Hi, everybody. Thank you for coming today. Thank you, Nisa. I'm really excited about today's program. But before we begin today, I do want to give a shout out to Eden. She is the dynamic engine who made all of this possible and pushed each and every one of us to reach for the skies in developing this course. Some of you noticed that this course is a bit different than in the past. Each lecture, I think, could easily be a course in of itself. Each faculty member has distilled this knowledge into just 15 minutes. And you will see that the format of the course is also slightly different than in the past, where we have formatted case-based discussions. Some of you actually contributed to these. The registration list that we have seen includes a mix of physicians, nurses, technicians, and other team members who are participating. I want to thank you for joining us today and our all-star faculty team. So it's going to be a great day. I look forward to your participation. Hopefully, we can hear your thoughts, comments, and suggestions. So quality and safety really is kind of the horizontal threads that run through the tapestry of all we do to provide safe and efficient care, effective care to our patients. And this work takes every member of the healthcare team working at the top of his or her game. So for the first lecture, we're going to be talking about the case for team-based care. So the Triple Aim, as mentioned by the Institute for Healthcare Improvement, which was actually founded in 1991, it really began in the 1980s with Dr. Donald Berwick, who was a quality and safety guru who contributed most of this. And this is what's actually served as the North Star for healthcare organizations to kind of align their delivery models with these three things, improved population health, improved patient experience, and lower healthcare costs. And all of this is to drive this insistence to make outcomes, costs, and experience all together. One of the interesting things that began in 2014 was this recognition and challenge of burnout, the exhaustion, criticism, or cynicism, or professional dissatisfaction with healthcare providers. And really, this came to a head in 2020 with the COVID pandemic, which resulted in quote, unquote, the great retirement in which many nurses, and physicians, and technicians, and other healthcare providers left healthcare altogether. And so this was proposed as kind of another aim, so-called the Quadruple Aim. But I do want to mention that in last year, Dr. Nundy and colleagues in JAMA advocated for a quintuple aim, which is to include healthcare equity, healthcare equity in which every patient has the opportunity to attain their full healthcare potential, and no one is disadvantaged because of their social position or other socially determined circumstances, including whether they were in a rural area or an income bracket such as poverty, they had disabilities, their access to housing, food, transportation, and ultimately healthcare of itself was impaired. So when focusing on the quote, unquote, quadruple aim to include healthcare providers, over the last several decades, growth and team-based models of care has emerged in many sectors. And many of you have seen this in the hospital setting between ORs and floors. And there is still a great need to transition this type of team-based care into the outpatient setting. Growth has largely occurred because of the complexity of healthcare system that we are currently in and recognizing that really it's not just one individual that can provide comprehensive care. We really need a team-based approach. Without improving clinician and caregiver experience, the original aims of triple aim won't occur. And so that's why building an effective team is really imperative. So what's a healthcare team? Really, the definition is that two or more healthcare professionals who work collaboratively with patients and their caregivers to accomplish shared goals. And this team-based model of care strives to meet patients' needs and preferences. And this includes everything from the front office logistics, the logistics at home, how do you get a patient to a clinic visit or a procedure site? How do they get their prep done? Who supervises their prep if they need to have a supervision of their preps? How do you accomplish the goals of getting them prepped? And amongst other things. And then you have the other side of the team itself that you really want to exploit their excellence. You want them to achieve the full extent of their education, their training, and their experience that they have. So endoscopy teams that are patient-centered and team-centered really achieve better patient outcomes and have greater staff satisfaction. This leads from the physicians, the nurses, the technicians, the front office staff, the PAs and the NPs who are in the offices who are seeing these patients beforehand, the biomedical engineers who are handling the equipment and safety issues with the equipment, and then the IT people who are in the background who handle all of those EMR issues. So why have teams? The medical team is often much greater than the individual when it comes to things such as patient care, innovative ideas, productivity, efficiency, and even more important is that effective teamwork leads to fewer medical errors. So this chart, I think if you're going to capture one thing out of this talk, take this chart home and bring it to your team because really this is what high-performing teams utilize. Shared goals, the mission statement, clear roles, what each team member is expected to do, mutual trust or the so-called psychological safety. Do team members trust each other enough to admit a mistake or try a new skill without feeling like they're going to get embarrassed or punished. Effective communication, obviously this works well with anything that anybody does, but really trying to develop those skills and those channels to have effective communication is extremely important. And then having measurable processes and outcomes, how do you assess what you're doing is working. The team structure, the function, the performance can all be measured in various ways, whether it's qualitative or quantitative to improve their performance. So there are six strategies that I've kind of distilled to get the most out of your team. Not all teams are created equal. There's different pressures in different situations. Every unit has unique circumstances in which teams are formed, but these are some of the things that I think are primarily effective for creating high-performance teams. Developing a team mission, so it's having a common purpose, feeling like everyone is working towards that goal. You need to really have that North Star to drive camaraderie and teamwork. Reminding people that that North Star, whether it's patient care, comfort, safety, quality, really gives the team a sense of meaning and significance. And it should start to break down those barriers that get to that high-performance team. You avoid those silos where the techs are doing different things than the nurses and the physicians are doing different things than what's recommended by society guidelines or things of that nature. It's really critical for teams to understand that really success is best defined by the team success rather than individual success. Develop team agreements. One of the most common traits of successful teams is that they have established norms which they agree to operate under. And some of these questions could include, what are the behaviors we need from each other to develop greater trust? How do we want to make the team decisions? And how do we ensure that everyone is heard? So one of the things that often teams do well is define those roles. When team members really understand what their role is and what each other's roles are and responsibilities are, then they can find opportunities to help each other out. And teamwork is not just about the best interest, but it's the best interest of patient care, of the quality of services that are provided, the costs that are associated with providing that care, making sure that everyone has an equitable stake in their own health care excellence, and assisting colleagues when needed. Establishing a common set of metrics also helps to define success, whether it's qualitative or quantitative. And then you need to find ways to measure that progress and come up with solutions if problems occur. So this pictorial basically defines how the endoscopy unit team is made up. And each one of these individuals plays a role in how teamwork happens. The ability to achieve goals not only boosts team morale, but reinforces the team mission and helps the team identify factors that contribute to a successful team. When goals are not achieved, it allows the team to discuss strategies that might be more effective. So learn from mistakes and failures. There really are opportunities in every failure. I think Michael Jordan, the basketball player who some consider the greatest of all time, would say that his successes were based on 100 instances of failure. So teams that learn together really bond together, having that opportunity to realize what happened, what mistake occurred, learning from that rather than trying to create punishment or embarrassment. If everyone strives to understand what happened during that mistake or failure, you really do create team bonding. Everyone feels supported and doesn't feel neglected or ashamed from a particular mistake. And it's critical that mistakes are seen as an opportunity to learn and improve. And these should be in a team agreement up front. So obviously, this is a cartoon showing how quality improvement occurs. But this can also be instituted in team culture. You want people to openly discuss errors and your misses so that they can continuously improve patient care and safety. If you have that culture of continuous improvement, everyone knows that mistakes are bound to happen and that the next best thing that can come from that is learning. Share knowledge. Learning and development is one of the most effective tools to help teams develop their effectiveness. These can include sessions in which a new device or a new accessory is brought into the endoscopy unit. And everyone gets a chance to identify or learn the kinds of skills that they need to become either a better technician, a better nurse, or a better physician. So this works when you have simulation experience and reviews. It's often a good idea to consider strategizing meetings that are set up to try to figure out how do we improve a certain process. Somebody may have the knowledge or skills to do that. And one of the ways to have an effective team is if that knowledge does not exist in the team, is for that one of the team members to go out and get that knowledge. And sharing that knowledge builds relationships and also creates this culture of belonging and value. So the last thing that I would recommend is provide opportunities for team engagement on a personal level. You could consider a personality workshop. There's other team building activities such as a compliment circle or code names game, lunch and learn, where you take somebody who's really good at Excel and shows everybody some of the tricks with Excel or they have a language that they speak that others don't. You could teach them some common phrases or say, for example, one of the biomedical engineers is a pretty slick electrician at home. He could bring his skills to show you how to change an electrical outlet. Have a hack day. A hack day is a way that the tech and engineering spheres use to have a special project that the work or hospital or endoscopy unit might have in which everyone gets together on a special project to figure out what's the best solution to accomplish that project. Have a cooking class where everybody joins. Go and have the entire unit go to a volunteer project such as a food bank to develop those team building activities. Celebrate team and personal accomplishments. It's not just the team per se, but every individual in the team has either a personal or a professional accomplishment that they've achieved. You want to celebrate those. Teams really need also to have that time to plan, create, polish, synergize. One of the ways to get that is to hold quarterly think tank sessions at outside that incorporate everyone's input. You can be in situations where you're trying to decide how best to accomplish a specific quality metric and you want everybody's input. If somebody is being quiet in the back of the room, it may be because they're too shy to voice their opinion. Whoever is running the meeting should ask them, do you have any thoughts about or comments about this? This is a way to incorporate everyone's input. Team stands for together, everyone achieves more. Thank you.

team-based care

Triple Aim

Quadruple Aim

high-performance teams

patient outcomes