Teamwork and Thinking Differently: Can Healthcare Leaders Do This?

If you can make it to “When the Shark Bites…” you’ll have already seen what teamwork looks like in this talented quartet. A piano has just 88 keys, yet new music is created every day. How can we take what we have to work with in healthcare and see what has yet to be discovered or apply what has yet to be tried — especially when it comes to teamwork.

Please share creative examples of how your health system is applying teamwork!


A Short Story on Teamwork

In healthcare, we know teamwork is one key to safer care yet the adoption of interdisciplinary healthcare teams remains a work in progress across the country. In the following short clip, a middle school football team in Michigan defines what it truly means to be a team, and shares their short, but inspiring story. With well over 3 million hits, many have already been touched by the Olivet Eagles but please pass it on!


Teamwork + #SXSW + #Minecraft + #Healthcare = Sum Greater Than Parts

There is a call in healthcare for all stakeholders to move toward a culture where team-based care is the norm. Where patients are welcomed into the care team as equal partners, moving away from the traditional, hierarchical approach. To make this shift, new skills will need to be embraced by those accustomed to old ways of delivering care. Many of the younger learners, in medicine and elsewhere, are great resources to turn to as role models for these team-based skills, as their play environments have proven to be wonderful training grounds for the same. For example, teamwork is thriving in video gaming environments — environments that may seem an unconventional place for medical training, but are proving to hold promise for more than just acquisition of surgical skills.

It was this knowledge I carried while attending SXSW in Austin, TX two weeks ago, during which I had the pleasure of sitting in on the Mindful Minecraft session in the Gaming and Interactive track. For those who aren’t familiar, the video game, Minecraft, has sold over 20 million copies across all gaming platforms (PC, Xbox, iOS, mobile), and is played by both kids and adults, alone or in a multiplayer environment. Servers across the country house multiplayer Minecraft sessions, where players work together to build worlds limited only by their imaginations. My own Minecraft knowledge is nascent, and I hope to convince my niece or nephew to slow down when they play and explain it further. Until then, I’m left to appreciate the artistry and the opportunity this gaming environment offers young and old. Following is a video shared by the #SXSW Mindful Minecraft presenter, Mike Langlois, a social worker who uses the video game as a tool to better understand his young patients, and redefine the way gaming addiction is perceived and approached.

Langlois also shared a number of interesting facts about both the single-player and multiplayer Minecraft environments that could be directly applicable to our healthcare learning environments. Mindfulness and teamwork were the two components of this game mentioned that really hit home for me. If you watched the video above, and understand just the basics about the game, the creation of such a work of art by a team of individuals located around the world is amazing in and of itself, and speaks to the coordination and teamwork developed in order to be successful. Langlois reported on additional findings from these gaming environments which could also show promise for learning emotional intelligence not taught through traditional healthcare curriculum, such as:

  1. Mindfulness — The game requires intentional, focused attention and keeps players in the moment. By taking a non-judgmental approach to the game, players learn to experience “what is”.
  2. Bullies in a the multiplayer gaming environments are soon marginalized. According to research on bullying, video game environments are ahead of schools in how bullies are managed.
  3. Kids eventually work out issues that arise on their own, before their Minecraft-playing parents have to intervene.
  4. Mode of play (i.e. single-player, multiplayer, creative, survival) changes the way players interact with, and within the game, allowing them to practice different social skills accordingly.
  5. Through different modes of play, autistic learners may be able to learn empathy.

Research has shown that surgeons who play video games were 27% faster at advanced surgical procedures and made 37% fewer errors than those who did not play video games. Additional studies have shown that scientific reasoning is improved through certain video game environments. Wouldn’t it be reasonable to think that care providers who practice mindfulness and team-based play in a video gaming environment might have better outcomes related to both? This is a study I would like to see funded!


The Future of Medical Education: Very Real Simulation of Procedures and Teamwork

A resident at MedStar Washington Hospital Center practices laproscopic technique

A resident from MedStar Washington Hospital Center practices her laparoscopic technique.

In a previous ETY post, Medical Education and Classrooms of the Future, I briefly touched on the value of simulation in training healthcare professionals. Academic medical centers across the country continue to funnel resources toward high-tech simulation centers that put providers–young and old–in learning environments that spare the patient as test subject and encourage skill mastery through practice. Others are complementing high-tech learning with team-based drills, allowing multidisciplinary teams to practice emergency procedures long before they are faced with a similar real-time event. One such center, SiTEL, is one of many entities within the MedStar Health system in the Washington DC and Maryland area that is helping redefine the science of safety through translational research, education and innovation.

Dr. Tamika Auguste, an OB/GYN physician, is one of several innovators within the health system. Auguste is training residents and fellows at the MedStar Washington Hospital Center and Georgetown University Medical Center, as well as OB/GYN providers throughout MedStar, using technological and team-based simulation of obstetric and gynecologic procedures and emergencies. Skill development is only part of the equation, as the ability to anticipate next steps and effectively communicate with patients, and as a team, is what elevates care to new levels.

What is truly amazing is not so much the current technology being utilized, as Auguste will tell you that low-tech solutions sometimes create a more realistic feel of being “inside the body”, but rather the results from her MOST (MedStar Obstetrical Simulation Training) program, and the related reduction in adverse events for Moms and babies. Tamika, amiable and happy to relate her efforts even post-call when we spoke, shared that the MOST program focuses on teams who need to complete a set of tasks in rapid order to save the life of a Mom or baby. Her energy and enthusiasm is infectious in and of itself, but the results showing a reduction in the number of shoulder dystocia events at her hospitals are worth smiling about–whether a provider or patient in a MedStar hospital for OB/GYN care.

Residents from MWHC and MGUH watch as a colleague practices hysteroscopy skills

Residents from MWHC and MGUH watch as a colleague practices hysteroscopy skills.

A simple definition of shoulder dystocia, a sometimes unavoidable complication during childbirth, is a delay in labor due to the baby’s shoulder becoming lodged behind Mom’s pelvis. According to Auguste, the way a team responds to this occurrence is what can change outcomes for all involved. MOST training at all MedStar hospitals completed in 2012, and both brachial plexus injuries and clavicle fractures have been reduced overall. The Infant Mortality Rate (IMR=infant deaths/1000 births) in Washington DC has also declined from 13.1 in 2007 to 8.0 according to 2010 data. And while Auguste won’t take credit for the drop, the fact remains that in 2010 over half of all babies born in Washington DC came into the world at two of her hospitals (Washington Hospital Center and Georgetown University Medical Center).

MedStar programs to create simulation and training of obstetric procedures and emergencies reach deeper than just the training of healthcare providers and the care of Moms and babies within their own health system. In addition to MOST, the following programs Auguste oversees also reach into the local community, as well as the OB/GYN community across the US:

  • Resident, Fellow and Midwife Simulation Labs
  • Society of Maternal and Fetal Medicine Postgraduate Course Development
  • ACOG Simulation Consortium Member
  • Community Outreach Partnership – Unity Healthcare
  • Special Moms/Special Babies (SMSB)
  • Teen Alliance for Prepared Parenting (TAPP)
  • MedStar Georgetown University Hospital – Girl Talk 2 Program

For more information on residency programs or OB/GYN simulation training, contact Dr. Tamika Auguste at MedStar Washington Hospital Center. Meanwhile, stayed tuned for future examples of medical education simulation and training–both high-tech and low-tech–and please share what you have found along the way.


Using Games to Teach Medical Students About Healthcare Systems

The students meet their Egg-Headed Patients and will need to protect them from harm during their new device implementation.

Since the beginning of our Telluride Student Summer Camps, games have been used to teach problem solving skills in a novel environment with the goal of transferring those skills to similar challenges in healthcare. A favorite game of faculty and staff has become the “T3-Teeter Totter Technology”. The pictures below tell a visual tale of how the Egg-Headed Patient fairs in his/her aluminum ICU as the first group of students take on the challenge of implementing a theoretical new device and protecting their two patients from harm in the process.

What you will need:

  1. 10′ long 2″ x 6″ board
  2. Cinder block
  3. 2 raw eggs
  4. Black Sharpie
  5. Aluminum foil

The unsuspecting patient!

To prepare:

  1. Place the cinder block on a hard surface, preferably outside and center the board on the block to create the teeter totter.
  2. Draw smiley faces on the Egg-Headed Patients and place on two squares of aluminum foil underneath each end of the teeter totter.
  3. Split your group into two teams.

The rules are simple:

  1. Each team chooses six from their group to balance on the 10′ long 2″ x 6″ board.
  2. Teams have 10 minutes to prepare their approach and get all six students balanced on the board, one at a time, and then get all six students off the board without harming either of the Egg-Headed Patients.
  3. Everyone must get on the board at the center point, at the cinder block.
  4. Only the students on the board can hold or balance one another. No one on the ground can support their teammates.

Students attempt the side-by-side technique of solving the challenge.

Coaching is fair game and an excellent show of leadership.

Residents use the front-to-back technique.

The debrief and student comments afterward are what make this simulation so special, and drive home the learning objectives in a meaningful way. The following questions are typically used, but you can tailor yours to fit your group or address situations that arose during the game:

  1. What was the team’s “gaming” strategy? Why did they use that strategy?
  2. How well did team members communicate with each other? With the team leader(s)? Were directions or suggestions understandable to all team members?
  3. Were there multiple conversations going on at once? If so, did this lead to any confusion?
  4. What aspects of effective teamwork were done well? What aspects could have been done better? Did the group feel like they were united as one for the good of the patient?
  5. Did the leaders/coaches do their jobs well? What could they have done better?
  6. Were there any unintended consequences to the team’s actions or behaviors?
  7. What would have enhanced your ability to learn?
  8. What is the intended and unintended consequences of new technologies in healthcare?

A successful team!

Student comments always add new perspective to the game, and will forever keep all of us on our toes as educators. The following is a comment from one of this year’s students:

One of the most memorable activities of the week was the teeter totter game.  We worked as a team to balance 6 people on a wood plank for 10 seconds without falling.  Upon stepping off of the wood, our team unfortunately could not maintain balance, and the egg/”patient” was crushed.  Following this incident, we debriefed to learn from the experience and to understand what we could do differently in the future.  We understood that clear and consistent messages by team leaders combined with critical thinking and mutual support among team members are the necessary components of success.  We were also able to improve our strategy by observing subsequent teams.  The valuable lessons from this experience will remain with me in the years ahead as I begin to interact with and play a role in health care teams. Emily Coplin, Emory University, MD/MBA 2016


Students As Superheroes of Healthcare

Last week’s class at the Telluride Student Summer Camp proved to be very prolific, sharing their experience through metaphor and analogies found in everyday life to bring home the educational concepts shared during the week. Eva Luo, University of Michigan-Class of 2013, shared an excellent post–Health Care Assemble!–on the Transparent Health blog using the latest blockbuster movie, The Avengers, as an analogy for teamwork in healthcare. She writes:

As a fan of superhero movies, our deep confusion about how doctors and nurses work together to safely take care of patients reminded me of the movie, The Avengers. In the first half of the movie, a rag tag team of super heroes is brought together with the mission to save the world from alien domination. Each hero has his or her own superhuman talents (intelligence, strength, lightning generating hammer, etc.), not to mention movie franchise. However, the villain’s first attack quickly demonstrates that even superheroes are not effective alone and are at risk of causing unintentional harm…

The transformation in the second half of the movie was remarkable. Captain America rose to the challenge of leading the team. Each of the members communicated effectively removing any ambiguity about each member’s role. Most importantly, the superheroes played to each other’s strengths and supported each other. If my memory serves me correctly, I don’t believe any human lives were lost despite impressive damage to much of Midtown. Is similar effective teamwork possible in health care? I think so. But, we need to invest in building teams while we are still in school.

As an educator, Eva’s message is a reflection of how we are failing to properly prepare health science students and resident physicians to successfully address the complex needs of a team-based, patient-centered healthcare system. Patient care is now a team sport, not an individual sport as in years past.  Health science curricula needs to be changed so students and resident physicians understand interprofessional roles, train in teams, and fully appreciate the powerful role patients can play when included on that care team. All too often, we continue to throw traditional curricular “roadblocks” into their educational schedules, those which only superheroes could overcome at times. Yet the young warriors attending this year’s summer camp remain eager to learn not only the science, but also the team-based, patient-centered, systems approach to making healthcare delivery safer.

The development of cohesive, multidisciplinary teams that include the patient’s voice can be instrumental in making care safer. Training around this important theme needs to be incorporated into all health science school curricula…not just at the few sites that have started moving towards this educational model. One nice example of interprofessional training is the work being done by Gwen Sherwood (a Telluride Patient Safety Summer Camp faculty member) and others, at the University of North Carolina. For more information go to: http://www.ncbi.nlm.nih.gov/pubmed/20427311