Give my daughter the shot

 
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Recently a loved one fell ill and was hospitalized in critical care. Fortunately, all is well now. However, at the time, we were very concerned. A medical team was quickly assembled by the hospital to address the problem. This team included roughly 25 doctors, physician’s assistants, nurses, and technicians providing round-the-clock care. The interesting thing about this team is that they never met each other. Some had never worked together before. They didn’t convene in a team meeting to discuss the patient and agree on a course of treatment. They were as virtual as a team could be. Each saw the patient on his/her own time, recorded notes on diagnoses and orders for treatment. One doctor’s orders regularly changed another doctor’s orders. Three people differed in the opinion of the diagnosis, which had an impact on treatment options. 

 Watching this with growing concern for the loved ones – it looked like a recipe for disaster. There was a constant change of people coming on and off the case. The first day we had to repeat why we were there to each person that entered the room. There was disagreement on the diagnosis, and it seemed each doctor kept changing the orders which changed the treatment. It was moments like this that make you understand how people can act the way Shirley MacLaine did in “Terms of Endearment”, demanding care for her daughter and screaming for the nurses to “Give my daughter the shot!”

 This case was atypical, causing disagreement on diagnosis. The case was also one where the patient gets worse before s/he gets better, even while in intensive care. Watching the patient decline was very frustrating and made us challenge each member of the medical team if we were on the right treatment…and if they should come together to discuss treatment. By the second day in intensive care, the patient finally rounded the corner and started making improvement. It was at this point that I realized we misunderstood the medical team. They were an extremely high performing team that had great trust for one another. This high performing team didn’t follow the conventional norms:

  •  This team of was completely united on the same outcome: to make the patient healthy and do no harm in the process. There didn’t need to be discussion or debate that this was the outcome upon which everyone was focused. Each action was taken to make sure that the treatment helped advanced towards the outcome.

  •  Everyone had a very clear role on the case upon being added to the team. Some were there as specialists to consult and advise, some were there to administer treatment and care, some were to help ramp up anyone new to the case and others were there to check in on the family. With each role, it was clear whether the person had the ability to change another doctor’s orders or just advise. With this role clarity, the resulting action from each visit was always clear. At times, the leadership of the team changed based on the care needed. While it was confusing for us to watch orders and treatment be changed, to that team it was finely choreographed so there was no debate. There was also no offense taken by a doctor when changes were made. It was all viewed as necessary changes to achieve the same outcome. Additionally, when the need for each person’s expertise ended, they officially declared themselves off the case and handed off responsibility to those still caring for the patient.

  •  Each person documented their diagnosis, recommendations and treatments. After the first day, every time there was a shift change or someone new came on the case, the nurse sat down and took them through the history and all the details. It was expected that each person on the team receive the same level of information to ramp up and take things forward. No one left without sharing what they did to make it easier for the next person added to the case. This allowed anyone joining to immediately get up to speed with the history and not have to chase down a previous care giver to understand what was done.

  • Disagreements were handled respectfully, quickly and out of patient view. There were a few instances where the caregivers disagreed with one another’s treatment. No one took it personally. They always stepped out of the room, away from their patient to discuss the disagreement and determine the best path forward that worked toward the same outcome.

  • Respect was paramount. Many times, when someone new was added to the case, a nurse or doctor already on the case would tell us how fortunate we were to have that person, and how much they respected him or her. In one instance we were even told that one of the doctor’s brought onto the case was consulted by the Centers of Disease Control (CDC) because of his expertise. It was clear they had respect and trust for one another, and they tried to pass that to us. This respect helped the new caregiver have instant credibility and rapport with us. Trust had a compounding effect. We built trust early with a few people on the case and that grew as they added more people. Their trust for one another grew as they reached another successful outcome and teaming.

How do you go about building trust on your teams? What can you do going forward to be thoughtful about creating and maintaining a trusting environment?