Team-Based Care Delivery: The Worth of Social Capital

August 28, 2013
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team-based healthcareHealth care enterprise models tend to be born from economics rather than the value of exceptional patient experiences. We see this manifested in the manner hospitals score success. Incremental change is scrutinized for financial return on investing in “customer satisfaction” and jauntily correlated with care provider performance.

team-based healthcareHealth care enterprise models tend to be born from economics rather than the value of exceptional patient experiences. We see this manifested in the manner hospitals score success. Incremental change is scrutinized for financial return on investing in “customer satisfaction” and jauntily correlated with care provider performance. Human capital—one’s practicing experience, medical knowledge and capability of care—becomes the scapegoat for struggling hospitals. Low performers are trained harder and longer under the exhausted conventional wisdom that more knowledge is the solution. Such guidance is dangerously comforting for an uncertain industrial climate: “where this a problem, there is training to fix it.” But it is that very wisdom that has created the vicious break-fix cycle your organization can’t seem to escape.

An organization-wide value of exceptional patient experiences, in contrast, recognizes the impact of social capital: the capacity and leverage of social interactions among your staff. Where an emphasis on human capital suggests organizational strength lies in an individual’s knowledge and performance, social capital holds personal networks and team-based care delivery in a higher regard. Where does a nurse turn when she witnesses aggressive physician behavior? Who does a physician consult when he needs a second opinion on a diagnosis? How does a surgeon stay connected to referring primary doctors? Who do they all confide in when they just don’t know the cure? Better staff interactions ultimately enable better patient experiences.

Enlightening empirical evidence surfaced by Carrie Leana, Professor of Organizations and Mangement at the University of Pittsburgh, shows direct correlation between strong social capital, particularly one of high trust and frequent interaction, and student achievement scores in education. In her research, teachers with the highest human and social capital produced the greatest student outcomes. Those with the lowest collective capital produced the lowest outcomes. This is expected. What’s interesting is teachers with lower human capital can fare just as well as their mid-range colleagues if they have stronger social capital. A teacher’s network becomes her lifeline for extra help when needed. The same applies to medical professionals.

Dr. Brian Sexton, an Associate Professor at Johns Hopkins University School of Medicine, found that health care organizations with strong workplace cultures of communication have better clinical outcomes. His landmark Safety Attitudes and Safety Climate Questionnaire is so effective it can predict infection and surgical complication rates. As Sexton’s colleague, Atul Gawande, puts it, “Man is fallible. Men are less so.” The bare minimum of medical professionals knowing each other’s names even has great potential for better outcomes. Nurses, surgeons and anesthesiologists report greater comfort in vocalizing red flags they see as well as having greater awareness of the patient’s condition during an operation. A simple pre-operative introduction has been shown to reduce complications and deaths by 35%.

Areas of your organization like the ICU that experience high staff turnover could benefit most from greater attention to such social capital development. With more than 17% of critical care RN’s voicing intention to leave their current position within one year, the creation of principles that encourage and reward supportive symbiotic relationships could mitigate complications through allowing newer nurses to lean on the more seasoned for guidance.

Emphasizing social capital reorients your organization’s values onto an axis of altruism and patient safe-guarding. The development of human capital is still of an utmost importance, but it must not cloud your vision of the other contributors to exceptional patient care delivery. Changing your accountability model to one that considers both the strength of your staff and it’s combined potential is most promising, for caregivers become more effective when their knowledge is built on the support of their peers. It’s time we move from “Who has the best physicians in the country?” to “Who has the best care team in the country?”

(healthcare teamwork / shutterstock)

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