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The team approach to health care
By Ronald M. Davis, MD
This column was originally published in AMA eVoice on May 29, 2008. Dr. Davis is president of the American Medical Association.
I'd like to devote this column, in part, to Oncology Nursing Month, which is being observed this month. That might seem to be an unusual focus for a column written by the president of the AMA. But given my recent diagnosis of pancreatic cancer—see the interview about my illness in the April 14 issue of American Medical News—you'll appreciate my reason for doing so.
I've been fortunate to have received outstanding care from my internist, two oncologists, two gastroenterologists, anesthesiologists, radiologists, and many other physicians. Registered dieticians have given me great advice on nutrition. But as is typical for many or most patients, I've probably spent more time with nurses—oncology nurses in my particular case—than with any other type of health care provider. And their care has been outstanding as well.
My experience as a patient has reinforced to me how valuable the team approach to health care is, when the team functions as designed. In an article in the June 2008 issue of the Joint Commission Journal on Quality and Patient Safety, Eduardo Salas and colleagues present a three-pronged framework for effective teamwork in health care, based on communication, coordination, and cooperation.
Last week I was discharged from Henry Ford Hospital in Detroit after a five-day hospitalization, during which I needed treatment for a toxic chemotherapy reaction and replacement of a biliary stent. I was on the "P2" oncology ward, and as I was walking through the ward one day, getting my exercise, I stopped to read testimonials from oncology nurses in a display case, which explained why they had decided to become oncology nurses. Here are two of those testimonials:
I am an oncology nurse because my sister was diagnosed with non-Hodgkin lymphoma five years ago.… During her course of treatment … I discovered that the curse of cancer affects people so differently than the usual medical diagnoses, leading me to conclude that cancer patients find courage and strength to live and that life is more precious than ever before. I then became addicted to cancer patients, and my own sister's journey led me to know that I needed to be an oncology nurse and this is why I have now become a full-time team member on P2 for the last four years. Be strong, live in the present moment.
I am an oncology nurse because I want to make a difference in how our patients and their families perceive their situation. I want to try to give them the care that I would want to receive when I am in their shoes one day or when I face it with my family. I want them to feel safe. Some of our patients return many times for treatments and I want them to feel like we are part of their extended family now and we will be there for them (a little comfort)—through all the hills (cheering them on) and valleys (respecting their needs, letting them cry, and accepting their down days). I want them to be open to say whatever they feel and know that I will not judge them and will try to help them through this time in their lives. They are not a burden. I want them to know that this effort to make a difference gives me a feeling of great purpose (and) warms my heart.
Well, reading those testimonials was heart-warming to me. And I got a chuckle when I read the first nurse's comment about being "addicted to cancer patients." We talk about addictions to tobacco, alcohol, prescription drugs, and illicit drugs. And we've had some debate in the AMA House of Delegates (HOD) about the notion of video game addiction. But this was the first time I had heard about "addiction" to a class of patients.
Many of the discussions in medical society meetings about nonphysician clinicians deal with scope of practice, an issue I wrote about in a past column. However, physicians need to remember the common ground we share with those clinicians—a tireless devotion to the welfare of our patients. In fact, AMA leaders have met with leaders of the American Nurses Association on two occasions in recent years, covering topics of mutual concern such as quality of health care, covering the uninsured, and public health.
The AMA has several policies that support the team approach to health care, with topics covering evidence-based principles of discharge and discharge criteria, access to specialty care, medicine and pharmacy relations, advanced practice nurses, and the Medicine and Public Health Initiative, a working alliance established by the AMA and the American Public Health Association to develop innovative solutions to deal with the nation's health needs.
From a scope-of-practice perspective, AMA policy addresses the roles and responsibilities for nurse practitioners and offers guidelines for physicians when working with allied health professionals. Additionally, the subject of collaborative agreements between physicians and advance practice nurses is part of a resolution expected to be submitted by the AMA's New England delegation for next month's Annual Meeting of the HOD.
As part of its Making Strides in Safety campaign, the AMA developed three toolkits that encourage physicians to take a leadership role in the team approach, and a tip sheet (PDF, 92KB) for improving communication among hospital staff. It's worth pointing out that one of the toolkits, which covers systems improvement (PDF, 72KB), lists desirabe attributes of a team, an important reminder that everyone in the system shares a common goal and needs one another to achieve the best possible outcome for our patients.
The AMA's interest in ensuring the highest quality of team-based care also is evident in graduate medical education. The AMA's Health Care Careers Directory lists more than 8,100 educational programs and 2,500 educational institutions in 77 different health professions, such as physician, dentist, nurse, optometrist, pharmacist, podiatrist, psychologist, veterinarian, and veterinary technologist and technician. It's a leading resource for information on the diverse career opportunities in health care.
The complexity of today's health care system makes it nearly impossible to achieve desired outcomes by working alone or without the support of the entire system. Through my own treatment, I'm seeing firsthand how indispensable the team approach is to patient care.
Please send comments, questions, and replies to amaprez@ama-assn.org.
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