Recently, my colleague-in-blogs Darlene D’Altorio-Jones, wrote a description of the required elements for documentation of team conference and communication in an IRF. Darlene’s attention to detail and CMS law should be well heeded as this function surely is a differentiating factor for an IRF level of care. Having sat through no less than sixty conferences in no less than sixty different rehabilitation hospitals, I have come to recognize that not all team conferences are alike, but their differences speak volumes about the model of rehabilitation care practiced within each.
An observer of the rehabilitation team process will identify six attributes that contribute to successful team process and function:
4. Decision making
5. Role function
6. Conflict management
Communication between members of the team is the easiest attribute to observe and most telltale of success potential. Freely expressed comments and ideas between team members accepted and acknowledged is evident in conversational dialogue. Too often dialogue is one way often disguised as reporting. Comment is restricted or nonexistent with little collaborative discussion in evidence.
Trust of team members is demonstrated by preparedness, follow-through and dependability which provide the basis for mutual respect. When team members doubt each other barriers are created limiting the necessary interdependencies of team effectiveness.
Goals are set with the patient and constructed mutually with team members; goals are written, explicit and clear to all. Goal status is frequently observed, discussed and openly celebrated when achieved. Very often goals are set without the team’s involvement or are unilaterally determined by one team member. Team members may compete for resource or attention by prioritizing goals. When goals are imposed or assigned by an autocratic member successful attainment potential is diminished.
Decisions are made by consensus and involve the patient. Less successful teams allow unilateral decision making by the highest authority to be the norm.
Members of successful teams have clearly defined role responsibilities as opposed to undefined, assumed, territorial or unrecognized by other team members. Every team has a captain, a coach, players and an opponent. These roles are not always assigned to or assumed by the same people, but may change depending on the nature of the competition or requirement.
Disagreement is expected with all teams. How the conflict is addressed and resolved leads to team effectiveness. When conflict is ignored or suppressed, resentment breeds dysfunction and subverts success.
In retrospect, anyone who has read any book on team building recognizes these attributes are fundamental to team success. If we all know this then why aren’t they more evident in rehab team conferences? Perhaps, because no one expects this level of performance?
Stay tuned to future episodes of Managing the Rehabilitation Care Delivery Culture.