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"If the goal is to deliver patient care, that should determine how the team functions," Tsukuda said. "What does the patient need and how do we deliver the care they need? If you think about it, everybody doing their own thing isn't going to work."

Interdisciplinary teamwork is already a mainstay in certain areas like hospice and elder care. More hospitals are looking at team models of caring for patients and involving the patients more intensely in their own care.

Cardiac care centers, orthopedic units, oncology units and well-mother-baby units are looking at increasing patient education and focusing team efforts-from physicians to housekeepers-on sending home educated patients who have the resources and education to care for themselves.

Emergency departments in some hospitals are creating teams that might consist of a physician or nurse practitioner, one or two nurses, a nursing assistant and support staff to work on a specific group of patients. Chronic illness centers are experimenting with team approaches to helping patients manage their disease.

"Forty years ago, there was the nurse and the doctor," said Mark Darby, RN, CEO of Darby Training Programs in Omaha, Neb. Darby creates training programs that teach nurses, among other things, how to work in teams. "The doctor did one thing and the nurse did everything else."

Now, a hospital patient might receive care from a variety of health care workers, including respiratory therapists, physical therapists, occupational therapists, physicians of various specialties, pharmacists and social workers, Darby said. "It's now the nurse, the doctor and everyone else."

But although the players in health care have changed, in many cases the system has not, Darby said. Modern patient care, with much of its origins in the military, still has hierarchical roots. When there's a problem, he said, the tendency is to "push it upstairs, to take it to the doctor and let him solve it. … We have to start moving away from that. We have to move toward people who are equals. We have to treat other people on the team as equals as well as expect to be treated as equals."

Satisfaction guaranteed

Lori Stubbs, RN, case manager at Alegent Health Bergan Mercy Medical Center Joint Replacement Center has spent three years creating a team of nurses, physical and occupational therapists, physicians, even a housekeeper. Her team works together to educate patients, get them successfully through hip or knee replacement surgeries, get them moving and send them home with full knowledge of how their recovery will proceed.

The center has the highest patient satisfaction scores in the hospital-higher than even the well-mother and baby center, traditionally the highest scorer in patient satisfaction.

Patients send cards and letters, talking about the excellent care they received from the team. They come back to visit and give encouragement to new patients. The center has won awards for its team care.

But creating the team was no easy process, Stubbs said. Initially many people resisted changing, expanding or, in some cases, giving up part of their old roles.

At first, she said, many staff members resisted the idea that everyone help set up the common room for a picnic-style lunch that included patients, their families and caregivers.

But when they saw her doing it, and when they realized how much the patients enjoyed these meals, nurses, therapists, secretaries and anyone else available began pitching in.

Now, Stubbs said, everyone sets up the room, helps transport patients down to lunch and helps clean up. There is no "low man on the totem pole" expected to do the work, she said.

"There are pretty strong personalities here and pretty strong ideas," she said of the center staff. "They all know their own roles, but they all work together, too."

At SMDC Emergency Department, staff members worked as a team long before "teamwork" became a buzzword in health management circles. Because of the nature of their work, they have no choice, said Linda Way, RN, director of emergency services and Life Flight at SMDC Health System. "We don't know from minute to minute what we're going to be encountering. Teamwork is a part of the culture of the unit and the success of the unit."

The unit is working to formalize and tighten its teams, she said. Eventually, teams will consist of a physician, two registered nurses, a nursing assistant and a health unit coordinator, who answers phones and processes orders. Social workers, chaplains and other support staff will continue to work with the teams, she said.