128 patient self management particularly for chronic

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128 Patient self-management, particularly for chronic conditions, has been shown to be associated with improvements in quality of life 129 and health status, decreased utilization of services, 130 and improved physical activity. 131, 132 The Chronic Care Model developed by Wagner and colleagues 133–135 similarly emphasized the importance of actively engaging patients in achieving substantial improvements in care. Patient-centeredness is increasingly recognized as an important professional evolution 124 and holds enormous promise for improving the quality and safety of health care. Yet, patient-centered care has not become the standard of care throughout care systems and among all clinicians as recommended by the IOM. 7, 136 For patient- centered care to become the “standard” care process, care processes would need to be redesigned and the roles of clinicians would need to be modified 137, 138 to enable effective teamwork and collaboration throughout care settings. Teamwork and Collaboration It is nonsensical to believe that one group or organization or person can improve the quality and safety of health care in this Nation. In that patient safety is inextricably linked with communication and teamwork, 6 there is a significant need to improve teamwork and communication. 139, 140 Teamwork and collaboration has been emphasized by the Joint Commission. The Joint Commission has found communication failures to be the primary root cause of more than 60 percent of sentinel events reported to the Joint Commission. 141 Ineffective communication or problems with communication can lead to misunderstandings, loss of information, and the wrong information. 142 There are many strategies to improve interdisciplinary collaboration (e.g., physician and nurse), 140, 143 including using multidisciplinary teams as a standard for care processes. Interprofessional and intraprofessional collaboration, through multidisciplinary teams, is important in the right work environments. Skills for teamwork are considered nontechnical and include leadership, mutual performance monitoring, adaptability, and flexibility. 144 Teamwork and interdisciplinary collaboration 139 have the potential to mitigate error and increase system resilience to error. 145 Clinicians working in teams will make fewer errors when they work well together, use well-planned and standardized processes, know team members’ and their own responsibilities, and constantly monitor team members’ performance to prevent errors before they could cause harm. 6, 146, 147 Teams can be effective when members monitor each other’s performance, provide assistance and feedback when needed, 147 and when they distribute workloads and shift responsibilities to others when necessary. 144 The importance of training members to work effectively in multidisciplinary teams to achieve high reliability in patient (e.g., no adverse events) and staff outcomes (e.g., satisfaction working with team members and improved communication) 145, 148–151 was found to be especially significant when team members were given formal training to improve behaviors.

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