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.

Cross-unit Collaboration

Setting the Stage for Success: An Eye on Safety Culture and Teamwork (Patient Safety II)

Meet the Instructors