Thank you for watching this video on Cross-unit Collaboration. Previously, we've talked about how to move from an individual expert to an expert team and what that takes and what interventions are available and how we can assess, how we're doing on the journey of building team expertise. In this video, we're going to talk about larger issues of coordination across our organization that will impact patient outcomes. We're going to talk about cross-unit collaboration. We're going to talk about what we mean by a multi-team system and how we can start managing those more effectively. For a point of reference, to illustrate the issue that we're trying to address, this is a diagram of patient movement data over three months in our organization. Each of the bars is a specific physical location. The larger the bar the more patients pass through that area. Each of the gray lines are patient transfers from one area to another. As you can see, this is a pretty complex workflow and we initially did this to start identifying some risk points for hand-offs and transitions of care that we could start managing more effectively. What we found is that there's really a lot of complexity in how patients move and that we may not always be mindfully managing all of these different interconnections and it's a huge challenge to manage all these interconnections. We want to think about the outcomes that we really care about for the patient are a product of people throughout this journey. What can we do to help them coordinate those efforts more effectively were still managed in geographic silos, in disciplinary silos and in departmental silos. So we need some structures that help bridge those to connect the dots for patient care across their entire experience in our organization, and those are really multi-team system interventions, multi-team system interdependencies. There's a team in each of those bars but their work is dependent on teams in other bars as patients move from unit to unit. By multi-team system, we really need two or more teams that interface directly and interdependently in response to environment contingencies and were working towards collective goals. It is very much the teamwork definition that we introduced before, a real team extended to this idea that we have multiple teams that are accountable or should be accountable for the ultimate outcomes that we care about, interdependent with each other to achieve the patient outcomes we care about. We can think about this in terms of traditional organizing and what that looks like in multi-team system organizing and what that looks like from the literature. We can define a traditional kind of organization where we have essentially self-contained work units for the most part if there's connections between them that usually happens at the managers level so there'll be committee meetings or other things where there's connections between one another but the specific people in those areas don't interact very much. We are members that identify with their team more than the whole system. Within those units, we have a lot of variability in the practices. People have their routines, the tools and technology that they use and they're really loosely coupled in terms of any accountability or reward system so, really, a traditional hierarchical organization with compartmentalized units. You think about what a multi-team system approach to organizing might look like. The units are a lot more interdependent and membership is little more diffuse, people's identity is really in the larger system and not necessarily the work area that they're in, and boundaries spanning is really critical for making this work. We have people that travel from all of those different areas and it can help bridge the gaps and understanding the differences and work practices. We have people moving horizontally to help coordinate work and we have them more tightly coupled accountability, right. We're all held responsible for outcomes that we care about or the organization cares about. In health care, you can identify different pieces from each of these columns. To some extent we still look like a traditional organization in many ways but as illustrated in the graph previously our work is actually organized and there's multi-team system way where there's lots of interdependence across these areas but we might be set up to manage a more traditionally compartmentalized way. This, from team steps curriculum, shows or illustrates what one version of a multi-team system in healthcare might look like. Of course, the patient at the center or the top of the organization, you have a core team member with anyone who has kind of hands on direct patient care responsibilities, you have a contingency team that comes in for a very specific purpose for a very limited amount of time. This could be a procedural team, this could be a rapid response team, things of that nature and you have some coordinating team which might be the local unit leadership and management and you have some support services which could be environmental services, imaging, those types of things, pharmacy nutrition. Then, you have an administration layer, of course. For the comprehensive unit-based safety program. One of the features of that structure is that it tries to include executive leaders as a part of improvement teams run by the core team and the coordinating team. The leadership and the frontline providers are on the same team with the administration. That's an effort to introduce some boundary spanning functions which are part of the multi-team system into our improvement efforts. That helps to tackle some of the vertical breakdowns we see in organizations and our teams and how we're able to coordinate, but we also need to think more horizontally across those patient care pathways, how are we coordinating our efforts for care but also for improvement. One way to start addressing these multi-team system issues is a very simple practical approach called the teamwork across units tool and this is really designed to surface, prioritize and address inconsistent expectations around coordination across these clinical units. Imagining you're implementing this in two units whose work is tied together quite closely, this could be a suite of operating rooms and ICU or step down unit or something to that effect. What you would do is go start with one unit and ask them what they need from the other units, right? We're generating coordination needs, communication needs. What do I need most from this other unit in order for me to take good care of this patient and what do I most frequently not get. That helps generate a list of priorities of things we can start working on together. We do that within one unit, the second step is to bring staff together from these units and share what those priorities are. This can elicit a lot of interesting feedback and ideas because it's very difficult to understand what other people may need from you. We get very focused of course on the work that we do and it's not that easy to understand how it's going to impact someone once a patient gets moved to a totally different area and is undergoing totally different types of treatment. And then collaboratively as a cross unit team, identify what those top priorities are for improving coordination across the units. This is much like bringing to cusp teams together, to improvement teams together where you ask them individually first, what do you need, what do you struggle to get, bring them together to share those priorities and find something that we can work on and improve over time. That is one more bottom up way to engage staff in better managing these multi-team systems, better managing coordination of care across the patient's entire journey throughout an organization. In this short video, we introduce this idea of multi-team systems and talked about some of the drivers of effectiveness and ineffectiveness and provide a practical tool for surfacing some improvement needs and in following up with those.
