Making Multi-D Teams Work: Teambuilding

Cynthia StuhlmillerProfessor of Nursing, Mental Health University of HawaiiSeptember 24, 2004

Outline

Experiential intro’s Background Scenario and discussion Ideas for working together

Background

Disaster Studies (Stuhlmiller from 1989)Shared Values and Goals

Occupational Values & Goalsmeanings and concerns influence appraisal and coping

socialization into practicecustoms

Example: PJ’s, firefighters, transportation workers

*Stress is when that which matters is blocked. (To be celebrated!)

Disease/Health Care Paradigms

Pathogenesis (disease) —that which creates pathology (medical model, cause and effect)

language of disorder, inability, disability, risk etc…

Salutogenesis (health ease)—that which creates health and wellness

language of capability, capacity, ability

Scenario

You are team leader of community mental health center. The team is fighting over the “proper” care of a difficult client. The problem is heating up to the point where you want to slip away on vacation and hope that when you return the problem will have gone away. You do not want to confront members of your team because you don’t want to make things worse. This problem has been brewing with other clients as well.

Treatment team consists of:

Case Manager (Nurse) Psychiatrist Social Worker Psychologist Team Leader

Scenario

Joe Jones is a 37 year old long term Ice user who is also homeless. He has been in your service on and of for years because of his concomitant psychotic illness. He seems to be getting more disorganized, demanding and abusive. It was reported by another client that Joe was seen running from an incident where someone had been mugged and assaulted. It is suspected that Joe is selling his medication. Electronic equipment is missing from the clinic following his appointments.

Nurse/case manager

Joe’s case manager wants the team to pick up some of her workload to enable more intensive time with Joe. Joe’s mother has recently died which she suspects accounts for his worsening condition. She believes there is a window of opportunity for a therapeutic breakthrough.

Psychiatrist

The psychiatrist does not see the value of intensive case management. She/he thinks Joe needs to be involuntarily admitted to the State hospital for detox and medication management.

Social Worker

The social worker has known Joe over the years and thinks hopsitalization will deepen Joe’s problems because he is well known and disliked by staff. The social worker is advocating for admission to the Steadfast Program thinking that stable housing will enable Joe to begin sorting out his problems.

Psychologist

The psychologist has known Joe from the neighborhood since childhood. He has recently seen Joe on the streets wheeling and dealing in a most competent manner. Joe only seems disorganized and psychotic when coming for appointments—most likely drug seeking. She/he believes Joe is socio-pathic and thinks he should be set up, caught for theft, and sent to jail or the forensic unit. According to neighbors and friends of the psychologist, the death of Joe’s mother was unacknowledged by Joe.

Team leader

You want to go on holiday. You agree with the psychologist, your friend. Joe has been abusing the system, sucking your staff dry, and now stealing. These kind of guys use up all the resources and now you have to replace computers and VCR equipment using funds you do not have.

The psychiatrist is strong arming toward admission where at least Joe will be off the scene for awhile. You want the guy jailed but team members (nurse & social worker) already think you are cold hearted. They make life miserable around the clinic by undermining when they don’t get their way.

???

Name the overall goal of the team in this scenario?

Identify the values, concerns, and what is at stake for each disciplinary group?

Name what might be considered stressful to the disciplinary perspective?

???

What might you do in this scenario?

Where does the Joe and his family stand in all of this?

What might you do to promote better teamwork in the future?

Ideas for Teambuilding

Rotate leading client rounds Make visible disciplinary perspectives Display research and highlight summaries in

meetings Make use of research Multi-d clinical supervision

Share educational endeavors Adopt philosophy of patient-centered

collaboration Implement consumer feedback surveys

(display good feedback) Coordinate assessments Promote fun, social activities, mark events