2007_03_01_archive

Teamwork in health care - evidence-based?

Does teamwork in health care improve health outcomes? Nobody really

knows.

Here's a 13-minute video by health journalist Ray Moynihan, who's a

stickler for evidence, and filmmaker Miranda Burne. Moynihan is

Australian and works a lot in the British Commonwealth, where

evidence-based medicine is taken pretty seriously (see groups such as

NICE and Cochrane). This film was funded by the Canadian Health

Services Research Foundation, a policy group (though that's an

oversimplification) that works with provider and government

organizations to try and increase the uptake of research evidence into

practice.

The film focuses on a program to integrate care for stroke victims. It

raises some good questions: do you really need evidence when it's so

obvious that an approach like team care is a good idea? My answer

would be yes, if it's something that requires a lot of resources to

bring about, and could have other hidden downsides. How do you get

that evidence? Do you need a randomized trial? My answer: That's the

best way, and you needn't rule out an RCT just because you are in a

"complicated" setting with a lot of variability. Randomization takes

care of a lot of that. Finally, shouldn't providers always work

together as a team, just as a part of good practice, and what does

"good practice" mean anyway? I'll leave that one open, but after

reading some anecdotes recently about lack of coordination in hospital

care, where patient charts became a sort of wastebasket for notes and

lab slips that no one bothered to consult, I'd hazard that, yeah, some

level of coordination probably makes sense.

What I would have liked to see more of in this film is an idea of what

was meant by teamwork - is it just a series of case meetings like the

one shown? How many such meetings were there? What sort of follow-up

was there clinically? What does it actually mean to accumulate