This article details the use of the Multi-Team System (MTS) Model for Patient Carethe components of an interdisciplinary healthcare team. The team structure will be described in further detail using the Multi-Team System (MTS) Model for Patient Care developed by the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS program. This model includes several levels of teams that range from those directly caring for the patient to those supporting front-line staff.
What is a team?
A team differs from a group because, within a group, people can work independently to achieve a goal. Being a part of a team requires people working together towards a shared goal, with structured roles for a limited amount of time. There are many teams involved in health care, from frontline staff caring for patients to ancillary support staff and administration. All members are important in contributing to patient care and overall safety.
Team members:
- Include those involved in patient care activities
- Have specific roles/responsibilities
- Are responsible for their actions (team accountability)
- Must have a continual awareness of the current situation to function effectively (AHRQ, 2012).
Multi-team system (MTS) model for patient care
The MTS model for patient care describes different levels interacting with and impacting the patient, from direct patient care providers to emergency response teams, support staff, leadership, and administration. It breaks down the team structure into the following components: core and contingency teams, coordinating, ancillary/support services, administration, and the patient. The patient is at the top of this model, reflecting the different teams leading to a shared goal of patient support (AHRQ, 2012).
(Reprinted with permission from AHRQ TeamSTEPPS 2.0 Pocketguide)
Core and Contingency Teams
The team interacting most closely with the patient is described as the core team. Core teams consist of staff members directly caring for the patient and continuity providers such as case managers. For example, in the neonatal intensive care unit, this could be the nurse, midlevel (physician assistant or nurse practitioner), neonatologist, and case manager. Contingency teams are formed from the core team and are members who are needed for specific or emergency events such as a Code Blue team and OB emergency response. They are mobilized quickly for a limited amount of time. Effective communication and defined roles are essential to these teams performing well. Leadership is based on the situation and experience level of the team members. Team members are pre-identified, typically come from several different areas within the hospital, and provide services that are needed for the patient above and beyond what the core team can provide (AHRQ, 2012). Consider an obstetric emergency response team at a teaching hospital with in-house 24/7 laborist coverage. This could include defined team members such as L&D charge nurse, laborist, obstetric resident, anesthesiologist, two designated labor and delivery nurses, and a neonatal intensive care unit midlevel & nurse. Specific roles might include the designated labor nurses helping to move the patient back to the OR and functioning as a scrub nurse if emergency cesarean delivery is required.
Coordinating and Ancillary/Support Service Teams
The next level consists of teams that support the front-line staff: coordinating team, ancillary, and support services. The coordinating team consists of members who help manage the day-to-day environment so that the core team has what they need to effectively care for the patient (AHRQ, 2012). An example of this could be the charge nurse, senior resident, and/or laborist actively involved in assessing unit resources. For instance, on a busy day in labor and delivery with a full census, this team would come together periodically to decide how best to free up some beds and facilitate patient flow (dependent on the structure of the unit): deciding if antepartum patients could be transferred off the labor floor, evaluating if any patients meet discharge criteria, and calling housekeeping to turn rooms over more quickly. This team could also evaluate for immediate increased staffing needs and help mobilize resources.
Ancillary and support services are teams that function primarily to support the core team (front line staff) and ultimately the patient. They are essential in day-to-day operation, ensuring a safe, clean, and well-organized environment. See below for examples:
- Blood bank
- Pharmacy
- Storeroom (supplies)
- Biomedical engineering
- Facilities management
- Environmental/housekeeping (AHRQ, 2012)
Administrative Team
Lastly, the administrative team includes leadership on the unit and/or organization and has the overall responsibility for function and management. This team creates and supports an environment for effective teamwork and safe patient care. Some of the responsibilities include: developing a shared vision, guidelines with clearly defined roles/responsibilities, eliminating barriers, and providing resources to front-line staff to enable the safe delivery of care. This team could include physician and nursing department leadership, unit educators, perinatal safety specialists, and organization executive leadership, to name a few.
All of these teams work together to support the patient (family included & inferred), depicted at the top of this model. Patient care preferences, along with respect for individual values and priorities, are a central piece of this model in that care is directed based on these facets (AHRQ, 2012). In summary, the MTS model for patient care describes different levels interacting with and impacting the patient, from those directly caring for the patient to those supporting front-line staff.
In addition to the team structure described above, interdisciplinary teams can also come together on an ad hoc basis for various types of project work. These may be more long-term and include things such as quality improvement work or program development. For example, developing a nursing clinical ladder program may require collaboration among nursing administration, varying levels of nursing staff representation, finance, and nursing leadership. The same overall concepts of a team structure and function including collaboration, defined roles and responsibilities, and accountability are applicable.
Jeanette Zocco RNC-OB, C-EFM, C-ONQS
References
Agency for Healthcare Research and Quality (2012). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. TeamSTEPPS Fundamentals Course: Module 2. Team Structure. Retrieved from https://www.ahrq.gov/teamstepps/instructor/fundamentals/module2/igteamstruct.html#multi
Agency for Healthcare Research and Quality (2013). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. Pocket Guide. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf