient Care Experience, 2003. Available at https://www.cahps.ahrq.gov/default.asp.
3. MacColl Institute for Healthcare Innovation. Integrating Chronic Care and Business Strategies in the Safety Net. Prepared for Agency for Healthcare Research & Quality. US Department of Health and Human Services, 2008, p 27. Available from http://www.improvingchroniccare.org/downloads/ICIC_Toolkit_Full_FINAL.pdf