Collaborative care teams are already firmly established in many settings and the approach will only become more common. Being a leader in team-based care is an added responsibility for the physician, yet also represents the opportunity to create an outstanding experience for patients and the team members.
For some physicians, excellence in that role may come naturally. The AMA Code of Medical Ethics offers concise and actionable guidance available for all physician team leaders to consult in opinion 10.8, “Collaborative Care.”
Here are some pointers on how physicians can model ethical leadership, drawn from the formal language of the Code and from the AMA Council on Ethical and Judicial Affairs’ report on this topic.
Understand the range of your own and other team members’ skills, expertise and role. Teams may be made up of physicians, nurses social workers and other health professionals. “Members of a well-functioning team will acknowledge and appreciate the contributions made by each and every team member,” notes the CEJA report. Remember, also, that patients and their families are part of the team.
Clearly articulate individual responsibilities and accountability. “Physicians are uniquely suited to serve as clinical leaders by virtue of their thorough and diverse training, experience, and knowledge,” the CEJA report says. That does not mean, however, that the physician “will take the helm for every aspect of decision-making or coordinate every detail of treatment. Other health care personnel bring expertise and knowledge to the team and in many instances will be in charge when their expertise is most needed.”
Physicians can also expect to be held accountable for the patient’s care and outcomes, but “all members of the team are accountable for their individual practice and each shares responsibility for the functioning of the team as a whole.”
Encourage insights from other members and be open to adopting them. Physician leaders are urged to “encourage open discussion of ethical and clinical concerns and foster a team culture in which each member’s opinion is heard and considered and team members share accountability for decisions and outcomes,” the CEJA report says.
Creativity is an important part of that, because it energizes the team to work effectively, enthusiastically and innovatively. “Creative teams do not view failed attempts and negative outcomes as the destruction of team goals, but as opportunities to learn,” CEJA’s report notes.
Master broad teamwork skills. Opt for transformational leadership instead of transactional leadership. In the transformational model, leaders “are continuously engaged in relationships that inspire followers through charisma, clearly articulated visions, and ongoing personalized guidance,” the CEJA report says. The example given is the brief, informal huddle—five to 10 minutes is enough—that, along with weekly meetings, keeps the activities of team members in sync. Transactional leaders, in contrast, operate correctively when a team member strays from standards.
The AMA Code of Medical Ethics says that, as leaders within health care teams, physicians should:
- Promote core team values of honesty, discipline, creativity, humility and curiosity and commitment to continuous improvement.
- Help clarify expectations to support systematic, transparent decision-making.
- Encourage open discussion of ethical and clinical concerns and foster a team culture in which each member’s opinion is heard and considered and team members share accountability for decisions and outcomes.
- Communicate appropriately with the patient and family and respect their unique relationship as members of the team.
The Code also points out that beyond leading teams, physicians are expected to take leadership roles in their institutions. In that light, physicians are urged to be advocates to ensure the resources and support health care teams need to collaborate effectively. That includes education about the principles of effective teamwork and training to build teamwork skills.
