Monday, April 23, 2012

Teamwork: For Better or for Worse

As a first year medical student looking into the future, I often wonder what it will be like not to fly solo, as we must to earn a grade in medical school, but to solve problems as a part of a health care team. This idea has been touched on, but not fully explored as of yet in my medical career, though it can be said to be an essential aspect of health care. I have personal experience with both the positive and negative sides of teamwork. When I was in the third year of my chemical engineering major, one of the required classes was a chemical engineering lab, Unit Operations (it was like a chemistry lab, except we used industrial sized equipment). The class was designed so that students were employees of a company and were sent “Memos” asking for reports or designs on different topics; the memos did not provide any instructions on how to complete the task. Students were divided into groups, and members of the group were assigned different jobs which changed for each lab: Planner, Experimenter, Analyst, and Consultant. The group had to complete a minimum 50 page paper every other week, as well as present every week on their progress to their “Supervisor”. Each member received their own score, but it was impossible to complete any one section if the other members hadn’t completed their own work. Unit Operations created a situation where you are only required to complete your job, but you are penalized if a member of your group doesn’t do their job. At the time I began this class, I was excited because we used real industrial-sized equipment, but I quickly learned the frustrations inherent in mutually dependent teamwork. I struggled in the first semester of Unit Operations because my group members did not pull their own weight, leaving me to pick up the slack if I did not want to be pulled down. Actually, in the end, one of my group members failed the class. However much work it was at the time, I truly learned how essential communication and follow-through are for successful teamwork. Now, the failed teamwork in that case led to a member’s failing the class (and poor grades for the rest of the team), but on a health care team, such failure could end up having a negative impact on a patient.
 I first encountered the importance of health care teams when my father became sick my freshman year of undergrad. He went to the ER with severe abdominal pains anticipating that it would be another blockage resulting from scarring from his past abdominal surgeries. However, the general surgeon and ER physicians he saw upon arrival discovered that he had acute necrotizing pancreatitis. As they couldn’t figure out why my father had pancreatitis (turns out the pancreatitis was a side effect or a reaction to his blood pressure medicine), and he was rapidly deteriorating, multiple other health care providers were called to provide assistance. These physicians included: internal medicine, GI, pulmonary/Critical Care, interventional radiologist, and ID. All of these physicians were needed to maintain his health until a decision could be made for a recovery plan. After three days with no progress, it was decided that he could not be successfully cared for in Sioux Falls, so he was airlifted to the Mayo Clinic where he was under the care of a whole other set of the same type of physicians caring for him in Sioux Falls with the addition of a thoracic surgeon, a general radiologist, a biliary surgeon, and a transplant doctor. It took another three days in the Mayo ICU surrounded by dozens of doctors, fellows, residents and nurses before someone finally realized the most likely cause of his pancreatitis. The blood pressure medicine was pinpointed and discontinued, and my father was able to leave the ICU two days later, though it took another couple of months before he was able to return to a normal life style. Throughout this ordeal, my father was frequently not aware of what was going on to him and about him; he did tell me two things he managed to notice, 1) that many times there were potential miscommunications between different doctors and between doctors and staff (nurse, respiratory therapists etc.) which luckily my mother was able to catch and 2) from the many doctors who assisted on his case, it was a GI doctor, who had clearly been in excellent communication with the other doctors, who first recognized the pancreatitis as a potential side effect of the medication and took control of my father’s care once he had stabilized.
My father’s case clearly demonstrates the need for inter-disciplinary collaboration, the need for improvement in the communication between physicians and other supportive health care providers, as well as the importance of family support. The IHI Open School was created to ensure that health care teams, like those that took care of my dad, can succeed beyond their current level. If the students of today truly learn to collaborate, then situations like my dad’s may not occur; instead of 6 days to figure out what was causing his condition, it could have been discovered in the first couple of days. Acute necrotizing pancreatitis is not something that is easily survived and it was only with the successful collaboration of multiple health care teams that my father is alive today.

- Laura Danielson is a first year medical student at the Sanford USD School of Medicine and is the editor of Unum Vox. 

Sunday, April 22, 2012

Introduction to “Unum Vox” & The Importance of Health Care Team

Ryan Miller, second year med student
IHI Open School, SD Chapter President

In 1910, William James Mayo spoke of what we now call “patient-centeredness” at the commencement address of Rush Medical College.  He stated, "It (has become) necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient.”  He further stated, “Individualism in medicine can no longer exist."  As you can see, teamwork in medicine is not a new concept yet 20th century medical education and healthcare delivery has greatly struggled not because we haven’t seen new and improved ways to treat the patient’s disease but because we have been doing this largely in “silos”. So here we are in the 21st century with its growing complexity, having to revisit these fundamental concepts and place them as priorities. 
The Institute for Healthcare Improvement (IHI) South Dakota chapter’s mission is “To bring together multiple healthcare disciplines and teaching institutions for learning and collaboration on patient safety and quality improvement. We seek to do this through the common platform of the IHI Open School and by building teamwork among us as South Dakota learners. All of this is for the patient’s best interest, which is healthcare’s reason for being. We therefore seek to foster patient-centered environments through learning approaches that address the complexity inherent in healthcare delivery systems, into which the patient enters. To these ends we seek to help equip students from all disciplines and at any stage of learning, with the tools necessary to become leaders in patient safety and quality improvement.”
Students recognize the need to work as a cohesive team. When members of our IHI Open School chapter were asked what they think most needs to be improved in healthcare settings today, the themes of teamwork, communication, and patient-centeredness were far and away the most mentioned. One of our Physician Assistant students said, “Ensuring that the patient and family are WELL informed and understand the situation. COMMUNICATION between disciplines. No one is ever on the same page. E.g. order CT with contrast on patient with renal disease… causes lots of delays to determine if risk outweighs benefit.”  An occupational therapy student said, “Professionalism both with interactions between workers, patients, and co-workers; true empathy or care for the patient at all times.” Maureen Bisognano, President and CEO of the Institute for Healthcare Improvement, has spoken widely about the impact of these types of stories on the care we provide patients.
Recognizing the power of story and perspective, we would like to introduce the inaugural blog of the IHI Open School, South Dakota Chapter!  The blog, “Unum Vox,” (Latin for “One Voice”), serves as a new way to share our experiences, learn from each other, and most importantly, speak with one voice for the patient.  Unum Vox” will feature the writings of South Dakota health care students, professionals and faculty on topics related to the South Dakota chapter’s theme “Together One Voice For The Patient.” Potential areas include patient safety, performance improvement, leadership, professionalism, communication, teamwork, systems thinking, human factors, reliable design and just culture. It is hoped that these subjects will be explored through stories of real patients and their caregivers, allowing all who read it to continually improve their own ability to seek out the patient’s best interest. This blog will be updated monthly and every South Dakota health care professional student, who is also a member of IHI, has the opportunity to contribute. We are delighted that Laura Danielson has both taken on the leadership for editorial review of Unum Vox…and has written the first Unum Vox blog with a compelling account of events in her personal journey as a learner and as a family member.
Blog posts may be a maximum of 1,000 words and must relate to the chapter’s theme “Together One Voice For The Patient”. Ideas can be drawn from clinical, classroom, personal experiences, opinion, responses to articles and more. Upon submission, several editors will evaluate blogs and the chosen blog author will be notified. Individuals who are chosen will be identified on the website. To submit a blog post, email Laura at  We encourage you to write for this blog!  With the diverse experiences that members of our chapter have had, we can truly learn from each other to improve care, and speak as “one voice.” 

Ryan Miller is the founder and chapter president of the South Dakota Chapter of IHI Open School and is a second year medical student at the Sanford USD School of Medicine.