Notes from the Hotspotters: Teamwork Is Hard

Originally published October 21, 2014

By Meg Lagunas

The 2014 Hotspotting Mini-Grant Project gives health professional students an unprecedented hands-on opportunity to practice an innovative model of care delivery called hotspotting. Hotspotters identify health care super-utilizers: people who are admitted to the hospital multiple times a year, frequently for avoidable complications of chronic conditions, and who often have social barriers to adhering to their care plan. The hotspotters proactively bring additional attention, follow-up, resources and care to these patients in their homes and communities to help keep them out of the hospital. Student hotspotters will share their experiences here twice a month for the rest of this year in “Notes from the Hotspotters.”

I had a 17-year-old brother with Prader-Willi Syndrome who required the care of numerous specialists.  Each specialist was individually an great health care provider who worked hard to give the best care possible to my brother and family, but each of these specialists only worked within their own specialty, their own body system, their own silo. 

His endocrinologist passionately advocated for him to receive growth hormones so that his body would look his age regardless of the fact that cognitively he was a toddler and having a smaller body allowed him to do the activities he loved, like playing in ball pits and swinging on swings. Seeing him as nothing more than a collection of body systems, his doctors did not realize that all together he was one complete amazing boy.
Ultimately through a complex chain of reactions stemming from a variety of well-meaning health interventions, my brother passed away unexpectedly of drug-induced hypothermia secondary to his underlying syndrome. Though each of his health care providers gave him the best care they could, it was fragmented care that only addressed isolated body systems rather than the whole person and situation. We all will forever wonder if a team working together who discussed and debated each intervention on a global level would have allowed my family to celebrate more birthdays with my brother. 
Teamwork is hard though.  From the day, we enter our individual professional training programs, as nursing, physician assistant, pharmacy, or medical students, we are socialized to believe in and identify with our own profession. We study the history of our profession and its codes of conduct. We are taught to emulate others in our profession. And we share “stories of the field.”  This socialization keeps us up late studying and prevents us from ripping the batteries out of our pagers. However, it also trains us to feel – because we rationally and logically don’t believe this – that our profession is the best, the most capable, the almighty. Just think of the last joke you heard about your profession, did the punch line not involve some sort of stereotype about another profession? Sure, it may be a survival mechanism, but it’s an epic hurdle for teamwork. Combine our socialized egos with the different skills, training, and knowledge that define each profession, and the various health care professions are like oil and water.
So how do we make teams work?
My very first nurse job was in a team-orientated trauma ICU.  While on the job, I learned through observation the power of a team. I saw how patients could conquer their injuries through the combined assistance of trauma surgeons, ICU nurses, respiratory therapists, physical therapists, numerous other staff and family. I learned how respect and open communication created an environment where professionals could discuss and debate various viewpoints without ego — truly allowing the focus to be the patient.
The only formula I have found that makes teams work is effort and commitment. My team in the ICU was committed to working as a team and they put effort into it. It’s the key to making any relationship work.
I wish I had had the maturity and insight to appreciate the culture and team work on that unit.  However, perspective is a great teacher. Not until I started working in other units and hospitals did I realize that not everyone values or practices team work in health care.
That’s one reason I was drawn to the hotspotting cohort.  This project presented itself as a great opportunity to learn about health care teams and practice being a part of one. Our particular hotspotting team is a great mixture of medicine, nursing, social work, pharmacy, and public health, whose members bring a variety of experiences and expertise. Our biggest challenges are time and communication. We are all extremely busy in our roles as students, employees, family members, and friends. Finding mutual time for meetings and discussions has been a struggle. The second struggle, communication, has also been an area of great learning for our team. Regardless of how many lectures or workshops you have attended, you don’t realize how tricky and complex group communication really is until you actually try it. We have had to experiment with different forms of communication technology, including email, text, video conference, and Google docs, as well as with how best to communicate within that technology. For example, do you hit “reply all” on every email? Does everyone on the team need to respond before a decision is made?  Ultimately through this trial-and-error process, we now have routine bi-monthly meetings and are able to stay in constant communication while establishing professional relationships, mutual trust, roles and responsibilities, and camaraderie.
Unfortunately, most students are not getting the hands-on experience with team work that my teammates and I are getting through hotspotting. Yet as the burden of chronic disease increases in our country, and people are living longer even with complicated conditions, more people than ever need a team approach like my brother did. Health care professionals cannot simply learn to work on teams once they are out in the field. We must learn how to work in teams during our first weeks and months in our profession – before we are socialized to believe that ours is the almighty profession and others are lacking in some way. 
I hope to start seeing more opportunities for teamwork in health professional training programs.  I hope more colleges and training programs make a commitment to interprofessional education (IPE).  IPE is a building block for teamwork and interprofessional practice. It not only teaches the skills necessary for teamwork, but also provides a space for students to explore and redefine their professional identity with the inclusion of other professionals.  Ultimately, however, teamwork is not about the health care professionals on the team. It’s about our patients. Teamwork is hard, but we all do much harder things on a daily basis for the good of our patients. 

Meg Lagunas is an ICU nurse and a PhD candidate in nursing science at the University of Washington. Her research interests are nursing education, team science, and interprofessional education.​ She is a member of the University of Washington’s Student Hotspotting team.