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By Dr Hanoku Bathula Friday. Sep 6, 2019

A multidisciplinary approach to healthcare: Why do we need it?

The learning context: We all know that healthcare requires not only clinical interventions but also support from experts from other disciplines such as psychology, management, sociology, operations and informatics. A recent article by Frimpong, et al. (2017) in Harvard Business Review (HBR) was titled, When Health Care Providers Look at Problems from Multiple Perspectives, Patients Benefit. Understandably, the authors call for a multidisciplinary care team model that brings together different providers such as physicians, nurses, social workers, and other specialists to reduce potential for errors and improve health care outcomes.

 

How to make it safe for patients: Given the need for active collaboration of teams from multiple perspectives, I have completed the module on “Making Healthcare Safer: What will It Take?” with a new curiosity. What I understood and found in various exercises in this module resonated with the what Frimpong, et al. (2017) have underscored in their HBR article. I will briefly highlight the learnings from the module through various exercises. First, the webinar by Liam Donaldson focused on patient safety and errors. In the medical sector, a single accident can kill. The seriousness is no different from the airlines' sector in terms of safety required in the health sector. Donaldson proposed a paradigm shift toward system thinking, how the people, machines and procedures are all linked and work in a common environment. There is always a need to have protective features like good communication, fully trained staff, team culture, professionalism and procedural guidelines. Still, there will be gaps, and they have to be filled professionally through a systems approach, accountability, re-training, etc. The metaphor of a cat looking at the mirror and finding a lion is useful to reduce the problem by dealing with a weak signal with a high response to increasing safety standards and reduce patient safety incidents.

 

Second, the next webinar by Daniel Hyman about leading for safety focuses on avoiding big medical errors. He gives examples of Grant and Alyssa where terrible mistakes were made resulting in fatality. Hyman refers to John Kotter’s change management model and in particular mentions the need to ‘creating urgency’ to deal with health safety issues. Hyman also highlights the usefulness of Colin Powell’s leadership model that provides practical tips to health care practitioners. He also proposed TargetZero approach and bundles of safety practices, leadership practices and cause analysis to create a culture of safety.

 

Third, I learnt about the importance of adverse event management for learning through a no-blame culture taken from a Japanese context. The new system of adverse event reporting and learning system in Japan faced challenges in 1990s. The main reason for under utilisation of the system by medical professionals is due to the fear of blame culture and unwarranted media publicity. After investigation, the approach had two operational principles of ‘no-blame culture’ and ‘anonymous nature’, thereby focusing on patient outcomes rather than apportioning the blame. This highlighted the need for taking the local context into consideration and to evolve a robust system of accountability and professionalism with collaboration from health professionals, media and society. The final piece of learning is from a recent article by Sexton et al. (2018) about the impact of Leadership WalkRounds (WRs) and how the feedback can improve patient safety climate in hospitals. The WRs can be of particularly use as a non-financial instrument towards patient safety and care in the context of the increasing demand and decreasing resources for the workforce.

 

Insights and applications from the multiple perspectives in healthcare quality: Insights that I gained in this module are twofold. First, patient safety is always a top priority. No small issue needs to be left unattended or ignored as it has the potential to cause a fatality. The examples of Grant and Alyssa show that even small errors that are avoidable have the potential to result in a fatality. Here patients are not just dots on a spreadsheet but specific persons with families. Two, there is a need for a multidisciplinary collaboration. The institutional and systems thinking approaches are critical in health care. Good procedures, communication, accountability and sharing of information are critical to avoiding mistakes and medical errors. The change models by Kotter and Colin Powell, although originated from social sciences, are very useful in health care institutions. It means system should allow for collaboration and improvement on a continuous basis. Taking a multiple perspectives approach, all stakeholders should take responsibility and be committed to patient safety. The system should allow for multiple perspectives, public engagement, support to health care professionals and look for opportunities to innovate and implement new methods to improve patient safety for TargetZero.

 

New innovation from multiple sources: The study by Sexton et al. (2017) shows that non-financial intervention like Leadership WRs also help in improving. But the Japanese case study shows how the systems can also help in reducing adverse events. These systems can now be on databases which allow for evidence-based decision making by examining patterns and outcomes. ICT provides for a new platform where experts from multiple disciplines can collaborate seamlessly but also has the additional benefits of transparency, immediacy and accuracy. The degree of interaction increased a manifold as physical meetings have become almost redundant. ICT is now used not only the whole process of the patient journey, but public health professionals can use big data to identify the pain points and help in cost-effective early interventions. Post-discharge monitoring is also made easy and effective in the process. We now live in an era where the average citizen can get health-related information on reliable websites like WebMD and Patient.Info. The application of  ICT in radiology and diagnostics sectors provide an immense benefit to treat the patients. The patient journey map has now a virtual ICT platform supporting this journey making it more efficient and seamless process. Even with all these benefits, the use of ICT is only at the initial stage. Some examples software systems in healthcare are presented by Evan Heier (2019). The application of artificial intelligence and virtual reality (AI & VR) to healthcare has just began. The full potential of digital health, precision medicine, health informatics and mobile phones for healthcare is yet to be fully leveraged. But the patient is at the centre of this dynamic new world. My Fellowship in ISQua allows me to follow this exciting journey.

 

The views expressed in this article are my own.

 

By Hanoku Bathula, PhD (Strategy, AUT), FISQua, PRINCE2 Practitioner. Graduate School of Management, The University of Auckland, New Zealand.

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References

  1. Frimpong, J. A., Myers, C. G., Sutcliff, K. M., & Lu-Myers, Y. (2017). When health care providers look at problems from multiple perspectives, patients benefit. Harvard Business Review [online] https://hbr.org/2017/06/when-health-care-providers-look-at-problems-from-multiple-perspectives-patients-benefit.
  2. Heier, E. (2019, April). 8 Types of health information technology and healthcare software systems. [online] https://selecthub.com/medical-software/7-categories-healthcare-information-technology/
  3. Kotter, J. P. (2012, October 31). Accelerate! Harvard Business Review. [online] https://hbr.org/2012/11/accelerate
  4. Sexton, J.B., Adair, K. C., Leonard, M.W., et al. (2018). Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout.  BMJ Quality & Safety, 27(4), 261-270.
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