Vol. 18 •Issue 23 • Page 33
Teamwork Plays an Important Role in Asthma Education
Patients with asthma have multiple medical and psychosocial complexities that require a concentrated collaborative approach to assure optimal outcomes.
Because of the unique teaching styles of each discipline, learning and retention is enhanced when asthma education is provided using an interdisciplinary management approach.
Asthma educators know the basic elements of asthma education, but are we aware of the issues and elements of teamwork that can affect asthma education?
Effective care requires a comprehensive, interdisciplinary approach to achieve successful outcomes. The interdisciplinary team, including the patient and family, establishes goals that minimize symptoms, prevent acute exacerbations and hospitalizations, normalize lung functions as much as possible and prevent development of airway remodeling.
Each discipline brings a unique and distinctive approach to improve asthma patients’ overall health and quality of life.
It is imperative that asthma educators understand the difference between multidisciplinary and interdisciplinary team collaboration.
A review of the literature describes a multidisciplinary team as multiple caretakers in different roles providing care, much like an assembly line. Each person contributes expertise, but the team doesn’t work together in a collaborative, coordinated fashion.
Interdisciplinary care promotes the coordination of care and collaboration of different providers. It can have an important effect on the education of asthma patients and families, improve clinical outcomes and patient satisfaction and decrease health care costs.
Numerous authors have examined the effect of teamwork on patient morbidity and mortality.1,2 While health care professionals often complain about lack of teamwork, it is shocking to think this void in hospitals and clinics actually could contribute to negative patient outcomes.
Patients with asthma and their families meet many different clinicians along the continuum of care, including the primary care provider, specialist, nurse, respiratory therapist and pharmacist. They may be confused about the role of all these different providers.
We have systems and structures, yet our teams are not offering the best we can to patients with asthma. Although teamwork is a common practice for other professions, the training of health care professionals continues to be isolated by each discipline.
Health care workers don’t always understand the academic curriculum and skills of other disciplines, and this inhibits the strength of teamwork. Role ambiguity and confusion and lack of communication also amplify poor teamwork.
What Can Go Wrong?
One researcher has examined the dysfunctional nature of teams and suggested it is due to an absence of trust, fear of conflict, lack of commitment, avoidance of accountability and inattention to results.3 These downfalls can translate to poor patient care.
In the 1998 Asthma in America survey of 2,509 patients, 26 percent said there was a moderate need and 71 percent said there was a strong need for better asthma education for patients.4
Other investigators found patient dissatisfaction was significantly associated with asthma control problems, patient-provider communication and issues with patients’ beliefs in their medication.5
Since care can be fragmented, whether providers are an actual team at the same institution or a virtual team, we need to find the best way to implement teamwork and provide asthma education to encourage patient/family self-management.
The proficient asthma educator creates a learning environment that empowers the patients and families to successfully achieve their personal goals and objectives. The patients, in turn, understand the basic concepts of their chronic illness, specific asthma triggers, medications and correct administration and individualized treatment plans.
The best way to achieve successful teamwork is implementing well-trained, prepared interdisciplinary teams with effective leaders and team members who know what to do, how to do it and how to work together for the good of the patient.
Look for Success
Collaboration and communication among team members is identified in the literature as an essential prerequisite for achieving successful outcomes in the delivery of health care. It is vital that the team embrace the same vision, which is built on a foundation of unity and respect.
Environment plays a key role in the formation and maintenance of teams. The earlier management leaders thought of organizations as closed systems that could be manipulated using scientific management principles.6
Later in the 20th century, authors began calling attention to the fact that organizations were open systems affected by influences from outside their internal environment.7-9
Leaders help set the stage for teamwork through their role-modeling behaviors, but leadership does not just take place at the top of an organization.
Every health care professional is a leader and an advocate for the patient and the family. Teamwork is not just about everyone getting along but is actually based on pushing the tension in the organization to resolve conflicts.
One expert described the role of middles, a condition in which an individual exists between two or more groups who exert pressure on the middle to focus on their different priorities, perspectives, goals and needs.10 The middles in an organization can be directors, managers or even staff nurses in leadership roles like a charge nurse or primary nurse.
Tops are in control, work in isolation, receive limited information from bottoms and are accountable to far fewer people when making decisions.
Bottoms feel powerless. They control very little about what influences their lives; but at the same time, they have the real information on what is and is not working if only someone would listen.
The dynamics of middle-ness are consistently present in all types of organizations, at various levels and regardless of the complexity of the service or product produced.
The continual rise in asthma morbidity and mortality, lack of asthma education and economic issues of managing asthma are some of the factors that command unified teamwork.
Each discipline must view itself as a team and partner in asthma management. A systematic, collaborative approach in the medical management and educational process is essential for successful outcomes.11
Teamwork influences purpose and strength for establishing and achieving goals and objectives. A team that embraces a vision becomes focused, energized and confident.12
Teamwork is a complex process that requires knowledge sharing and joint responsibility for patient care. Improving the functioning of interdisciplinary teams is an imperative challenge for today’s health care professionals.
When we recognize each team member has value and unique expertise, asthma education outcomes are successfully achieved. The impact of asthma education through teamwork enhances clinical outcomes and is truly professionally rewarding.
1. Rafferty AM, Ball J, Aiken LH. Are teamwork and professional autonomy compatible, and do they result in improved hospital care? Qual Health Care. (2001; 10 Suppl 2: ii32-7).
2. Sexton J. A matter of life or death: social, psychological and organizational factors related to patient outcomes in the intensive care unit. The University of Texas, 2002.
3. Lencioni P. Overcoming the five dysfunctions of a team. San Francisco: Jossey-Bass, 2005.
4. Asthma in America. Research Triangle, NC: GlaxoSmithKline, 1998.
5. Markson LE, Vollmer WM, Fitterman L, et al. Insight into patient dissatisfaction with asthma treatment. Arch Intern Med. (2001; 161, 3: 379-84).
6. Hoopes J. False prophets: the gurus who created modern management and why their ideas are bad for business today. Cambridge, MA: Perseus, 2003.
7. Bass BM. Bass & Stogdill’s handbook of leadership: theory, research, and managerial applications. 3rd ed. New York: Free Press, 1990.
8. Scott WR. Organizations: rational, natural, and open systems. 4th ed. Upper Saddle River, NJ: Prentice Hall, 1998.
9. Wheatley MJ. Leadership and the new science. San Francisco: Berrett-Koehler; 1999.
10. Oshry B. In the middle. Boston: Power & Systems, 1994.
11. Liedtka J, Whitten E. Building better patient care services: a collaborative approach. Health Care Manage Rev. (1997; 22, 3: 16-24).
12. Maxwell JC. The 17 indisputable laws of teamwork. Nashville, TN: Nelson, 2001.
Karen L. Gregory is an acute care clinical nurse specialist, respiratory therapist and certified asthma educator at the Oklahoma Allergy and Asthma Clinic, Oklahoma City. Michael B. Grossman is director of medical surgical and rehabilitation nursing at the Children’s Hospital of Philadelphia. Marcia Winston, is a certified pediatric nurse practitioner and a certified asthma educator at the Children’s Hospital of Philadelphia. Gregory and Winston are on the board of directors of the Association of Asthma Educators.ox, with this article is produced in conjunction with the Association of Asthma Educators. For more information on AAE offerings, write to 1215 Anthony Ave., Columbia, SC 29201, or call (888) 988-7747. Visit the AAE Web site at www.asthmaeducators.org.