An Endocrinologist’s Perspective on the Value of the Healthcare Team

Throughout my 20 years as an endocrinologist, I have seen a diverse range of patients with varying conditions, comorbidities, and backgrounds. While each case offers a unique set of challenges, there is one thing I know to be true—interprofessional healthcare is instrumental in providing the best possible care for patients and their families, especially amid a global pandemic.   

Diabetes care is an exemplar of the value of team-based collaboration. Because the disease is long-lasting, the most successful treatment plans involve a variety of healthcare specialists who can offer a wide array of services to care for the “whole” patient. 

When I was in medical school, I watched my senior physician mentors work autonomously, and they modeled a role where they served as the definitive and decisive leader of the healthcare team. Over time, I noticed that my colleagues in other professions had a range of valuable and complementary skills (that I don’t possess)—an observation that helped me realize the power of collaboration and the value of leveraging my colleagues’ expertise. Though my training might be longer, I realized that I didn’t necessarily have more or better skills than my colleagues; rather, I had different skills. In my practice, my colleagues and I depend on one another because we each have complementary skills and often have distinct observations. For example, a nurse doing home visits may have a better insight into the patient's actual needs, and a nutritionist may be able to discover underlying behavioral issues that are affecting that patient’s response to a treatment I might have prescribed. The more I can rely on the insights of my colleagues and their understanding of the patient, the more we can get a complete view of the patient’s needs and deliver the best care possible. Though collaborative decision-making and sharing is inevitably less efficient in the short term, it not only benefits the patient, but also it strengthens the team to allow us to be ready for a time when we are stretched.

The business world has been studying team development for decades—a simple Google search will generate thousands of articles, studies, and opinions on best practices for fostering an effective team. Many key learnings from business are transferrable to a healthcare setting, acknowledging that healthcare teams are typically created under different circumstances. For example, in a corporate setting, a considered selection process will take place to help the team determine if the potential member is the right fit. In a hospital setting, it’s common for healthcare teams to be pulled together spontaneously, with on-call physicians meeting emergency room nurses for the first time just moments before treating a patient together, while in the clinic, different staff may be working on differing shifts or across units. There are no interviews or compatibility testing when creating healthcare teams during a crisis —we’re just expected to perform. 

From my experience in delivering team-based care, I’ve learned several important lessons: 

1.     No two teams are exactly alike—take the time to get to know yours. The most successful teams are built on a foundation of trust, which begins with understanding one another on a personal level; a strategy that is appropriate if you’re going to be working together for a while. A study from Harvard Business Review found that socializing as a team can influence team performance, even accounting for more than 50% of positive changes in communication patterns. Consider hosting a virtual happy hour, a book club, poetry reading, or trivia night to connect with your colleagues while socially distant. Even if you have only a few moments, ask a question about how the person is doing, or what they’re looking forward to as a way to create a human connection. 

2.     Delegate and share responsibility for maximum efficiency. An effective leader will understand the team’s strengths and weaknesses and suggest responsibilities accordingly. Each team member will bring a distinct set of skills and perspective to the situation that will help deliver optimal care. Learn what your team members can do and what professionals with a certain training can do: pharmacists are often highly effective at managing medication compliance, for example. Be ready to be delegated to as often as you might delegate to others. 

3.     Rotate team leadership. If the team is stable and meets periodically to strategize care planning, invite others to lead the meeting and decision-making. This will facilitate recognition of the roles and capabilities of team members, demonstrating respect for one another. 

4.     Listen and be open-minded. Embrace multiple perspectives and allow each team member to share input. Sophisticated healthcare professionals will appreciate collaborative decision making, but may be reticent initially to challenge traditional hierarchies. Invite input, be curious, and listen. Flexibility and a willingness to learn will help the team make the best possible collaborative decisions. 

5.     Learn together. The team that teaches each other and learns together performs better. Asking one team member to teach the rest of the group something relevant to the practice, even for five minutes, lets the team members be in charge of their own learning agenda, and creates an environment where we learn to appreciate what our colleagues can teach us.

The continuing medical education (CME) community has a great opportunity to support team development in the healthcare setting. A common misconception is that CME only offers disease education, but in fact, CME offers a variety of training healthcare professionals may need, including how to support a collaborative healthcare team. An example of this type of initiative is Joint Accreditation for Interprofessional Continuing Education, founded by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC). As an organization, we at ACCME had to relinquish some of our traditional autonomy to create a collaborative accreditation process that meets the needs of the community and is in the public interest; in doing so, we’ve tried to lead by example. 

The COVID-19 pandemic has created incredible challenges for the global health community. While this pandemic can feel overwhelming, I am certain that healthcare teams are a part of the solution to a healthier future. Since I began my practice nearly two decades ago, the dynamic of the care team has evolved dramatically for the better. Interprofessional colleagues are collaborating to share insights and perspectives, and I feel hopeful that collaborative team care will continue to deliver optimal patient outcomes.