Taking a hard look at medical teams

While the search for a good doctor is as old as medicine itself, these days it’s more likely that a medical team is working together to provide the best care for the patient.

Which begs the question: what makes a good team?

Researchers here are trying to answer that question. A newly published study that included doctors and patients at University Hospital and the Audie Murphy Memorial VA Hospital looked at a number of qualities that add up to good teamwork.

And perhaps more significantly, the researchers found that good teams produced better outcomes for their patients — including shorter hospital stays and fewer complications.

“I think a lot of our focus on improving healthcare systems has focused on how to improve processes of care,” said Dr. Luci Leykum, associate professor of medicine at the UT Health Science Center, and a hospitalist at University Hospital. “But I don’t think that’s going to solve all our problems. Until we better understand how people relate to each other in the inpatient unit, in the clinic, in the operating room, we’re not going to get as far as we need to go in terms of improving patient outcomes.”

With a grant from the Department of Veterans Affairs, Dr. Leykum and her research colleagues followed 11 inpatient medical teams on their daily rounds. Those teams typically include an attending physician, residents and medical students. The researchers observed how team members interacted with each other, the types of patients they treated, and how those patients fared. A total of 576 patients were included in the study.

The teams were scored on a range of characteristics thought to encourage good communication and group decision-making, including trust, diversity of views, respect and “mindfulness” — an openness to new ideas and free discussion among members.

They found that the higher a team scored on these qualities, the fewer complications their patients had. Two qualities in particular — trust between members and mindfulness — led to shorter hospital stays and fewer complications.

Dr. Leykum said teams with better relationships are better able to make sense of what is happening with their patients and act accordingly. They make better decisions when the diagnosis isn’t clear. And members of those good teams also tend to learn better.

And while the kinds of physician teams taking part in medical rounds are most likely to be found in a teaching hospital such as University Hospital, other kinds of teams collaborate to provide care in all sorts of healthcare settings.

“I think you’d define the team a little differently and look at those interactions in different ways, but I think the principles are probably the same,” Dr. Leykum said.

“The trust is really important — creating a safe environment for people on the care team to be able to contribute their own thoughts and ideas,” said Dr. Caitlin McAllister, who while a medical student here was part of the research team, and is now a medical resident in Washington D.C. She also served as first author of the paper, published early online in the Journal of Hospital Medicine.  “Also, the good team works together to engage in meaningful discussions around patient care.”

The next phase of Dr. Leykum’s research is looking at ways to improve teams, especially how they collectively make sense of what’s wrong with the patient, and how to fix it.