The Health Care Dream Team: How to collaborate with Physicians

Transcription

1 The Health Care Dream Team: How to collaborate with Physicians Zubin Austin BScPhm MBA MISc PhD FCAHS Professor and Murray Koffler Chair in Management Leslie Dan Faculty of Pharmacy, University of Toronto Toronto Canada Annual Meeting & Exposition Seattle, Washington March 22 25

2 Disclosures Zubin Austin has received an honorarium and travel expenses to deliver this presentation at the APhA 2019 Conference in Seattle Washington 2

3 CPE Information Target Audience: Pharmacists ACPE#: L04 P Activity Type: Application based 3

4 Learning Objectives At the completion of this application based activity, participants will be able to: 1. Identify the barriers that pharmacists must overcome to increase awareness about their skill sets among other members of the health care team. 2. Demonstrate effective relationship building strategies that pharmacists can use to develop collaborations with other members of the health care team. 4

5 Assessment Questions 1. Which of the following statements regarding trust in interprofessional collaboration is true? A. For physicians, trust in other health professionals is usually linked to level of degree or qualification. B. For pharmacists, trust in other health professionals is usually earned over time, based on experience with them. C. For physicians, trust in other health professionals is usually earned over time, based on experience with them. D. For both pharmacists and physicians, trust in colleagues is helpful but not necessary to be part of successful primary care practice. 5

6 Assessment Questions 2. Power index: A. Refers to the psychological sense of superiority or inferiority one feels with respect to others. B. Is a useful tool for establishing boundaries within an interprofessional team. C. Should be encouraged as a way of incentivizing individuals to perform better within a team. D. Is generally not an issue in primary care but can be an issue in specialty practices. 6

7 Assessment Questions 3. As a model of clinical problem solving, reasoning from first principles is usually the dominant method used by: A. Physicians B. Pharmacists C. Most experienced practitioners in any profession D. Least experienced practitioners in any profession 7

8 Assessment Questions 4. Which of the following best describes the usual interprofessional communication style of most pharmacists in primary care? A. Direct, focused, terse B. Indirect, story oriented, wordy C. Clear, story oriented, terse D. Focused, wordy, indirect 8

9 Everything is Awesome! Everything is Cool when you re part of a team! Teams are the central organizing principle of modern life from primary school to the workforce Teams are supposed to enhance efficiency and effectiveness through synergistic processes do they? 9

10 Activity On a piece of paper, write down a single word or short phrase that describes your impression of either A) pharmacists (right side of the room) OR B) family physicians (left side of the room). Fold over the page and pass it on to someone else. Don t unfold! Repeat this five times. And don t unfold! 10

11 Learning to be part of a health care team Assumptions: Health care professionals are generally smart, nice, well intentioned people We assume that asking smart, nice, well intentioned people to work together for a greater good should be easy Apparently.it s not 11

12 The experience of being in a team Inefficient Disorganized Mechanism for diffusing responsibility Method for containing power of certain professions Time consuming and resource intensive Does not produce desired outcomes Eddy JK.(2014) The experiences of health professionals who participate in teamwork education in acute hospital setttings: a systematic review of qualitative evidence. MSc Thesis, School of Translational Health Sciences, Joanna Briggs Institute, University of Adelaide, South Australia 12

13 Entitativity: the psychology of teamness What does it feel like to you when you are part of a high functioning team? What is your emotional/psychological state? 13

14 Entitativity Social awareness Social engagement Investment in outcomes Desire to collaborate Shared culture/goals 14

15 Theories of teamness Social Identity Theory (Tajfel) Personal identity built upon foundation of group memberships Group hierarchies define self Social Identification Theory (Phinney) Need to establish personal dominance through in group favouritism and out group derogation Teamwork in healthcare: promoting effective teamwork in healthcare in Canada. Accessed at: fcass.ca/searchresultsnews/ /7fa9331f ca787daa71ec.aspx 15

16 Learning teamness Personal psychology Professional education Professional socialization Societal cues 16

17 1. Personal Psychology The Big Five Personality Traits: Openness Conscientiousness Extraversion Agreeableness Neuroticism Interested in learning about your own Big Five? (or just attend the session tomorrow morning on work life balance at 730am!) 17

18 Are we really all that different? Openness 100 Big 5 Comparison Class of 2T0 (University of Toronto) Neuroticism 80 60Pharmacy Medicine Conscientiousne ss Agreeableness Extraversion 18

19 2. Professional Education How do different professionals learn to approach and solve clinical problems? Reasoning from First Principles Application of Rules Pattern Recognition Groopman J (2007). How doctors think. Random House Publishing, NY. 19

20 3. Social cues Reinforcement of social group hierarchy (social identity theory) Media/popular culture depictions of different professions and professionals Cultural/parental expectations and their influence on self esteem and personal identity 20

21 What this means for teamness What are the psychological underpinnings of teamness? Shared goals Commitment to collaborative processes Investment in outcomes Social awareness and engagement 21

22 What this means for pharmacists Trust: firm belief in the reliability, truth, ability, or strength of someone or something Cognitive model of trust for pharmacists more frequently shaped by externalities (e.g. degree, status, stature, non verbal cues) than for physicians who are more influenced by history and personal relationships Gregory P, Martin C and Austin Z (2015). Trust in interprofessional collaboration: perspectives of pharmacists and physicians. Submitted to CPJ (in review) 22

23 What this means for pharmacists Communication: the imparting or exchanging of information or news In a well intentioned but spectacularly misdirected attempt to be polite, respectful and deferential to authority, pharmacists frequently communicate indirectly with physicians which may appear to be uncertain or unwilling to actually take responsibility ( power distance index ) National Transportation Safety Board Accident Report Summary. Available at: Abstract.aspx 23

24 What this means for pharmacists Responsibility: the state or fact of having a duty to deal with something, of being accountable or to blame For pharmacists, responsibility is about doing everything possible within the rules and respectful of processes, while for physicians it means willingness to put one s own neck on the line to break a rule when necessary to solve a problem Frankel G and Austin Z (2013). Responsibility and confidence: identifying barriers to advanced pharmacy practice. CPJ 146(3):

25 What this means for pharmacists Self confidence: assurance, belief in oneself and one s abilities For pharmacists, clinical confidence means certainty in having the RIGHT answer, while for physicians it means serenity in believing that if/when things go wrong, they will cope and deal with it at that time Frankel G and Austin Z (2013). Responsibility and confidence: identifying barriers to advanced pharmacy practice. CPJ 146(3):

26 What this means for pharmacists Learning more about ourselves is the essential first step in thinking about enhancing our practice Personal development and professional development are the same thing with respect to interprofessional practice 26

27 What does this mean for you? In your groups, discuss how you might be able to apply what we ve discussed today to your collaboration/work with physicians. How might you be able to share this new learning with your pharmacy colleagues who aren t here today? 27

28 The P Factor in collaboration Recognize importance of social identity and social identification theories on shaping human behaviours/interactions Accept that certain professions may cluster in certain psychographic typologies and remember that culture eats strategy for breakfast if we think we can change this! 28

29 The P factor in collaboration Help individuals to recognize and better manage emotional responses to inteprofessional team dynamics Do not rely upon policy procedure to fix team dynamics this will generally only reinforce social hierarchy Do not assume that smart, nice, well intentioned people will just figure out how to collaborate effectively 29

30 The P factor in collaboration Manage our own communication (e.g. reduce subconscious hierarchical language use) Anticipate, accept, and respond to psychological needs of other team players (e.g. need to prove oneself) Value the contribution of different modes of clinical reasoning to better team based decision making (e.g. first principles vs pattern recognition) Don t try to turn everyone into a physician 30

31 Summary Current emphasis in team based education may actually only reinforce problems of hierarchy This is ultimately an interpersonal psycho social issue, not a technicalcompetence problem Encouraging honest self assessment and reflection to support personal development is neither easy nor efficient but may be the missing link in enhancing team functioning 31

32 Further reading Teamwork in healthcare: promoting effective teamwork in healthcare in Canada. Accessed at: fcass.ca/searchresultsnews/ /7fa9331f ca787daa71ec.aspx WHO Safety Curriculum: Topic 4 Being an effective team player. Accessed at: 4.pdf 32

33 Assessment Questions 1. Which of the following statements regarding trust in interprofessional collaboration is true? A. For physicians, trust in other health professionals is usually linked to level of degree or qualification. B. For pharmacists, trust in other health professionals is usually earned over time, based on experience with them. C. For physicians, trust in other health professionals is usually earned over time, based on experience with them.*** D. For both pharmacists and physicians, trust in colleagues is helpful but not necessary to be part of successful primary care practice. 33

34 Assessment Questions 2. Power index: A. Refers to the psychological sense of superiority or inferiority one feels with respect to others.*** B. Is a useful tool for establishing boundaries within an interprofessional team. C. Should be encouraged as a way of incentivizing individuals to perform better within a team. D. Is generally not an issue in primary care but can be an issue in specialty pratices. 34

35 Assessment Questions 3. As a model of clinical problem solving, reasoning from first principles is usually the dominant method used by: A. Physicians B. Pharmacists C. Most experienced practitioners in any profession D. Least experienced practitioners in any profession*** 35

36 Assessment Questions 4. Which of the following best describes the usual interprofessional communication style of most pharmacists in primary care? A. Direct, focused, terse B. Indirect, story oriented, wordy*** C. Clear, story oriented, terse D. Focused, wordy, indirect 36