What are the key components for improving our systems?
- Create a carefully designed playbook or musical score sheet : Defines the roles of each member of the team, and creates a series of plays or specific notes that describe how the team members will coordinate their roles to create a successful team.
- Know who is passing and who is catching. Create harmony. Everyone needs to understand their working relationships and coordinate their work. Just as the passer and receiver need to practice over and over again to consistently complete their passes, primary care teams and consultants must establish highly efficient relationships that provide the most up-to-date care. We must never forget our patients and their families depend on effective teamwork to coordination their care.
3. Game films and musical recordings need to be constantly reviewed: Healthcare systems need to create a culture of constant innovation and improvement. Everyone must understand that to err is human. Just as players learn from missed blocks, fumbles, and dropped passes, healthcare providers can learn from errors in diagnosis and treatment. Mechanisms for constant constructive feedback need to be established. At the end of every daily rounding session we need to ask, “What went well today and what could be improved?”
- Just as coaches stand on the sidelines observing, advising, problem solving, and cheering on their players, attending physicians and administrators must be constantly present on the front lines (wards and clinics) performing these same roles.
- Just as team members respect and trust their fellow players to perform their roles during a game, physicians and nurses must respect and trust each other’s ability to care for the patient.
- Just as team members gather in a circular huddle to communicate. Members of the rounding team must practice horizontal communication, share ideas, and as a group, create management plans for each of their patients. In almost every situation the plans created by the group prove superior to the plans created by a lone individual, no matter how experienced.
- Just as teams learn by practicing their plays over and over, health care teams learn to work together and to apply efficient systems by doing. Lecturing and encouragement can start the ball rolling, but only by actually following coordinated systems, such as Gatorounds, can physicians, nurses and other healthcare providers truly understand the principles and power of a systematic approach to rounds.
- Just as in all team sports, no one player wins the game. The ball is shared and all the players contribute to victory in a carefully coordinated fashion. Similarly the work of caring for each patient must be shared between the primary care team and the consultants, between the nurses, pharmacists, patient care managers, social workers, and physicians.
- The Trap Play is one of the most complex and effective running plays in football (X = defensive player, O = Offensive player). During the University of Florida National Championship Game against the University of Oklahoma this play resulted in runs by Percy Harvin of 60 and 70 yards. For this play to work a number of conditions must be met:
- No ambiguity: Every player knows his exact role
- Exact timing: Each part of the play is described in complete detail
- Stable relationships: Hand off has to be perfect and players know how to work together
- Learn and improve by doing
- Constant Feedback from the coaches
- Continuous change and improvement
These same conditions are required for effective multidisciplinary rounds.