Making Multi-D Teams Work: Teambuilding

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Making Multi-D Teams Work Teambuilding

• Cynthia Stuhlmiller
• Professor of Nursing, Mental Health
• University of Hawaii
• September 24, 2004

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Outline

• Experiential intros
• Background
• Scenario and discussion
• Ideas for working together

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Background

• Disaster Studies (Stuhlmiller from 1989)
• Shared Values and Goals
• Occupational Values Goals
• meanings and concerns influence appraisal and
  coping
• socialization into practice
• customs
• Example PJs, firefighters, transportation
  workers
• Stress is when that which matters is blocked.
  (To be celebrated!)

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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

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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
  dont want to make things worse. This problem has
  been brewing with other clients as well.

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Treatment team consists of

• Case Manager (Nurse)
• Psychiatrist
• Social Worker
• Psychologist
• Team Leader

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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.

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Nurse/case manager

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

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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.

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Social Worker

• The social worker has known Joe over the years
  and thinks hopsitalization will deepen Joes
  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.

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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
  appointmentsmost 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 Joes
  mother was unacknowledged by Joe.

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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 dont get their way.

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???

• 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?

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???

• 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?

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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

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• Share educational endeavors
• Adopt philosophy of patient-centered
  collaboration
• Implement consumer feedback surveys
• (display good feedback)
• Coordinate assessments
• Promote fun, social activities, mark events