Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 11.1 Building Interdisciplinary Teams

By its very nature, health care demands that people from different disciplines collaborate on patient care. Good end-of-life care, however, requires more than multidisciplinary care it requires an interdisciplinary approach in which, while each team member has a defined role, each often takes on other roles too. Team members need to understand their roles within the context of the team and to understand and appreciate colleagues' roles as well.

All team members - professionals, paraprofessionals, and volunteers - need to feel that they are equals and that each can offer ideas and recommendations about how to improve care and routine operations. On Lok Senior Health Services exemplifies this approach in the way it relies on its drivers to observe how patients are doing - if they seem to be stiff or sluggish or if they have trouble moving. Drivers report their observations to the care team, who can then act on the information.

Good teams do not just happen; they happen by design. Members are recruited, screened, reviewed, and observed as they interact with others. Team members need to communi cate with each other, review their work together, work out problems and barriers, and share successes and failures. Analogies for teamwork abound in American culture, from professional to intramural sports, from large corporations to community activism. No matter where they perform, teams represent a complex array of relationships, which take energy and time to develop and sustain. Today's environment of rapid change challenges the best of teams to keep up.

End-of-life care relies on several levels of teamwork. Not only must members of the care team work together; so, too, must clinical, administrative, and financial teams. When teams work well, patients benefit because their care plan considers the clinical situation and the use of financial and community resources. As in family systems, when any member of the team is overwhelmed, exhausted, or tuned out, others in the team live with the consequences and may find themselves compensating for one another.

It is important to note, however, that not every patient requires the service of every team member. Some patients may primarily need physician or professional nursing services; others will only want to interact with social workers or chaplains at a particular time. Some families may require extensive support and come to rely on volunteers to help with routine activities such as transportation to medical appointments or grocery shopping; still others will cope with transportation but will look to home health aides for help with laundry and cooking. Health care managers must balance the diversity of needs by having an array of staff - often both paid and volunteer - to meet an array of patient and family needs.

Here are goals to consider when fostering interdisciplinary teams:

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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