Team Meetings: What if Everyone Gets A Voice?

Teamwork is now the name of the game in group endeavors. Google recently conducted Project Aristotle, a three-year study on teamwork, synthesizing its experiences along with previous research.  Some teams got better results than others. Why? 

Among the key variables were:

• The ability of every person to speak up equally. No one individual dominated discussions.
• The freedom to share what each member was really thinking. The team is psychologically safe.
• The availability of a good model to guide their problem-solving.

Julia Rozovsky, the Project Aristotle lead, concluded, “Don’t underestimate the power of giving people a common platform and operating language." [1]

Could this principle apply to health care teams when discussing patients’ care? Could team conferences be regarded as the “common platform” and the Siebens Domain Management Model (SDMM) framework as the “operating language”?

Yes on both counts. The conference assembles the members in one platform. The SDMM serves as a simple “operating language”. 

Recent studies examined this approach for inpatient rehabilitation team meetings, with emphasis on barriers to discharge home. When the SDMM served as the team’s framework: 

• Many patients left functioning better,
• More went directly home rather than to nursing homes or back to acute care hospitals,
• Patients spent less time in the rehabilitation hospital.

These results are summarized in the table below. 

What’s the take-away?  Clinicians improved teamwork significantly using the SDMM to guide their work.  Other teams – within health organizations and/or the community - may also benefit when applying the SDMM as they serve individuals with health care needs.

TABLE - Outcomes from Use of SDMM with Focus on Barriers to Discharge in an Inpatient Rehabilitation Hospital[2]

Comparison/Variable	All Stroke	Geriatric Stroke	All Geriatric
	Patients’ Demographics
Number of Patients   Before and After	154 and 151	66 and 58	429 and 524
Average ages in years in Before and After Groups	70.8 and 68.9	83 and 82.8	82.8 and 83.5
Percentage of Women In Before and After Groups	45%  and 53%	58%  and 64%	65%  and 64%
Results
Did rehabilitation happen using fewer inpatient days?	Yes, 5 fewer days	Yes, 4 fewer days	Yes, 2.6  fewer days
Did both groups have similar function on admission?	Yes	No, the after group has slightly better function	Yes,
Were more patients discharged home in the After group? By what percentage increase?	Yes 23.4% more	Yes 19.4% more	Yes 15.9% more
Were fewer patients discharged to nursing homes?	No	No	Yes 13.6% fewer
Were fewer patients discharged back to the acute care hospital?	Yes 17.9% fewer	No	No -
Results Compared with National Benchmarks
Was the shorter length of stay even shorter than changes nationally between 2010 to 2012?	Not compared	Yes	Yes
Was the improvement in function per day of inpatient treatment higher than the national averages?	Yes	Yes	Yes
Were the increased number of discharges to home more than national averages?	Yes Four times more	Yes Four times more	Yes  More than three times more
Were there fewer readmissions to the acute hospital compared to national averages?	Not compared	Yes Six times fewer	Yes Almost three times fewer

Patients are in three different groups – all stroke patients, stroke patients 75 years old and older (geriatric stroke) and all patients 75 years old and older (all geriatric).  The groups’ results are compared between 2010, before the SDMM was used in team conference, and  2012, after the SDMM was started in 2011. 

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[1] Duhigg C. What Google learned from its quest to build the perfect team. New York Times Magazine, February 25, 2016.

[2] Adapted from Kushner DS, Peters K, Johnson-Greene D. Evaluating the Siebens Model in geriatric-stroke inpatient rehabilitation to reduce institutionalization and acute care readmissions. Journal of Stroke and Cerebrovascular Diseases 2016;25(2):317-326.