In response to my own comment, along with unconscious biases, there's also systemic and institutional biases and prejudice. This is where more work in Diversity, Equity and Inclusion is needed. I see my own comment above about fear generated from a 'benign interaction'; well, that comment is biased, likely a micro-aggression, and minimizes an experience felt by others. Discussing it does open the door for conversation though. The willingness to have conversations and learn from each other, is what is important for team work. So, lack of this is a barrier to team work.
Original Message:
Sent: 03-25-2023 21:32
From: Tina, Hoang
Subject: Barriers to Teamwork
I agree with many of Lana's points, especially MDs untrained in, but thrown into, leadership roles. I've taken some CMA Physician Learning Institute courses in the past. (It will be interesting to know what changes are coming to PLI.). Still need to learn more about effective leadership!
I work on an interdisciplinary team, and we've encouraged learning from each other since the start...though many came to it kicking and screaming, as it differs from the sense of "that's not my job." Consistency and modelling has been very helpful, from the feedback I get from team. We learn from each other in formal education sessions (which PCN does not include MDs in), at patient rounds and more information case-based discussions with team members. As for modelling, MDs will bring questions to team as well, which apparently has been great for team to see. Similar to the ECHO strategy of all-learn.
It is an interesting point about staff coming from acute care, without primary care training. I haven't seen that as an issue with new team members, as we are able to bring them into the primary care world quite quickly. I think that has to do with a combination of management picking the right candidates with mindset for collaborative primary care, as well as amalgamating them into a group that is solidly working in primary care.
When I look at various health care teams across different work places I've have been over the years, where I see the most problems is when there is an environment of fear. Fear about asking a question, fear about pointing out a potential issue, fear about retaliation etc. Trust and respect are so important to combat this.
This also brings up biases. Often many, many unconscious biases that we hold, that come out in interpersonal interactions. This may be us (not) saying/doing something that affects trust and respect in interactions. Alternatively, sometimes, depending on the other persons' previous experience, there may be fear generated from what may be a very benign interaction.
Lastly, I think that the hierarchy really needs to be flattened. Lana mentioned MOAs! MOAs are an amazing part of the team, often with really good insight about clinic flow, patient health etc, but what I've seen is they are often minimized as "just" a MOA. I dislike when someone uses the word "just" in front of their own or someone else's title. I mean, I'm just a physician, what do I know about....? Flattening (I use that word, because we can't totally eliminate it) the hierarchy, helps build trust, reduce fear and creates a more naturally collaborative team.
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Tina Hoang
Calgary AB
Original Message:
Sent: 03-18-2023 16:26
From: Lana M. Fehr
Subject: Barriers to Teamwork
Here are some of my thoughts based on my own experiences trying to build teams in my practice:
- lack of leadership skills (I'm often in positions of leadership, but as I learn more about leadership as a skill I was woefully unprepared coming out of residency and am still very much a work in progress). Note - the best training I've had so far came from Physician Champion Network. Second Note - UofC has some very interesting start-ups. This one is focused on leadership training. I wonder if we could have something made for family docs: https://www.leadwithmonark.com/
- lack of communication skills (I was raised to be a very indirect communicator and to avoid conflict, this has not panned out well in trying to build teams. There are some very effective models out there, would be great to learn more of these skills.)
- lack of skilled team members with primary care training (I've had RN's, LPN's and NP's in my space. RN's/LPN's did not have any primary care training which meant I had to come up with their job description. Tons of extra work and stress. Hard to translate acute care training to primary care at times. I feel like we need data, experimentation and lots of work to figure out what are best practices. MOAs have the most useful training I've found)
- challenging models for primary care teams (PCN model I've experienced so far is staff hired by and managed by PCN embedded in my office. I found it very challenging to manage and direct staff that were not my employees and whose schedule was controlled by an outside entity. I find it hard enough to manage my own employees).
- lack of interdisciplinary training (we did not have any training with other disciplines, would be great to try things as learners)
Great question! It would be awesome if the ACFP/CMN would provide some resources and leadership around this.
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Lana M. Fehr [Designation]
Carseland AB
[Phone]
Original Message:
Sent: 02-22-2023 14:22
From: Cathy, Scrimshaw
Subject: Barriers to Teamwork
What are the barriers to working with our health care team members? What skills and information would be helpful to developing connected teams that work consistently together?
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Cathy Scrimshaw [Designation]
Pincher Creek AB
[Phone]
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