Pit Crew vs Cowboys: Involving Families in the Wild West of Health Care

To the Northeastern community who missed Jason Rodriquez’s talk yesterday, you missed out. Being the terrible tech-addicted millennial multimedia journalist I am, I live-tweeted the talk and put it up on Storify if anyone wants to get a idea (albeit truncated) of what it was about.

This is Dr. Jason Rodriquez, an alum of Northeastern (’01), a professor of sociology at the University of Massachusetts Boston and the author of numerous articles and the book Labors of Love: Nursing Homes and the Structure of Care Work. He got his grad degree at UMass Amherst, followed up with post-doc work at Rutgers that eventually became Labors of Love. He focused his talk, titled Are Families on the Team?: Intensive Care and the Shifting Boundaries of Belonging, on team-based health care in the ICU of a teaching hospital in the Midwest.

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A key component of healthcare is the need for trust granted from patients to doctors and conversely, on the trust doctors need to have for family members. The latter point, that doctors need to trust and include family members in decision’s about the patient (especially in the ICU) is critical and Rodriquez acknowledged it early on in his talk. On the one hand, we utilize team-based care to make the care more like a racetrack than the Wild West; your team is your pit crew, getting you back on the road, rather than cowboys doing whatever they see fit. (Aside: cowboys probably weren’t that lawless, according to the Libertarian think tank Independent Institute.)

Anyhow, which would you rather have on your side: a bunch of doctors who operate independently of each other, or a unit, working together to get you better? It seems pretty straightforward. But issues arise when the team falls apart, which it tends to do once an immediate task is completed.

So the gang is falling apart, and who steps in to remind the team that they still have a job to do? Family members! Which, Rodriquez notes, doesn’t always go over so well with doctors. “Professional authority remains a key component of contemporary hospital care work,” said Rodriquez and the result is that it effectively shuts out the family.

Viewing the family members as a threat completely undermines the entire purpose of utilizing team-care. One faculty member in the audience brought up the fact that within mental health care, team-care is structured around a leader, who essentially takes the blame when things go wrong. She wondered how much risk-management affects the effectiveness of team-care, to which Rodriquez responded that the resistance seen in team-care regarding risk management tends to be a result of the boundaries and hierarchies not within the team but between units.

Essentially, the key takeaway here is breaking down the boundaries and hierarchies between not only the professional team members, but also the barriers edging out the family members–whether thats ego-based, knowledge-based, or a fear of a lawsuit that building that boundary. When properly involved, families can actually promote cohesion within the staff, because they help the team to consider different approaches and to listen to the other members.

 

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