Leadership Strategy Actions and outcomes Collegial Physician, RN Leadership Shared goals, mission Leveled hierarchy Team oriented Shared values Shared knowledge Encourage new ideas Transparency Engage the frontline members Delegate work Honor the team for great work done All members of the team are invited, Include all who have a role in what the patient experiences Web-based agenda, team members encouraged to share their work Meeting Platforms Multidisciplinary Open agenda Promote discussion New projects are vetted Feedback is incorporated Stakeholders are included Communication Daily situational awareness e-mail MD/RN Leadership rounds Patient rounds every shift Multidisciplinary Patient centered care I-PASS handoff Electronic track board Prepares the team for the day Standardized communication Repeat back, clarify Closed-loop communication List of patients, list of actions, shows where patient is in the process, includes ability to enter a message Team Structure, Physical Space Team Assessment Defined geographic cohort of 12–15 beds Core members Attendings Nurses Frontline clinicians Social work Child life Respiratory therapy Patient care associates RN and MD/APP meet the patient together at the start of the visit Temporary, smaller teams work together in the same location for a designated shift Brief introductions occur at rounds Family meets the team at the outset Decreased duplicative interviews Promotes team members to be on the same page Promotes shared perspectives and knowledge sharing Sets expectations for the team which includes the patient and the family Clinical Standards Clinical pathways Shared mental model program Sets team expectations Guides care for common Platform for chief complaints, communication diseases Work done with subspecialists ED team can implement care and reduce delays as well as unnecessary Patient Communication Boards Organized Discharge Multidisciplinary QI Projects Simulation Debriefs variation and overtesting Clinical decision support to assist bedside work Sets expectations of visit Updated throughout the with patient and stay family Provides timeline List of actions Promotes discussion and mutual decision making MD, APP, RN Team Complex discharge, done take responsibility for by MD, APP discharge Routine done by RN Team collaboration to Promotes improve patient care multidisciplinary and remove potential solutions barriers that cause Assists in flattened frustration hierarchy All team members responsible for “boots on the ground” education Multidisciplinary Team practices good team behaviors High-fidelity mannequins Closed-loop communication Shared mental models Mutual respect Recorded resuscitation Multidisciplinary team reviews reviews medical and trauma resuscitations Real-time patient events Good team behaviors are called out Conflict Identifies areas for improvement Debrief, assign roles before event when possible Teams gather following resuscitations, sexual assault evaluations, physical restraint episodes, etc briefly to identify what went well, share ideas/perspectives for further improvement Focus on what is best for Emphasize importance of the patient and the listening family Avoid blame Strategies to Enhance Teamwork Team work is critical to achieve the best patient outcomes and experience and staff engagement It is also a requirement for continued improvement and innovation of the care model, the care delivery, and the environment Team members recognize that they have shared responsibility for clinical decision making, the process through which care is delivered as well as physical, experiential, and cost outcomes Table 4.2 provides some strategies to build a culture that supports strong interdisciplinary team work CONCLUSION Improved patient outcomes come from taking a team approach to the clinical care of patients Collaboration streamlines care and reduces error This is increasingly more important as complexity of care and technology continues to grow Healthcare leadership must incorporate education and resources to promote teamwork to assure clinical excellence and continued innovation