TEAM, TEAM DEVELOPMENT,

AND EFFECTIVE TEAMWORK

DESAK KETUT ERNAWATI PHD APT

UNIT IPE FK UNUD
Learning Outcomes

The undergraduate students will be able to describe the process of team development and the
roles and practices of effective teams
Learning Objectives:
1. Understand terminology used in interprofessional collaboration
2. Identify process of team development
3. Discuss team model in providing healthcare services
4. Identify teamwork ineffectiveness due to team conflict
5. Discuss characteristics of effective interprofessional collaboration
OVERVIEW
- Terminologies

- Process of Team Development

- Team model

- Effective vs ineffective teamwork

 Lessons learned
❖ One may have certain expertise not everything

❖Need to talk and open their mind to other expertise's

❖Need collaboration in place to treat patients’ problems

Building common understanding
 Terminology
Team Teamwork
a group of people organized to is the ability a group of people have to
work together work well together.
Today's complex buildings require close
a group of players forming one of
teamwork between the architect and the
the sides in a sporting contest
builders.
Interprofessional Synonyms: cooperation, collaboration,
unity, concert
Collaboration

is the act of working together to produce a

piece of work, especially a book or
some research.
Himmelman’s Collaborative Continuum, 2012
Various ways of working together between organisations
Networking: involve exchange of information for mutual benefit
Coordination: builds upon aspects of networking by adding the
dimension of altering activities for mutual benefit and to achieve a
common purpose. Typically through better coordinating of programs and
services, user-friendliness and access can be enhanced
Cooperation: builds on all the dimensions of cooperation and adds
sharing of resources. Resources can be human, fiscal, or technical,
such as knowledge resources.
Collaboration: includes all of the above dimensions plus
involves enhancing the capacity of another for mutual benefit and to
achieve a common purpose.
 Group vs Team
GROUP TEAM
Not all group is a team All team is a group
Members only do their role – based on what to do Members have the contribution to organization
Grouping is based on administrative approach Members realise interdependences among each other
Commitment based on benefits obtained Commitment based on sense of belonging
Carefully deliver their thought Trust is built and members freely deliver their
thought
Lack of tolerance Understand of each other’s perspective
Conflict mostly unresolved Conflict as a resource for creativity
Members has no active contributions to group Members participated actively in group decisions
decisions
Process of Team Development
(Tuckman Model)
https://drive.google.com/file/d/10thTNfJu-4kb0lk1hWtOM7iY2ni21B1G/view?usp=sharing
 Team building development
(Richard Chang)

Arriv
Thriv e
Striv e
Drive e
The importance of Leadership
- Define and maintain the structure of team

- Manage human resources

- Manage conflict in the team

- Listen, support and trust the members

- Shared leadership – people and task management

Shared leadership occurs when a group of individuals lead each other to achieve
successful outcomes (Carson, Tesluk, & Marrone, 2007).
Team Model in Healthcare
One stop shopping 🡪 rapid communication and the opportunity for multiple team
members to see a patient during a single clinic encounter 🡪 coordination based on team
member’s availability

Teamlet 🡪 longer time (15mins) for patients with chronic disease 🡪 primary care provider
and health coach – ‘a little team’ within a larger primary care team

Integrated care 🡪 bringing together comprehensive care based on patients’ needs.

Employ multidisciplinary approach and across care (mostly involving mental healthcare)
Team decision making
To assess whether a patient receive sufficient support and skills from other healthcare
providers

How? Who?

Where What?
?

When?
Team Conflict
Step 1 Step 2
Step 3 Listening
Acknowledging Identifying ‘real’
all perspective
conflict conflict

Step 4 Step 5 Gaining

Evaluating ways agreement and Step 6 Further
to resolve responsibility to examination
conflicts find solutions
 Styles in Resolving Conflict
Style Characteristics Reasons
Avoid Avoiding confrontation, denying May ruin relationship, no big deal,
conflict is happening may cause other BIGGER problems
Accommodate Approval, not aggressive, May ruin relationship
cooperative and ignoring own needs
Win-Lost Confrontative, aggressive, must win Show superiority
Compromise Aims to reach main target and No body perfect
maintain relationship, aggressive but
cooperative
Win-win Both sides are valid and relevant, Open discussion, both side win
respecting each other, supportive and
cooperative
EFFECTIVE TEAMWORK
Effective Team Work - Do's and Don't - YouTube
 The importance of effective
teamwork
o Reachable team goal

o Commitment to support each other

o Open communication

o Resolve conflict more effectively

o Obtain feedback of their performance

o Improve productivity

o Rewards to team work

o Members of team have full of ideas

o Task is completed
 Effective vs Ineffective
Teamwork
❖Shared goals ❑ unclear team goals

❖Clear roles – every team member ❑ unclear roles

have different role and ❑ ineffective communication
complimentary
❑ not freely to talk – judgemental, lack of trust
❖Trust – no hidden agenda
❑ Formal meeting and very rigid
❖Effective communication – freely ❑ high participation, but no results
says their words, no hesitance
❑ team decision is made by the leader with lack
❖Effective leadership of members’ involvement

❖ Each team member is willing to do ❑ no self assesment

a self reflection on what to improve
 Characteristics of Effective Team
Member
1. being proactive
2. first thing first
3. always begin from an end
4. win – win solutions
5. try to understand others before being understood
6. togetherness
7. self-development
8. Communication is the KEY
 References
1. Collaboration Structures : Toolkit2Collaborate

2. Buring SM, Bhushan A, Broeseker A, Conway S, Duncan-Hewitt W, Hansen L,

and Westberg S. Interprofessional Education: Definitions, Student Competencies, and
Guidelines for Implementation. Am J Pharm Educ. 2009 Jul 10; 73(4): 59.3.

3. Guraya SY, Barr H. The effectiveness of interprofessional education in healthcare: A

systematic review and meta-analysis. The Kaohsiung Journal of Medical Sciences;
34(3), March 2018, 160-165.

4, Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education:effects on professional

practice and healthcare outcomes. Cochrane Systematic Review Intervention.

5, Lamb G. Introduction to Team Decision Making in Primary Care. Center for Advancing Interprofessional Practice,
Education and Research, 2017.
OVERVIEW IPE - 4
TEAM IPE 3 AND 4
2023
Core Competencies of IPE

Values/Ethics Roles/Responsibilities

IP Communication Team and Teamwork

 TIMETABLE IPE - 4
The IPE-4 will be held from 3rd March to 7th July 2023
There are ten lectures, four small group discussions, two plenary sessions and four hours field practices.

L (Lecture)
TIME/ DATE 3/3 10/ 17/3 31/3 14/4 28/4 5/5 12/5
3 SGD (Small Group Discussion)
14.00 – 14.50 L1 L3 SGD FP1 IL L5 L7 L9 SGD 1 and 2 (group discussion intervention)
1 SGD 3 and 4 (group discussions evaluation)
15.00 – 15.50 L2 L4 SGD FP2 IL L6 L8 L10 IL (Individual Learning),
2 P (Plenary),
FP1 and 2 (Field Practice - intervention),
TIME/ 19/5 26/ 2/6 9/6 16/6 23/6 30/6 7/7
DATE 5 FP3 and FP 4 (Field Practice – evaluation),
14.00 – SGD FP3 IL P1 FPE CBT REMEDI I REMEDI II CBT (Computer-Based Test),
14.50 3
15.00 – SGD FP4 IL P2 FPE CBT REMEDI I REMEDI II FPE: Field practice examination – in groups
15.50 4
Lecture Topic
1 Overview of Interprofessional Education- 4
2 Describe the process of team development and the roles and practices of effective teams

3 Develop consensus on the ethical principles to guide all aspects of team work as well engage health and other professionals in shared
patient-centered and population focused problem-solving

4 Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting
patient and community values and priorities/preferences for care

5 Apply leadership practices that support collaborative practice and team effectiveness

6 Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among healthand
other professionals and with patients, families, and community members

7 Share accountability with other professions, patients, and communities for outcomes relevant to prevention and health care

8 Reflect on individual and team performance for individual, as well as team, performance improvement

9 Use process improvement to increase effectiveness of interprofessional teamwork and team-based services, programs, and policies

10 Use available evidence to inform effective teamwork and team-based practices.

Perform effectively on teams and in different team roles in a variety of settings

SGD 1 & 2
SGD yang pertama adalah
− Mendata ide yang muncul dari masing-masing mahasiswa,
− kesimpulan intervensi yang akan dilakukan beserta alasannya/rasional
− membuat scenario untuk intervensi yang akan dilakukan ke keluarga binaan
− mahasiswa mempresentasikan ke fasilitator – mock intervensi (bermain peran)
SGD 3 & 4
SGD yang kedua adalah
− mendata ide kegiatan monitoring dan evaluasi dari masing-masing mahasiswa
yang dapat diberikan ke keluarga binaan sesuai dengan kondisi keluarga
binaan
− Menyimpulkan kegiatan monev yang dapat dilakukan beserta alasan/rasional
− Membuat scenario untuk monev
− Mahasiswa bermain peran untuk melakukan monev di depan fasilitator
PLENARY
Presenting groups’ reports based on the results of their discussions in SGD
Individual learning
Students learn by themselves
Prepare study material
Prepare student project
 FIELD PRACTICE (FP)
Kegiatan Praktek Lapangan akan dilaksanakan sebanyak 2 hari x 2 x 50 menit pada
tanggal 31 Maret 2023 dan 26 Mei 2023. Adapun kegiatan yang dilakukan pada praktik
lapangan adalah melakukan pengkajian berupa:
1. Memberikan intervensi dari hasil identifikasi masalah Kesehatan yang dimiliki
oleh keluarga binaan yang telah ditemukan di semester sebelumnya. (di
pertemuan pertama)
2. Melakukan evaluasi hasil intervensi yang diberikan (di pertemuan kedua)
 Keluarga yang dijadikan keluarga binaan oleh
kelompok dengan syarat sebagai berikut:
1. Keluarga kooperatif (bersedia dilakukan pengkajian mengenai masalah kesehatan anggota keluarganya)
2. Memungkinkan dilakukan pengkajian dan intervensi secara luring atau daring
3. Salah satu atau lebih anggota keluarga memilki masalah kesehatan yang memungkinkan untuk
diberikan intervensi berupa edukasi kesehatan
4. Keluarga yang djadikan sebagai keluarga binaan ditentukan oleh kelompok dengan persetujuan dari
pembimbing masing-masing
5. Keluarga yang dijadikan sebagai kelurga binaan boleh berasal dari keluarga anggota kelompok (bukan
keluarga kandung) maupun keluarga lain yang ada di lingkungan sekitar anggota kelompok
6. Masing-masing kelompok mengelola sebanyak 1 keluarga binaan
7. Jika pengkajian secara Luring mahasiswa dan keluarga binaan wajib mematuhi protokol kesehatan yang
sudah ditetapkan
 Ketentuan Student Project:

Tugas Kelompok
1. Membuat video tentang kegiatan intervensi, evaluasi yang dikerjakan mahasiswa di Semester VI
2. Mahasiswa melaporkan kelebihan dan kekurangan kelompok IPE mereka dari semester III – VI
3. Jangan lupa cantumkan kelompok dan nama anggota kelompok di awal video
4. Durasi video maksimal 10 menit.
5. Video student project berpotensi untuk dapat diurus penerbitan sertifikat Hak Atas Kekayaan Intelektual
(HAKI).
6. Video student project juga berpotensi sebagai media promosi kegiatan IPE Fakultas Kedokteran
Universitas Udayana ke pihak luar.
7. Mahasiswa mengumpulkan video melalui link yang disediakan
8. Penilaian video dilakukan oleh fasilitator melalui rubrik
 Tugas Individual
Ketentuan student project:
1. Masing-masing mahasiswa membuat video tentang hasil refleksi diri tentang 4
core competencies IPE yang telah mereka pelajari dari semester III – VI
2. Durasi video maksimal 5 menit.
3. Mengupload dokumen di link yang disediakan
4. Penilaian video dilakukan oleh fasilitator dengan mengisi rubrik penilaian
CBT
Google form
60 questions MCQ in 75minutes
40% of overall mark
Remedial when the CBT score < 65
FIELD PRACTICE EXAMINATION
Facilitator of
SGD 1 vs SGD 25
SGD 2 vs SGD 26
SGD 3 vs SGD 27
SGD 4 vs SGD 28
….
SGD 24 vs SGD 48
 FORMATIVE
• Performa presentasi kelompok pleno
• Kuesioner related IPE (ICCAS)
• Refleksi diri
 SUMMATIVE
• Nilai SGD 15% (fasiliator pembimbing)
• Nilai kelompok student project 15% (fasiliator pembimbing)
• Nilai individu mahasiswa 5% (fasilitator pembimbing)
• Nilai ujian praktik lapangan 25% (fasiliator pembimbing dan evaluator)
• Nilai ujian akhir CBT 40%
 IMPORTANT NOTES
CBT – google form online
Semua tugas diupload di link gdrive
Field practice - Laporan dalam bentuk manuscript dan presentasi
Video SP – hanya dinilai oleh fasit – mahasiswa mengirimkan file di link gdrive yg disediakan
Dosen mengisi lembar absen dan penilaian mahasiswa melalui google form
FPE – 16 Juni 2023
CBT – 23 Juni 2023
Remedial – 30 Juni 2023
 TUGAS MAHASISWA
TUGAS AKTIVITAS Deadline PENILAI
STUDENT PROJECT File video individu dan video 2 Juni 2023 Fasilitator
kelompok diupload di gdrive
https://bit.ly/Selfvid
https://bit.ly/GroupVid
LOG BOOK FIELD Upload Logbook Intervensi di gdrive 14 April 2023 (intervensi) Fasilitator
PRACTICE https://bit.ly/FPIntervention)
Evaluasi-https://bit.ly/FPEvaluation) 2 Juni 2023 (evaluasi)
LAPORAN IPE Manuscript format – upload gdrive 9 Juni 2023 Fasilitator dan
https://bit.ly/ManuscriptIPE Evaluator
Ujian FPE Ujian Lapangan 16 Juni 2023 Fasilitator dan
Evaluator
 TUGAS DOSEN
KEGIATAN AKTIVITAS PENILAIAN MELALUI GFORM DEADLINE
SGD 1-4 Menilai aktifitas mahasiswa selama SGD Mohon penilaian dilakukan
berlangsung dengan rubrik di google excel segera dilakukan saat/setelah
doc yang disediakan selesai SGD
(17 Maret dan 19 Mei 2023)
Penilaian Student Project Individu Fasilitator menilai berdasarkan rubrik yang 16 Juni 2023
dan Kelompok - Video disediakan
Field Practice Mendampingi mahasiswa 31 Maret dan 26 Mei 2023
Penilaian FPE (manuscript dan Fasilitator dan evaluator menilai 16 Juni 2023
presentasi) berdasarkan rubrik yang disediakan

Nilai ke Prodi 12 Juli 2023

Questions?
 SHARE ACCOUNTABILITY WITH OTHER
PROFESSIONS, PATIENTS, AND
COMMUNITIES FOR OUTCOMES
RELEVANT TO PREVENTION AND HEALTH
CARE
(BERBAGI AKUNTABILITAS DENGAN PROFESI LAIN, PASIEN,
DAN MASYARAKAT UNTUK HASIL YANG RELEVAN DENGAN
PENCEGAHAN DAN PERAWATAN KESEHATAN)
 WHAT IS ACCOUNTABILITY IN HEALTH SYSTEMS?
• INDIVIDUALS ARE RESPONSIBLE FOR THEIR ACTIONS
AND OBLIGATED TO EXPLAIN THEIR CHOICES.
• GENERALLY, BEING ABLE TO JUSTIFY YOUR ACTIONS
LEADS TO A REWARD.
• NOT BEING ABLE TO EXPLAIN AN ERROR OR
WRONGDOING BRINGS CONSEQUENCES.
Why Is Accountability Important in Healthcare?
1. Critical in all aspects of the healthcare system, from
government health policies to employee training
programs.
2. Without accountability, healthcare facilities and
counseling practices risk decreased morale and
productivity, ultimately reducing patients' quality of
care.
3. Members are prepared to correct mistakes, find
solutions and commit to responsibilities rather than
make excuses.
4. Allows to learn from errors: can improve your
practice's reputation, reach business goals, decrease
the risk of lawsuits and improve patients satisfaction.
Why Is Accountability Important in Healthcare?

5. Patient accountability in healthcare is

equally important and can lead to
positive treatment outcomes.
6. When patients acknowledge the
obstacles that keep them from reaching
goals, they can change negative
behaviors.
7. Improved quality of care and value of
services
8. Accountability reduces the amount on
miused resources: care more affordable
 THE COMPONENTS OF ACCOUNTABILITY
WHO—THE LOCUS OF ACCOUNTABILITY
1. INDIVIDUAL PATIENTS;
2. INDIVIDUAL PHYSICIANS;
3. NONPHYSICIAN HEALTH CARE PROVIDERS SUCH AS NURSES AND PHYSICAL
THERAPISTS;
4. HOSPITALS;
5. MANAGED CARE PLANS;
6. PROFESSIONAL ASSOCIATIONS;
7. EMPLOYERS
8. PRIVATE PAYERS, SUCH AS BLUE CROSS;
9. THE GOVERNMENT;
10. INVESTORS
11. AND LAWYERS AND COURTS.
 THE COMPONENTS OF ACCOUNTABILITY

WHAT—THE DOMAINS OF ACCOUNTABILITY

• PROFESSIONAL COMPETENCE
• LEGAL AND ETHICAL CONDUCT
• FINANCIAL PERFORMANCE
• ADEQUACY OF ACCESS
• PUBLIC HEALTH PROMOTION
• AND COMMUNITY BENEFIT
 SOCIAL ACCOUNTABILITY
• SOCIAL ACCOUNTABILITY HAS BEEN DESCRIBED AS A ‘‘CULTURAL
CHANGE’’ AND A ‘‘NEW PARADIGM’’
• MEMBUTUHKAN SEMUA PIHAK YANG BERKEPENTINGAN UNTUK BEKERJA
SAMA DALAM MENENTUKAN PERAN TIAP INDIVIDU DAN TANGGUNG
JAWAB KOLEKTIF YANG BERKELANJUTAN DARI WAKTU KE WAKTU
• KOMPONEN KEMITRAAN AKUNTABILITAS SOSIAL MELIBATKAN PEMBUAT
KEBIJAKAN, MANAJER KESEHATAN, PROFESI KESEHATAN, MASYARAKAT
DAN LEMBAGA AKADEMIK YANG BEKERJA SAMA DENGAN FOKUS UTAMA
PADA KEBUTUHAN MASYARAKAT
 THE COMPONENTS OF ACCOUNTABILITY
HOW—THE PROCEDURES OF ACCOUNTABILITY
• EVALUASI KEPATUHAN
• SOSIALISASI EVALUASI DAN TANGGAPAN ATAU
JUSTIFIKASI OLEH PIHAK ATAU PIHAK YANG
BERTANGGUNG JAWAB
• PROSEDUR EVALUASI FORMAL DAPAT MENCAKUP PEMERIKSAAN
FASILITAS, CATATAN, DAN KEBIJAKAN OLEH KOMISI BERSAMA
UNTUK AKREDITASI ORGANISASI KESEHATAN
 HOW IS ACCOUNTABILITY MEASURED?

• MORE LIKELY TO INCREASE IF IT CAN BE MEASURED

• IN GENERAL, HEALTHCARE FACILITIES MEASURE FINANCIAL AND
PERFORMANCE ACCOUNTABILITY.
• FINANCIAL ACCOUNTABILITY INVOLVES TRACKING AND
REPORTING THE USE OF MONETARY RESOURCES.
• PERFORMANCE ACCOUNTABILITY MAY REFER TO MEASURING
HOW WELL CLINICIANS AND STAFF MEMBERS MEET GOALS OR
SCORE ON PATIENT SATISFACTION SURVEYS.
 HOW IS ACCOUNTABILITY MEASURED?

• ACCOUNTABILITY CAN HELP PATIENTS WHO STRUGGLE TO

PROGRESS OR CHANGE HARMFUL BEHAVIORS.
• EVALUATE PATIENTS DEVELOPMENT OFTENLY.
• IF THE PATIENTS ISN'T ACCOMPLISHING ANY GOALS, ASK THEM
QUESTIONS AND DETERMINE WHAT NEEDS TO CHANGE.
• MAKE SURE PATIENTS UNDERSTAND YOU'RE TRYING TO FIND
SOLUTIONS AND ARE NOT INTERESTED IN PUNISHING THEM.
 HOW IS ACCOUNTABILITY MEASURED?

• YOU MIGHT ASK QUESTIONS SUCH AS:

• WHY ARE SOME TASKS NOT COMPLETED?
• ARE SOME ACTIVITIES NOT IMPORTANT TO YOU?
• ARE SOME ACTIVITIES TOO DIFFICULT TO COMPLETE?
• DID YOU SET TIME ASIDE TO COMPLETE THE TASK?
• DID SOMETHING UNEXPECTED HAPPEN TO PREVENT YOU FROM
FINISHING AN ASSIGNMENT?
 ACCOUNTABILITY BEST PRACTICES
HERE ARE A FEW BEST PRACTICES TO KEEP IN MIND REGARDING TO ACCOUNTABILITY:
• KNOW THE REASONS: MAKE SURE YOU AND YOUR PATIENTS UNDERSTAND YOUR ACTIONS AND THE PURPOSE OF THEIR
TREATMENT GOALS.
• CONSIDER YOUR QUALIFICATIONS: ALWAYS ENSURE YOU'RE QUALIFIED AND TRAINED TO PROVIDE A SERVICE YOUR PATIENTS
REQUESTS BEFORE TAKING ACTION.
• AGREE ON TREATMENT: ANY STEPS YOU TAKE TO HELP YOUR PATIENTS SHOULD BE PART OF AN AGREED-UPON PLAN.
• SET CLEAR BOUNDARIES: YOU MAY NEED TO ENSURE YOUR PATIENTS UNDERSTANDS YOUR ROLE BY ESTABLISHING CLEARLY
DEFINED BOUNDARIES.
• MONITOR AND EVALUATE: KEEP TRACK OF YOUR PATIENTS'S PROGRESS, SO YOU CAN IDENTIFY ISSUES EARLY AND MAKE
RECOMMENDATIONS. SPEND TIME PERIODICALLY ASSESSING THE EFFECTIVENESS OF A PATIENTS'S CURRENT TREATMENT PLAN.
• HELP EMPLOYEES CHANGE: MAKE SURE EMPLOYEES UNDERSTAND THE IMPORTANCE OF ACCOUNTABILITY IN YOUR PRACTICE
AND HOW IT IMPACTS PATIENT CARE AND YOUR FACILITY'S SUCCESS. ENCOURAGE EMPLOYEES TO SHARE THEIR THOUGHTS AND
FEELINGS.
• MAKE IT EASY: THE CONCEPT OF ACCOUNTABILITY CAN FEEL OVERWHELMING TO BOTH PATIENTS AND STAFF. FOCUS ON
CHANGING ONE BEHAVIOR AT A TIME.
• BE HONEST: PART OF ACCOUNTABILITY IS BEING HONEST. SET AN EXAMPLE BY BEING HONEST IF YOU MAKE A MISTAKE AND
ENCOURAGE EMPLOYEES TO DO THE SAME.
Challenges in Accountability
If theres any struggle with accountability, try to identify and address the root
cause. Some possible reasons patients may have trouble with this concept
include:
•Problems at home:
1. patients may face issues such as financial instability or lack of support at
home.
2. Some obstacles may prevent them from focusing on achieving treatment
goals and improving their mental and physical health.
3. If you find patients struggling to reach goals due to challenges at home,
you may need to adjust their treatment plan to suit their situation better.
4. Remind them that they can still change their behavior to improve their
health, even if they need to take baby steps.
Challenges in Accountability
•Fear of consequences:
1. If employees or patients worry about the repercussions
of making mistakes or failing to reach goals, they're
less likely to embrace accountability.
2. Remind staff members that everyone makes mistakes
sometimes, and help employees or patients feel safe
reporting errors or expressing their concerns.
•Mental health and health information systems
Challenges in Accountability
• Lack of Willingness to therapy:
1. Some patients may be pushed by their environment to meet with a
counselor.
2. If patients feel they don't need therapy, they might challenge
accountability.
3. Resistant patients require patience, empathy and creativity.
4. You may need to find new ways to interact with them.
5. Allow time for them to trust you.
6. Once you build a connection, they'll be more likely to work to change their
behaviors.
7. If you feel stuck along the way, consider turning to peers for support.
 How to Encourage Accountability
Begin With Collaboration
1. Ensure patients understand that change happens internally and that
you must work as a team to help them overcome difficulties and
improve their behavior.
2. Let them know you're there to help them make sense of their
priorities and transform these into real goals, but they still have to
do their part to make things happen.
3. Remind them that it's better to be honest if they can't reach a goal
rather than make an excuse.
 How to Encourage Accountability
Set Clear Expectations
Setting clear expectations is an essential part of accountability.
Patients or team are not likely to put their best effort into reaching goals if they
don't know what's expected of them or why they are working toward a specific
goal.
Be sure to express what you're hoping to achieve and how patients or employees
should complete tasks.
Invite others to share their ideas and concerns (eg. Community).
Find out what they want, what expectations they have and what issues they might
be experiencing.
You'll want to get everyone on the same page for easier collaboration and increased
willingness to share thoughts.
 How to Encourage Accountability
Discuss Capabilities
Patients can't reach goals if they do not have the skills or resources
needed to complete certain activities.
To avoid accountability issues in the first place, set patients and staff up
for success by making sure they are capable of doing what's asked of
them.
Consider what specific tools they might need to achieve certain
objectives.
Can they obtain these things if they don't currently have them? What
can you do to make that process easier?
How to Encourage Accountability

Determine How You'll Measure Progress

You and your patients should set clear, measurable treatment goals
and objectives together and agree on how you'll measure their
progress.
Find out how much time your patients is comfortable spending on
assessments or other tools to gauge treatment effectiveness.
How to Encourage Accountability
Give Feedback
Continually check in with patients and discuss their thoughts and
feelings about their therapy sessions.

You'll also want to provide feedback and share your thoughts about a
patients's progress to the collaboration team and community.

Encourage open communication and remind the patients that you want
them to have a more satisfying experience.
How to Encourage Accountability
Build a Strong Connection
If patients resist adopting accountability and working on treatment
goals, you may need to give them more time to develop a greater
sense of trust.
Patients more likely to share their true feelings, thoughts, needs and
anything else required to help them change and accomplish goals.
They are also more likely to admit mistakes. Ensure they know you're
there to help them find a solution if they're having trouble reaching
goals.
How to Encourage Accountability
Acknowledge Success

Whether you're working on building accountability in your practice

or helping patients get motivated, make sure to acknowledge
accomplishments.
Encourage them to reward themselves after they complete therapy-
related homework assignments.
How to Encourage Accountability

Provide Tools
Offering technological tools that make patients easier for them to manage their
health.
For example, you can use an electronic health record (EHR) system that provides
a patient portal.
Patients can use the patient portal to access their medical history, manage
appointments and request refills.
Overall, you can use technology to give patients greater control of their care and
help them be more accountable.
THANK YOU
REFLEKSI KINERJA INDIVIDU
DAN TIM

Ns. Oka Ari Kamayani

Definisi

“to bend”
Bahasa
Refleksi atau “to
latin
turn back”
Definisi

Proses atau Sehingga dapat

Untuk
tindakan diinterpretasi
Dlm konteks melihat memproses atau dilakukan
pendidikan pengalaman analisis
Kembali masa
yang didapat
lampau
Definisi

Proses terjadi sebelum, mengembangkan

metakogni selama dan pemahaman
mengenai diri
sesudah
tif (proses sendiri dan situasi
situasi tertentu yang dihadapi
berpikir)
Cara melakukan refleksi terhadap
performance diri
 Tanyakan pada diri sendiri
 Tanyakan pada teman
 Membuat catatan
Karakteristik Pembelajaran Reflektif
Model belajar yang mengutamakan:
 Proses belajar atas dasar refleksi diri
 Pengalaman masa lalu
 Harapan masa depan
Teori Belajar Kognitivist
 Teori kognitivisme mempercayai bahwa
belajar merupakan pengorganisasian
unsur-unsur kognitif dan persepsi untuk
mendapatkan pemahaman dan
pengertian
 Mengembangkan pemikiran kritis melalui
refleksi adalah salah satu komponen paling
penting dari orientasi pembelajaran
kognitivist.
Teori Belajar Kognitivist
 Menurut Boud dan Walker, proses reflektif
memiliki tiga tahapan, yakni:
✓ Kembali ke dan memutar balik
pengalaman
✓ Menghadirkan perasaan yang ditimbulkan
oleh pengalaman tersebut
✓ Mengevaluasi ulang pengalaman yang
didapat.
 Proses refleksi ini dapat terjadi selama
atau setelah pengalaman terjadi
Manfaat refleksi
 Meningkatkan profesionalisme
 Meningkatkan kompetensi
 Menemukan kelebihan dan kekurangan
masing-masing
 Menanggapi sesuatu dengan bijak
Proses refleksi
Menurut Schon, ada dua macam proses
refleksi diri yaitu:
 Refleksi on action adalah proses berpikir
atau refleksi diri yang dilakukan setelah
suatu kejadian berlangsung.
 refleksi in action merupakan proses
berpikir atau refleksi diri yang dilakukan
selama kejadian masih berlangsung
Model refleksi
 Kolb’s Experiential Learning Cycle
 Model ALACT (Action, Looking back on
action, Awareness of essential aspect,
Creating alternative method)
Kolb’s Experiential Learning Cycle
 Proses dimana pembelajaran terjadi melalui
pengalaman.
 Pengalaman ini harus diinterpretasikan dan
diintegrasikan dengan struktur pengetahuan
yang sudah ada untuk menjadi pengetahuan
baru atau yang lebih luas.
 Refleksi menjadi penting untuk proses
pembelajaran ini.
 Pendekatan “experential learning cycle”,
memiliki empat fase utama
Kolb’s Experiential Learning Cycle
Kolb’s Experiential Learning Cycle
Where did you start?
 Did you think about it or imagine what it’d
be like first? (Abstract Conceptualization)
 Did you go in and just start doing stuff with
no experience? (Concrete Experience)
 Did you watch somebody? (Reflective
Observation)
 Did you try to do something a little
differently or better? (Active
Experimentation)
Cara melakukan refleksi model
ALACT
Action
 Tahap pertama adalah tindakan yang
dilakukan sebagai pengalaman. Tahap ini
membantu kita untuk mendapatkan
pengalaman.
Looking back on the action
 Tahap kedua ini adalah tahap melihat
kembali kebelakang terhadap tindakan
yang telah dilakukan.
 Memikirkan lagi apa yang ingin dicapai
atau yang diinginkan
Looking back on the action
Hal-hal yg dipertanyakan:
 Apa konteksnya?
 Apa yang kita inginkan?
 Apa yang kita lakukan?
 Apa yang kita pikirkan?
 Apa yang kita rasakan?
Awareness of essential aspect
 Tahap ini bertujuan untuk menilai kualitas
keputusan pada situasi yang nyata dan
mengatasi keterbatasan (keterbatasan
tindakan, perasaan dan kepercayaan).
 Aspek yang ada pada tahap ketiga ini
adalah perhatian, empati, penerimaan,
kesungguhan, kenyataan, konfrontasi,
kesimpulan, kegunaan untuk sekarang,
serta membuat sesuatu.
Creating alternative methods of
action
 Semua keterampilan atau pengalaman
sebelumnya, dapat membantu menemukan
dan memilih solusi.
Trial
 Melanjutkan proses pembelajaran dengan
melakukan tindakan lebih baik
 TEAM, TEAM DEVELOPMENT,
AND EFFECTIVE TEAMWORK

DESAK KETUT ERNAWATI PHD APT

UNIT IPE FK UNUD
Learning Outcomes

The undergraduate students will be able to describe the process of team development and the roles and
practices of effective teams
Learning Objectives:
1. Understand terminology used in interprofessional collaboration
2. Identify process of team development
3. Discuss team model in providing healthcare services
4. Identify teamwork ineffectiveness due to team conflict
5. Discuss characteristics of effective interprofessional collaboration
OVERVIEW
- Terminologies

- Process of Team Development

- Team model

- Effective vs ineffective teamwork

Lessons learned
❖ One may have certain expertise not everything

❖Need to talk and open their mind to other expertise's

❖Need collaboration in place to treat patients’ problems

Building common understanding
 Terminology
Team Teamwork
a group of people organized to work together is the ability a group of people have to
work well together.
a group of players forming one of the sides in
Today's complex buildings require close
a sporting contest
teamwork between the architect and the
Interprofessional builders.
Synonyms: cooperation, collaboration, unit
Collaboration y, concert

is the act of working together to produce a

piece of work, especially a book or
some research.
Himmelman’s Collaborative Continuum, 2012
Various ways of working together between organisations
Networking: involve exchange of information for mutual benefit
Coordination: builds upon aspects of networking by adding the dimension
of altering activities for mutual benefit and to achieve a common
purpose. Typically through better coordinating of programs and services,
user-friendliness and access can be enhanced
Cooperation: builds on all the dimensions of cooperation and adds
sharing of resources. Resources can be human, fiscal, or technical,
such as knowledge resources.
Collaboration: includes all of the above dimensions plus
involves enhancing the capacity of another for mutual benefit and to
achieve a common purpose.
 Group vs Team
GROUP TEAM
Not all group is a team All team is a group
Members only do their role – based on what to do Members have the contribution to organization
Grouping is based on administrative approach Members realise interdependences among each
other
Commitment based on benefits obtained Commitment based on sense of belonging
Carefully deliver their thought Trust is built and members freely deliver their
thought
Lack of tolerance Understand of each other’s perspective
Conflict mostly unresolved Conflict as a resource for creativity
Members has no active contributions to group Members participated actively in group decisions
decisions
Process of Team Development
(Tuckman Model)
https://drive.google.com/file/d/10thTNfJu-4kb0lk1hWtOM7iY2ni21B1G/view?usp=sharing
 Team building development
(Richard Chang)

Arrive
Thrive
Strive
Drive
The importance of Leadership
- Define and maintain the structure of team

- Manage human resources

- Manage conflict in the team

- Listen, support and trust the members

- Shared leadership – people and task management

Shared leadership occurs when a group of individuals lead each other to achieve
successful outcomes (Carson, Tesluk, & Marrone, 2007).
Team Model in Healthcare
One stop shopping → rapid communication and the opportunity for multiple team members to
see a patient during a single clinic encounter → coordination based on team member’s
availability

Teamlet → longer time (15mins) for patients with chronic disease → primary care provider and
health coach – ‘a little team’ within a larger primary care team

Integrated care → bringing together comprehensive care based on patients’ needs. Employ
multidisciplinary approach and across care (mostly involving mental healthcare)
Team decision making
To assess whether a patient receive sufficient support and skills from other healthcare providers

How? Who?

What?
Where?

When?
Team Conflict
Step 1
Step 2 Identifying Step 3 Listening
Acknowledging
‘real’ conflict all perspective
conflict

Step 5 Gaining
Step 4 Evaluating
agreement and Step 6 Further
ways to resolve
responsibility to examination
conflicts
find solutions
 Styles in Resolving Conflict
Style Characteristics Reasons
Avoid Avoiding confrontation, denying May ruin relationship, no big deal,
conflict is happening may cause other BIGGER problems
Accommodate Approval, not aggressive, May ruin relationship
cooperative and ignoring own
needs
Win-Lost Confrontative, aggressive, must win Show superiority
Compromise Aims to reach main target and No body perfect
maintain relationship, aggressive
but cooperative
Win-win Both sides are valid and relevant, Open discussion, both side win
respecting each other, supportive
and cooperative
EFFECTIVE TEAMWORK
Effective Team Work - Do's and Don't - YouTube
 The importance of effective
teamwork
o Reachable team goal

o Commitment to support each other

o Open communication

o Resolve conflict more effectively

o Obtain feedback of their performance

o Improve productivity

o Rewards to team work

o Members of team have full of ideas

o Task is completed
 Effective vs Ineffective
Teamwork
❖Shared goals ❑ unclear team goals

❖Clear roles – every team member ❑ unclear roles

have different role and complimentary ❑ ineffective communication
❖Trust – no hidden agenda ❑ not freely to talk – judgemental, lack of trust

❖Effective communication – freely says ❑ Formal meeting and very rigid

their words, no hesitance ❑ high participation, but no results
❖Effective leadership ❑ team decision is made by the leader with lack of
members’ involvement
❖ Each team member is willing to do a
self reflection on what to improve ❑ no self assesment
 Characteristics of Effective Team
Member
1. being proactive
2. first thing first
3. always begin from an end
4. win – win solutions
5. try to understand others before being understood
6. togetherness
7. self-development
8. Communication is the KEY
 References
1. Collaboration Structures : Toolkit2Collaborate

2. Buring SM, Bhushan A, Broeseker A, Conway S, Duncan-Hewitt W, Hansen L,

and Westberg S. Interprofessional Education: Definitions, Student Competencies, and
Guidelines for Implementation. Am J Pharm Educ. 2009 Jul 10; 73(4): 59.3.

3. Guraya SY, Barr H. The effectiveness of interprofessional education in healthcare: A

systematic review and meta-analysis. The Kaohsiung Journal of Medical Sciences;
34(3), March 2018, 160-165.

4, Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education:effects on professional

practice and healthcare outcomes. Cochrane Systematic Review Intervention.

5, Lamb G. Introduction to Team Decision Making in Primary Care. Center for Advancing Interprofessional Practice,
Education and Research, 2017.
 Apply leadership practices that
support collaborative practice and
team effectiveness

Dr.dr. Desak Ketut Indrasari Utami, SpS (K)

*InterprofessionalUnit Medical Faculty of Udayana University

**Neurology Department Medical Faculty of

Udayana University
2022
LEARNING OBJECTIVE: At the end of the lecture the students must be able to:

1. Describe the core competencies of interprofessional education

2. Describe the definition of leadership practice
3. Describe the meaning of collaborative practice
4. Describe the meaning of team effectiveness
5. Explain the example of leadership practice in healthcare
6. Explain the principles of leadership practice to support collaborative practice
and team effectiveness
7. Explain the obstacles/challenge of leadership practice in interprofessional
collaboration

LEARNING OUTCOME:

The students understand how to apply leadership practice to support collaborative

practice and team effectiveness
 Collaborative
practice

Team effectiveness

Leadership practice
• The six CIHC competency domains are:
1. Role clarification
2. Team functioning
3. Interprofessional communication
4. Patient/client/family/community-centered care
5. Interprofessional conflict resolution
6. Collaborative leadership

Canadian Interprofessional
competencies (CIHC 2010)
• The Interprofessional Education Collaborative
(IPEC,2016) core competencies are :
1. Values/Ethics for Interprofessional Practice
2. Roles/Responsibilities
3. Interprofessional Communication
4. Teams and Teamwork.

IPE FK Unud 2020

• Competency 1 : Work with individuals of other
professions to maintain a climate of mutual
respect and shared values. (Values/Ethics for
Interprofessional Practice)
• Competency 2 : Use the knowledge of one’s own
role and those of other professions to
appropriately assess and address the health care
needs of patients and to promote and advance
the health of populations. (Roles/Responsibilities)
• Competency 3 : Communicate with patients, families,
communities, and professionals in health and other
fields in a responsive and responsible manner that
supports a team approach to the promotion and
maintenance of health and the prevention and
treatment of disease. (Interprofessional Communication)

• Competency 4 : Apply relationship-building values and

the principles of team dynamics to perform effectively in
different team roles to plan, deliver, and evaluate
patient/population- centered care and population health
programs and policies that are safe, timely, efficient,
effective, and equitable. (Teams and Teamwork).
 Collaborative
practice

Team effectiveness

Leadership practice
Interprofessional collaboration is the process of
developing and maintaining effective
interprofessional working relationships with
learners, practitioners, patients/clients/ families
and communities to enable optimal health
outcomes. Elements of collaboration include
respect, trust, shared decision making, and
partnerships.
Interprofessional collaborative practice
is
“When multiple health workers from
different professional backgrounds work
together with patients, families, [careers],
and communities to deliver the highest
quality of care.

WHO, 2010
Team Effectiveness

Adalah kapasitas yang dimiliki tim

untuk mencapai tujuan dan
sasarannya dari waktu ke waktu.

Agar tim menjadi sangat efektif,

pemimpin perlu menciptakan
lingkungan kerja dan budaya tim yang
baik untuk mencapai tuuan.
• A team is not always effective, especially a team
consisting of a variety of different professions.

• Six factors that must be obeyed by each member

in order for a team to be effective, namely:
(1) understanding the goals that must be achieved
(2) provide support and be guided by the rules in
determining every decision
(3) can communicate openly
(4) mutual acceptance and assistance
(5) resolving conflicts openly and constructively
(6) diagnosing each problem and increasing the
ability of each according to its function.
Five essential components to every effective team :

1. Psychological safety: Team members feel safe taking risks,

frequently asking for feedback, and being vulnerable in front of
each other. Folks comfortably admit to failure and bring up issues
they may be experiencing.
2. Trust: Team members can count on each other to get things done
on time and meet a shared standard for excellence. Your team
knows what everyone is working on and communicates about
deadlines and progress.
3. Structure and clarity: Team members have clear roles, plans, and
goals. There's a clear process for decision-making. Every project has
one owner and folks have all the information they need to do their
job, which helps everyone stay accountable to commitments.
4. Meaning: Team members find a sense of purpose in their work.
Some examples of purpose include: financial security, supporting
family, helping the team succeed, or self-expression for each
individual.
5. Impact: Team members believe their work matters and can create
change.
1. Effective Communication

2. Integrity Leadership practice

3. Accountability
4. Charisma → actions and strategies
5. Empathy
6. Confidence
7. Humility
8. Positivity
9. Vision
10. Delegation
11. Loyalty
12. Influence

Leadership qualities
o More recently, the focus has shifted towards “team
leadership”, with distributed leadership becoming
more prevalent within healthcare education, where
different professions share influence.
o Increasingly, leadership involves a collaborative role,
with an emphasis on shared leadership and thoughtful
allocation of responsibilities. Team-based organisations
shift central control from the one leader, to the team
o There are now many leadership programmes available
to healthcare professionals. The more recent
Healthcare Leadership Model has been designed to
allow healthcare workers of all backgrounds to become
better leaders and consists of nine dimensions
• Adequate and effective leadership is essential to
addressing effective team works.
• Heinneman and Zeiss suggest “leadership among
members is based upon the need for specific kinds of
expertise needed at a given point in time”
• There are two components to the leadership role:
task-orientation and relationship-orientation.
• In the former, the leader helps other members keep
on task in achieving a commonly agreed upon goal,
while in the latter, the leader assists members to work
more e ectively together
 Leadership for team effectiveness

Dalhousie University, Canada 2013

 DME team Terima kasih

16 June 2017 23
 SHARE ACCOUNTABILITY WITH OTHER
PROFESSIONS, PATIENTS, AND
COMMUNITIES FOR OUTCOMES
RELEVANT TO PREVENTION AND HEALTH
CARE
(BERBAGI AKUNTABILITAS DENGAN PROFESI LAIN, PASIEN,
DAN MASYARAKAT UNTUK HASIL YANG RELEVAN DENGAN
PENCEGAHAN DAN PERAWATAN KESEHATAN)
 WHAT IS ACCOUNTABILITY IN HEALTH SYSTEMS?
• INDIVIDUALS ARE RESPONSIBLE FOR THEIR ACTIONS
AND OBLIGATED TO EXPLAIN THEIR CHOICES.
• GENERALLY, BEING ABLE TO JUSTIFY YOUR ACTIONS
LEADS TO A REWARD.
• NOT BEING ABLE TO EXPLAIN AN ERROR OR
WRONGDOING BRINGS CONSEQUENCES.
Why Is Accountability Important in Healthcare?
1. Critical in all aspects of the healthcare system, from
government health policies to employee training
programs.
2. Without accountability, healthcare facilities and
counseling practices risk decreased morale and
productivity, ultimately reducing patients' quality of
care.
3. Members are prepared to correct mistakes, find
solutions and commit to responsibilities rather than
make excuses.
4. Allows to learn from errors: can improve your
practice's reputation, reach business goals, decrease
the risk of lawsuits and improve patients satisfaction.
Why Is Accountability Important in Healthcare?

5. Patient accountability in healthcare is

equally important and can lead to
positive treatment outcomes.
6. When patients acknowledge the
obstacles that keep them from reaching
goals, they can change negative
behaviors.
7. Improved quality of care and value of
services
8. Accountability reduces the amount on
miused resources: care more affordable
 THE COMPONENTS OF ACCOUNTABILITY
WHO—THE LOCUS OF ACCOUNTABILITY
1. INDIVIDUAL PATIENTS;
2. INDIVIDUAL PHYSICIANS;
3. NONPHYSICIAN HEALTH CARE PROVIDERS SUCH AS NURSES AND PHYSICAL
THERAPISTS;
4. HOSPITALS;
5. MANAGED CARE PLANS;
6. PROFESSIONAL ASSOCIATIONS;
7. EMPLOYERS
8. PRIVATE PAYERS, SUCH AS BLUE CROSS;
9. THE GOVERNMENT;
10. INVESTORS
11. AND LAWYERS AND COURTS.
 THE COMPONENTS OF ACCOUNTABILITY

WHAT—THE DOMAINS OF ACCOUNTABILITY

• PROFESSIONAL COMPETENCE
• LEGAL AND ETHICAL CONDUCT
• FINANCIAL PERFORMANCE
• ADEQUACY OF ACCESS
• PUBLIC HEALTH PROMOTION
• AND COMMUNITY BENEFIT
 SOCIAL ACCOUNTABILITY
• SOCIAL ACCOUNTABILITY HAS BEEN DESCRIBED AS A ‘‘CULTURAL
CHANGE’’ AND A ‘‘NEW PARADIGM’’
• MEMBUTUHKAN SEMUA PIHAK YANG BERKEPENTINGAN UNTUK BEKERJA
SAMA DALAM MENENTUKAN PERAN TIAP INDIVIDU DAN TANGGUNG
JAWAB KOLEKTIF YANG BERKELANJUTAN DARI WAKTU KE WAKTU
• KOMPONEN KEMITRAAN AKUNTABILITAS SOSIAL MELIBATKAN PEMBUAT
KEBIJAKAN, MANAJER KESEHATAN, PROFESI KESEHATAN, MASYARAKAT
DAN LEMBAGA AKADEMIK YANG BEKERJA SAMA DENGAN FOKUS UTAMA
PADA KEBUTUHAN MASYARAKAT
 THE COMPONENTS OF ACCOUNTABILITY
HOW—THE PROCEDURES OF ACCOUNTABILITY
• EVALUASI KEPATUHAN
• SOSIALISASI EVALUASI DAN TANGGAPAN ATAU
JUSTIFIKASI OLEH PIHAK ATAU PIHAK YANG
BERTANGGUNG JAWAB
• PROSEDUR EVALUASI FORMAL DAPAT MENCAKUP PEMERIKSAAN
FASILITAS, CATATAN, DAN KEBIJAKAN OLEH KOMISI BERSAMA
UNTUK AKREDITASI ORGANISASI KESEHATAN
 HOW IS ACCOUNTABILITY MEASURED?

• MORE LIKELY TO INCREASE IF IT CAN BE MEASURED

• IN GENERAL, HEALTHCARE FACILITIES MEASURE FINANCIAL AND
PERFORMANCE ACCOUNTABILITY.
• FINANCIAL ACCOUNTABILITY INVOLVES TRACKING AND
REPORTING THE USE OF MONETARY RESOURCES.
• PERFORMANCE ACCOUNTABILITY MAY REFER TO MEASURING
HOW WELL CLINICIANS AND STAFF MEMBERS MEET GOALS OR
SCORE ON PATIENT SATISFACTION SURVEYS.
 HOW IS ACCOUNTABILITY MEASURED?

• ACCOUNTABILITY CAN HELP PATIENTS WHO STRUGGLE TO

PROGRESS OR CHANGE HARMFUL BEHAVIORS.
• EVALUATE PATIENTS DEVELOPMENT OFTENLY.
• IF THE PATIENTS ISN'T ACCOMPLISHING ANY GOALS, ASK THEM
QUESTIONS AND DETERMINE WHAT NEEDS TO CHANGE.
• MAKE SURE PATIENTS UNDERSTAND YOU'RE TRYING TO FIND
SOLUTIONS AND ARE NOT INTERESTED IN PUNISHING THEM.
 HOW IS ACCOUNTABILITY MEASURED?

• YOU MIGHT ASK QUESTIONS SUCH AS:

• WHY ARE SOME TASKS NOT COMPLETED?
• ARE SOME ACTIVITIES NOT IMPORTANT TO YOU?
• ARE SOME ACTIVITIES TOO DIFFICULT TO COMPLETE?
• DID YOU SET TIME ASIDE TO COMPLETE THE TASK?
• DID SOMETHING UNEXPECTED HAPPEN TO PREVENT YOU FROM
FINISHING AN ASSIGNMENT?
 ACCOUNTABILITY BEST PRACTICES
HERE ARE A FEW BEST PRACTICES TO KEEP IN MIND REGARDING TO ACCOUNTABILITY:
• KNOW THE REASONS: MAKE SURE YOU AND YOUR PATIENTS UNDERSTAND YOUR ACTIONS AND THE PURPOSE OF THEIR
TREATMENT GOALS.
• CONSIDER YOUR QUALIFICATIONS: ALWAYS ENSURE YOU'RE QUALIFIED AND TRAINED TO PROVIDE A SERVICE YOUR PATIENTS
REQUESTS BEFORE TAKING ACTION.
• AGREE ON TREATMENT: ANY STEPS YOU TAKE TO HELP YOUR PATIENTS SHOULD BE PART OF AN AGREED-UPON PLAN.
• SET CLEAR BOUNDARIES: YOU MAY NEED TO ENSURE YOUR PATIENTS UNDERSTANDS YOUR ROLE BY ESTABLISHING CLEARLY
DEFINED BOUNDARIES.
• MONITOR AND EVALUATE: KEEP TRACK OF YOUR PATIENTS'S PROGRESS, SO YOU CAN IDENTIFY ISSUES EARLY AND MAKE
RECOMMENDATIONS. SPEND TIME PERIODICALLY ASSESSING THE EFFECTIVENESS OF A PATIENTS'S CURRENT TREATMENT PLAN.
• HELP EMPLOYEES CHANGE: MAKE SURE EMPLOYEES UNDERSTAND THE IMPORTANCE OF ACCOUNTABILITY IN YOUR PRACTICE
AND HOW IT IMPACTS PATIENT CARE AND YOUR FACILITY'S SUCCESS. ENCOURAGE EMPLOYEES TO SHARE THEIR THOUGHTS AND
FEELINGS.
• MAKE IT EASY: THE CONCEPT OF ACCOUNTABILITY CAN FEEL OVERWHELMING TO BOTH PATIENTS AND STAFF. FOCUS ON
CHANGING ONE BEHAVIOR AT A TIME.
• BE HONEST: PART OF ACCOUNTABILITY IS BEING HONEST. SET AN EXAMPLE BY BEING HONEST IF YOU MAKE A MISTAKE AND
ENCOURAGE EMPLOYEES TO DO THE SAME.
Challenges in Accountability
If theres any struggle with accountability, try to identify and address the root
cause. Some possible reasons patients may have trouble with this concept
include:
•Problems at home:
1. patients may face issues such as financial instability or lack of support at
home.
2. Some obstacles may prevent them from focusing on achieving treatment
goals and improving their mental and physical health.
3. If you find patients struggling to reach goals due to challenges at home,
you may need to adjust their treatment plan to suit their situation better.
4. Remind them that they can still change their behavior to improve their
health, even if they need to take baby steps.
Challenges in Accountability
•Fear of consequences:
1. If employees or patients worry about the repercussions
of making mistakes or failing to reach goals, they're
less likely to embrace accountability.
2. Remind staff members that everyone makes mistakes
sometimes, and help employees or patients feel safe
reporting errors or expressing their concerns.
•Mental health and health information systems
Challenges in Accountability
• Lack of Willingness to therapy:
1. Some patients may be pushed by their environment to meet with a
counselor.
2. If patients feel they don't need therapy, they might challenge
accountability.
3. Resistant patients require patience, empathy and creativity.
4. You may need to find new ways to interact with them.
5. Allow time for them to trust you.
6. Once you build a connection, they'll be more likely to work to change their
behaviors.
7. If you feel stuck along the way, consider turning to peers for support.
 How to Encourage Accountability
Begin With Collaboration
1. Ensure patients understand that change happens internally and that
you must work as a team to help them overcome difficulties and
improve their behavior.
2. Let them know you're there to help them make sense of their
priorities and transform these into real goals, but they still have to
do their part to make things happen.
3. Remind them that it's better to be honest if they can't reach a goal
rather than make an excuse.
 How to Encourage Accountability
Set Clear Expectations
Setting clear expectations is an essential part of accountability.
Patients or team are not likely to put their best effort into reaching goals if they
don't know what's expected of them or why they are working toward a specific
goal.
Be sure to express what you're hoping to achieve and how patients or employees
should complete tasks.
Invite others to share their ideas and concerns (eg. Community).
Find out what they want, what expectations they have and what issues they might
be experiencing.
You'll want to get everyone on the same page for easier collaboration and increased
willingness to share thoughts.
 How to Encourage Accountability
Discuss Capabilities
Patients can't reach goals if they do not have the skills or resources
needed to complete certain activities.
To avoid accountability issues in the first place, set patients and staff up
for success by making sure they are capable of doing what's asked of
them.
Consider what specific tools they might need to achieve certain
objectives.
Can they obtain these things if they don't currently have them? What
can you do to make that process easier?
How to Encourage Accountability

Determine How You'll Measure Progress

You and your patients should set clear, measurable treatment goals
and objectives together and agree on how you'll measure their
progress.
Find out how much time your patients is comfortable spending on
assessments or other tools to gauge treatment effectiveness.
How to Encourage Accountability
Give Feedback
Continually check in with patients and discuss their thoughts and
feelings about their therapy sessions.

You'll also want to provide feedback and share your thoughts about a
patients's progress to the collaboration team and community.

Encourage open communication and remind the patients that you want
them to have a more satisfying experience.
How to Encourage Accountability
Build a Strong Connection
If patients resist adopting accountability and working on treatment
goals, you may need to give them more time to develop a greater
sense of trust.
Patients more likely to share their true feelings, thoughts, needs and
anything else required to help them change and accomplish goals.
They are also more likely to admit mistakes. Ensure they know you're
there to help them find a solution if they're having trouble reaching
goals.
How to Encourage Accountability
Acknowledge Success

Whether you're working on building accountability in your practice

or helping patients get motivated, make sure to acknowledge
accomplishments.
Encourage them to reward themselves after they complete therapy-
related homework assignments.
How to Encourage Accountability

Provide Tools
Offering technological tools that make patients easier for them to manage their
health.
For example, you can use an electronic health record (EHR) system that provides
a patient portal.
Patients can use the patient portal to access their medical history, manage
appointments and request refills.
Overall, you can use technology to give patients greater control of their care and
help them be more accountable.
THANK YOU
REFLEKSI KINERJA INDIVIDU
DAN TIM

Ns. Oka Ari Kamayani

Definisi

“to bend”
Bahasa
Refleksi atau “to
latin
turn back”
Definisi

Proses atau Sehingga dapat

Untuk
tindakan diinterpretasi
Dlm konteks melihat memproses atau dilakukan
pendidikan pengalaman analisis
Kembali masa
yang didapat
lampau
Definisi

Proses terjadi sebelum, mengembangkan

metakogni selama dan pemahaman
mengenai diri
sesudah
tif (proses sendiri dan situasi
situasi tertentu yang dihadapi
berpikir)
Cara melakukan refleksi terhadap
performance diri
 Tanyakan pada diri sendiri
 Tanyakan pada teman
 Membuat catatan
Karakteristik Pembelajaran Reflektif
Model belajar yang mengutamakan:
 Proses belajar atas dasar refleksi diri
 Pengalaman masa lalu
 Harapan masa depan
Teori Belajar Kognitivist
 Teori kognitivisme mempercayai bahwa
belajar merupakan pengorganisasian
unsur-unsur kognitif dan persepsi untuk
mendapatkan pemahaman dan
pengertian
 Mengembangkan pemikiran kritis melalui
refleksi adalah salah satu komponen paling
penting dari orientasi pembelajaran
kognitivist.
Teori Belajar Kognitivist
 Menurut Boud dan Walker, proses reflektif
memiliki tiga tahapan, yakni:
✓ Kembali ke dan memutar balik
pengalaman
✓ Menghadirkan perasaan yang ditimbulkan
oleh pengalaman tersebut
✓ Mengevaluasi ulang pengalaman yang
didapat.
 Proses refleksi ini dapat terjadi selama
atau setelah pengalaman terjadi
Manfaat refleksi
 Meningkatkan profesionalisme
 Meningkatkan kompetensi
 Menemukan kelebihan dan kekurangan
masing-masing
 Menanggapi sesuatu dengan bijak
Proses refleksi
Menurut Schon, ada dua macam proses
refleksi diri yaitu:
 Refleksi on action adalah proses berpikir
atau refleksi diri yang dilakukan setelah
suatu kejadian berlangsung.
 refleksi in action merupakan proses
berpikir atau refleksi diri yang dilakukan
selama kejadian masih berlangsung
Model refleksi
 Kolb’s Experiential Learning Cycle
 Model ALACT (Action, Looking back on
action, Awareness of essential aspect,
Creating alternative method)
Kolb’s Experiential Learning Cycle
 Proses dimana pembelajaran terjadi melalui
pengalaman.
 Pengalaman ini harus diinterpretasikan dan
diintegrasikan dengan struktur pengetahuan
yang sudah ada untuk menjadi pengetahuan
baru atau yang lebih luas.
 Refleksi menjadi penting untuk proses
pembelajaran ini.
 Pendekatan “experential learning cycle”,
memiliki empat fase utama
Kolb’s Experiential Learning Cycle
Kolb’s Experiential Learning Cycle
Where did you start?
 Did you think about it or imagine what it’d
be like first? (Abstract Conceptualization)
 Did you go in and just start doing stuff with
no experience? (Concrete Experience)
 Did you watch somebody? (Reflective
Observation)
 Did you try to do something a little
differently or better? (Active
Experimentation)
Cara melakukan refleksi model
ALACT
Action
 Tahap pertama adalah tindakan yang
dilakukan sebagai pengalaman. Tahap ini
membantu kita untuk mendapatkan
pengalaman.
Looking back on the action
 Tahap kedua ini adalah tahap melihat
kembali kebelakang terhadap tindakan
yang telah dilakukan.
 Memikirkan lagi apa yang ingin dicapai
atau yang diinginkan
Looking back on the action
Hal-hal yg dipertanyakan:
 Apa konteksnya?
 Apa yang kita inginkan?
 Apa yang kita lakukan?
 Apa yang kita pikirkan?
 Apa yang kita rasakan?
Awareness of essential aspect
 Tahap ini bertujuan untuk menilai kualitas
keputusan pada situasi yang nyata dan
mengatasi keterbatasan (keterbatasan
tindakan, perasaan dan kepercayaan).
 Aspek yang ada pada tahap ketiga ini
adalah perhatian, empati, penerimaan,
kesungguhan, kenyataan, konfrontasi,
kesimpulan, kegunaan untuk sekarang,
serta membuat sesuatu.
Creating alternative methods of
action
 Semua keterampilan atau pengalaman
sebelumnya, dapat membantu menemukan
dan memilih solusi.
Trial
 Melanjutkan proses pembelajaran dengan
melakukan tindakan lebih baik
Use Process Improvement to Increase
Effectiveness of Interprofessional
Teamwork and Team-based Services,
Programs, and Policies
Dr. dr. Ketut Suarjana, MPH
 Learning Outcome
1. To explain aspects of the quality of health services, i.e., safe, timely,
efficient, effective, and equitable.
2. To understand the concept of process improvement and continuous
improvement of health services, programs, and policies
3. To understand and explain methods or tools to improve health
services, programs, and policies
4. To assess the effectiveness of interprofessional teamwork and
team-based services, programs, and policies
5. To improve the quality of interprofessional teamwork and team-
based services, programs, and policies
Mutu?
Pasien ?
Masyarakat ?
Nakes ?
Manajemen ?
 Definition

Donabedian
• The absolutist definition: the possibility of benefit and harm to
health as valued by practitioner, with no attention to cost
• The individualized definition: the patient’s expectations of benefit
and/or harm and other undesired consequences
• The social definition: the cost of care, the benefit/harm
continuum, distribution of health care as valued by the population
in general
 Mutu Pelayanan Kesehatan
• Kinerja yang menunjuk pada tingkat
kesempurnaan pelayanan kesehatan,
yang disatu pihak dapat menimbulkan
kepuasan pada setiap pasien sesuai
dengan tingkat kepuasan rata-rata
penduduk, serta dipihak lain tata cara
penyelenggaraannya sesuai dengan
standar dan kode etik profesi yang
telah ditetapkan (Kemkes)
 Mengapa Kita Peduli Terhadap Mutu ?

• Pelayanan yang bermutu adalah pelayanan yang professional

• Pelayanan yang bermutu adalah hak pasien
• Memberikan pelayanan yang bermutu berarti memberikan yang
terbaik bagi pasien/pelanggan
• Pelayanan yang bermutu memberi peluang untuk memenangkan
persaingan
• Pelayanan yang diberikan melibatkan berbagai pihak terkait
(interprofesional)
• Hidup mati organisasi bergantung pada pelanggan, sehingga
pelanggan perlu dipuaskan
It Is All About Clients
 The SERVQUAL (Parasuraman)

• Instrumen untuk mengukur tingkat kepuasan pesien terhadap mutu

pelayanan kesehatan
Quality is not by accident
but it is by design

Organizing Quality
 Organizing Quality
• Koordinasi secara rasional kegiatan sejumlah profesi
untuk mencapai mutu pelayanan kesehatan yang
sempurna sesuai dengan standar yang telah
ditetapkan yang dirumuskan secara eksplisit, melalui
pengaturan dan pembagian kerja serta melalui
hirarki kekuasaan dan tanggung jawab
• Organizing Quality
✓Standar Profesi
✓Struktur organisasi
 Masyarakat

Standar Pelayanan

Standar Standar Standar

Teknis Teknis Teknis

Fasilitas dan peralatan

Kebijakan dan manajemen
Standar teknis
Organisasi dan manajemen pelayanan : Standard Operating
Procedures

Praktik klinis: Panduan praktik klinis, protokol klinis (Clinical Practice

Guidelines/ Standards or Clinical Protocols), dan Care Pathways
Integrated Standard
 Organizing Quality
• Struktur Organisasi
• Organisasi pelayanan kesehatan menggunakan beberapa alat
(tools) pengorganisasian mutu:
✓Tim manajemen mutu (mis: Puskesmas, RS, dll)
✓Gugus Kendali Mutu (GKM), contoh RS
Interprofesional
✓Akreditasi (Tim Task Force)
✓Sistem Manajemen Mutu (SMM)
 Quality
Empat Improvement
kaidah/prinsip Principles
perbaikan mutu
1. Berorientasi pada memenuhi harapan dan kebutuhan
pelanggan (pasien) dan masyarakat
2. Berfokus pada sistem (I – P – O) terutama proses
3. Menggunakan data untuk menganalisis proses pemberian
pelayanan → quality measure
4. Mendorong penerapan pendekatan tim (interprofessional)
untuk pemecahan masalah dan perbaikan mutu yang
berkesinambungan (continuous improvement)
 Quality Improvement Process

Tidak diukur Variasi Proses

?
Tidak dimonitor Ketidakmampuan
Tidak dikendalikan Masalah mutu
Proses
(dengan standar)

Tidak dipelihara Kegagalan proses

Pelanggan tidak puas
(audit klinis) Pelayanan lamban
Tidak diperbaiki Pelayanan tidak
mencapai sasaran
Pelayanan tidak efisien
 A S

C D

Perbaikan A P
Proses C/S D

Re-engineering
 Quality Improvement Process
1. Pendekatan dengan menetapkan standar mengikuti siklus SDCA:
• Standardize (Tetapkan standar)
• Do (Kerjakan)
• Check (Periksa hasilnya)
• Act (Kerjakan untuk seterusnya, atau lakukan modifikasi thd standar)
2. Pendekatan secara bertahap melalui tim (team based), mengikuti siklus
PDCA
• Plan (Rencanakan perbaikan melalui identifikasi masalah s/d menyusun rencana)
• Do (Kerjakan)
• Study/Check (Periksa hasilnya)
• Act (Kerjakan untuk seterusnya, standarkan, atau lakukan modifikasi)
3. Pendekatan perbaikan proses secara cepat/radikal: dengan
menerapkan re-engineering
The Chain of Effect in Improving Health Care Quality
(Donald Berwick)

Patient and the Experience Aims (e.g. safe, effective

Community Individualized prompt, affordable)

Simple rules/design concepts

Micro-system Process (e.g. science based action, system
Customization)

Organizational Facilitator of Design Concepts (e.g. managerial

Context Process Compensation)

Environmental Facilitator of Design concepts (e.g. financing,

Context Facilitators regulation)
The Chain of Effect in Improving Health Care Quality
(Donald Berwick)

1. Pengalaman pasien
• Kecewa terhadap pelayanan yang lambat sehingga ibu bersalin
mati
• Kecewa terhadap kurang profesional pelayanan yang diberikan
sehingga inu bersalin mati
• Terlambat merujuk
2. Sistem mikro (proses pelayanan)
• Sistem kerja yang tidak jelas
• Sistem kerja yang lambat dan tidak efisien
• Sistem kerja yang tidak efektif
The Chain of Effect in Improving Health Care Quality
(Donald Berwick)

3. Konteks organisasi 4. Kontek lingkungan:

• Job description yang tidak jelas • Kebijakan yang tidak mendukung
• Sistem pengembangan SDM yang • Sistem pembiayaan kesehatan
lemah yang relatif rendah
• Lemahnya sistem informasi • Sistem pembiayaan kesehatan
• Sistem manajemen yang lemah yang bersifat fee for service
• Kepemimpinan klinik yang lemah • Sistem rujukan yang tidak jelas
• Sistem procurement/pengadaan • Dukungan yang kurang optimal
yang lemah dari PMI
• Kebijakan internal organisasi yang
tidak mendukung

22
Perform Effectively of
Teams and The different
Team Roles in a Variety
of Settings
PENDIDIKAN INTERPROFESSIONAL YANG
EFEKTIF (IPE)

(WHO, 2010)
 Memungkinkan Praktik Kolaboratif yang Efektif, dan
Memperkuat Sistem Kesehatan (dan Perawatan
Sosial) serta Meningkatkan Hasil Kesehatan.
Kompetensi Praktek Kolaboratif Interprofesional

 1. (Nilai/Etika dalam Praktek  3. (Komunikasi Interprofesional)

Interprofesional)
Berkomunikasi dengan pasien, keluarga, komunitas,
Bekerja dengan individu dari profesi lain untuk dan profesional kesehatan lainnya secara responsif
menjaga iklim kerja saling menghormati dan dan bertanggung jawab yang mendukung
nilai-nilai bersama. pendekatan tim dalam pemeliharaan kesehatan dan
perawatan penyakit.

 2. (Peran/Tanggung Jawab)
 4. (Tim dan Kerja Sama Tim)
Menggunakan pengetahuan tentang peran
seseorang dan profesi lain untuk menilai dan Menerapkan nilai-nilai yang membangun hubungan
menangani kebutuhan layanan kesehatan pasien dan prinsip-prinsip dinamika tim untuk bekerja
dan masyarakat yang dilayani dengan tepat. secara efektif dalam peran tim yang berbeda untuk
merencanakan dan memberikan perawatan yang
berpusat pada pasien/populasi yang aman, tepat
waktu, efisien, efektif, dan adil.
Bekerja dengan individu dari profesi lain untuk menjaga
iklim saling menghormati dan nilai-nilai bersama.
 Harapan Perilaku Nilai/Etika:
 Menempatkan kepentingan pasien dan masyarakat sebagai pusat pemberian layanan kesehatan antarprofesional.
 Menghormati martabat dan privasi pasien sambil menjaga kerahasiaan dalam pemberian perawatan berbasis tim.
 Merangkul keragaman budaya dan perbedaan individu yang menjadi ciri pasien, populasi, dan tim layanan kesehatan.
 Menghargai keunikan budaya, nilai, peran/tanggung jawab, dan keahlian profesi kesehatan lainnya.
 Bekerja sama dengan mereka yang menerima perawatan, mereka yang memberikan perawatan, dan pihak lain yang
berkontribusi atau mendukung pemberian layanan pencegahan dan kesehatan.
 Mengembangkan hubungan saling percaya dengan pasien, keluarga, dan anggota tim lainnya (CIHC, 2010).
 Menunjukkan standar perilaku etis dan kualitas layanan yang tinggi dalam kontribusi seseorang terhadap perawatan
berbasis tim.
 Mengelola dilema etika khusus untuk situasi perawatan yang berpusat pada pasien/populasi interprofesional.
 Bertindak dengan kejujuran dan integritas dalam hubungan dengan pasien, keluarga, dan anggota tim lainnya.
 Mempertahankan kompetensi dalam profesinya sesuai dengan ruang lingkup praktiknya.
Menggunakan pengetahuan tentang peran seseorang dan profesi lain untuk menilai dan
menangani kebutuhan layanan kesehatan pasien dan masyarakat yang dilayani dengan
tepat.

 Peran/Tanggung Jawab dan Harapan Perilaku:

 Komunikasikan peran dan tanggung jawab seseorang dengan jelas kepada pasien, keluarga, dan profesional lainnya.
 Menyadari keterbatasan seseorang dalam keterampilan, pengetahuan, dan kemampuan.
 Melibatkan beragam profesional kesehatan yang melengkapi keahlian profesionalnya, serta sumber daya terkait, untuk
mengembangkan strategi guna memenuhi kebutuhan perawatan pasien yang spesifik.
 Menjelaskan peran dan tanggung jawab penyedia layanan lainnya dan bagaimana tim bekerja sama untuk memberikan
layanan.
 Menggunakan seluruh pengetahuan, keterampilan, dan kemampuan para profesional kesehatan dan petugas layanan
kesehatan yang ada untuk memberikan layanan yang aman, tepat waktu, efisien, efektif, dan adil.
 Berkomunikasi dengan anggota tim untuk memperjelas tanggung jawab masing-masing anggota dalam melaksanakan
komponen rencana pengobatan atau intervensi kesehatan masyarakat.
 Membina hubungan yang saling bergantung dengan profesi lain untuk meningkatkan pelayanan dan memajukan
pembelajaran.
 Terlibat dalam pengembangan profesional dan interprofesional berkelanjutan untuk meningkatkan kinerja tim.
 Menggunakan kemampuan unik dan saling melengkapi dari semua anggota tim untuk mengoptimalkan perawatan pasien.
Berkomunikasi dengan pasien, keluarga, komunitas, dan profesional kesehatan
lainnya secara responsif dan bertanggung jawab yang mendukung pendekatan tim
dalam pemeliharaan kesehatan dan pengobatan penyakit.
 Harapan Perilaku Komunikasi Interprofesional:
 Memilih alat dan teknik komunikasi yang efektif, termasuk sistem informasi dan teknologi komunikasi, untuk memfasilitasi diskusi
dan interaksi yang meningkatkan fungsi tim.
 Atur dan komunikasikan informasi dengan pasien, keluarga, dan anggota tim layanan kesehatan dalam bentuk yang dapat
dimengerti, sebisa mungkin hindari terminologi disiplin ilmu tertentu.
 Mengekspresikan pengetahuan dan pendapat seseorang kepada anggota tim yang terlibat dalam perawatan pasien dengan percaya
diri, jelas, & hormat, berupaya memastikan pemahaman bersama mengenai informasi, pengobatan & keputusan perawatan.
 Mendengarkan secara aktif, dan mendorong ide dan pendapat anggota tim lainnya.
 Memberikan umpan balik yang tepat waktu, sensitif, dan instruktif kepada orang lain tentang kinerja mereka dalam tim, dan sebagai
anggota tim tanggapi umpan balik dari orang lain dengan penuh rasa hormat.
 Gunakan bahasa hormat yang sesuai untuk situasi sulit, percakapan penting, atau konflik antarprofesional.
 Mengenali bagaimana keunikan diri sendiri, termasuk tingkat pengalaman, keahlian, budaya, kekuasaan, dan hierarki dalam tim
layanan kesehatan, berkontribusi terhadap komunikasi yang efektif, resolusi konflik, dan hubungan kerja antarprofesional yang
positif (University of Toronto, 2008).
 Komunikasikan secara konsisten pentingnya kerja sama tim dalam perawatan yang berpusat pada pasien dan berfokus pada
komunitas.
Menerapkan nilai-nilai yang membangun hubungan dan prinsip-prinsip dinamika tim untuk bekerja
secara efektif dalam peran tim yang berbeda untuk merencanakan dan memberikan perawatan yang
berpusat pada pasien/populasi yang aman, tepat waktu, efisien, efektif, dan adil.

 Harapan Perilaku Tim dan Kerja Sama Tim:

 Jelaskan proses pengembangan tim dan peran serta praktik tim yang efektif.
 Mengembangkan konsensus mengenai prinsip-prinsip etika untuk memandu semua aspek perawatan pasien dan kerja tim.
 Melibatkan profesional kesehatan lainnya—yang sesuai dengan situasi perawatan spesifik—dalam pemecahan masalah bersama yang berpusat
pada pasien.
 Mengintegrasikan pengetahuan dan pengalaman profesi lain—yang sesuai dengan situasi perawatan tertentu—untuk memberikan informasi
dalam pengambilan keputusan perawatan, dengan tetap menghormati nilai-nilai dan prioritas/preferensi perawatan pasien dan masyarakat.
 Menerapkan praktik kepemimpinan yang mendukung praktik kolaboratif dan efektivitas tim.
 Melibatkan diri sendiri dan orang lain untuk secara konstruktif mengelola perbedaan pendapat mengenai nilai, peran, tujuan, d an tindakan yang
muncul di antara profesional kesehatan dan dengan pasien serta keluarga.
 Berbagi akuntabilitas dengan profesi lain, pasien, dan masyarakat atas hasil yang relevan dengan pencegahan dan layanan kesehatan.
 Merefleksikan kinerja individu dan tim untuk peningkatan kinerja individu dan tim.
 Menggunakan strategi perbaikan proses untuk meningkatkan efektivitas kerja tim antarprofesional dan perawatan berbasis tim.
 Gunakan bukti yang tersedia untuk menginformasikan kerja tim yang efektif dan praktik berbasis tim.
 Berkinerja efektif dalam tim dan peran tim yang berbeda dalam berbagai situasi.
Modes of Collaboration

1. Multidisciplinary
 (a) pengetahuan adalah profesi yang spesifik: belajar tentang disiplin diri sendiri,
tetapi bukan yang lain.
 (B) perilaku: memberikan pendapat dari satu perspektif. Setiap "ahli" disiplin
memberikan rekomendasi dari perspektif tunggal mereka

2. Interdisciplinary
 (a) pengetahuan adalah profesi terikat: belajar tentang disiplin sendiri dalam konteks
dan dipengaruhi oleh kesadaran perspektif ahli lainnya.
 (B) perilaku: mengembangkan pendapat bersama. Setiap disiplin mempengaruhi
yang lain, bekerja menuju tujuan konsensual.
3. Transdisciplinary
 (a) pengetahuan secara profesional tidak terbatas: pemahaman intuitif tentang semua
perspektif dan pemahaman naluriah tentang bagaimana hal ini berlaku untuk tujuan
kelompok.
 (B) perilaku: fokus dialihkan dari disiplin dan individu tertentu dan menuju perilaku
kelompok yang sukses di sekitar domain yang heterogen.
Peran Pendekatan Kepemimpinan

Pendekatan kepemimpinan yang mendasari :

 filosofi pendidikan dan pembelajaran interprofessional, manajemen sumber
daya kru/pelatihan faktor manusia, dan praktik keselamatan pasien yang lebih
efektif.
Kepemimpinan dalam tim interprofesional berguna :
 mendorong peningkatan dan keselamatan pasien dibahas dalam konteks
pengembangan model pengembangan kerja tim interprofesional transformatif,
siklus peningkatan transformatif dan perangkat keterampilan kepemimpinan
interprofesional. (lamb & clutton, 2010)
Pengembangan Kepemimpinan untuk Tim Interprofesional
bertujuan Mendorong Peningkatan dan Keselamatan Pasien

Interprofessional Teams
 Sekelompok orang dari berbagai latar belakang profesional yang bekerja sama untuk
memberikan layanan dan mengoordinasikan program perawatan di seluruh lembaga di
seluruh jalur pasien;

➢ Tujuan ditetapkan secara kolaboratif melalui pengambilan keputusan konsensual untuk

meningkatkan praktik keselamatan pasien, yang menghasilkan rencana perawatan
individual/layanan berkualitas yang disampaikan oleh satu atau lebih anggota tim,
yang memaksimalkan nilai keahlian bersama dan meminimalkan hambatan otonomi
profesional (diadaptasi dari forman, 2007).
Human Factors (clinical) (HF)
 Berkaitan dengan peningkatan kinerja klinis melalui pemahaman tentang efek kerja tim,
tugas, peralatan, ruang kerja, budaya, dan organisasi pada perilaku dan kemampuan
manusia, dan penerapan pengetahuan itu dalam pengaturan klinis (CHFG, 2011).

Crew resource management (CRM)

 HF termasuk dalam CRM, yang didefinisikan sebagai sistem manajemen yang
memanfaatkan secara optimal semua sumber daya yang tersedia – peralatan, prosedur, dan
orang – untuk meningkatkan keselamatan (raes, 1999).
 Secara implisit CRM adalah sistem manajemen holistik yang melibatkan kepemimpinan
dan keterampilan tim yang meluas melintasi batas interprofesional dan yang mencakup
pengetahuan dan penerapan faktor manusia. Untuk tujuan bab ini, HF klinis dan CRM
mencakup bidang subjek yang sama.
Patient safety
 Bebas dari cedera yang tidak disengaja; memastikan keselamatan pasien melibatkan
pembentukan sistem operasional; dan proses yang meminimalkan kemungkinan
kesalahan dan memaksimalkan kemungkinan mencegatnya saat terjadi (kohn et al.,
1999)
Domain
Pendidikan Definisi Contoh Aktivitas Contoh Evaluasi
Perawatan selaras • Mini-Clinical
dengan nilai-nilai, - Kurikulum dan Evaluation Exercise
referensi, dan Keterampilan Pengambilan • Decision Support
perspektif budaya Keputusan Bersama Ottawa Analysis Tool
pasien; kurikulum fokus - Tiga - Bagian Membujur • Dyadic OPTION
pada keterampilan Seri - BELAJAR (Dengarkan, Scale
komunikasi yang Jelaskan, Akui, • Learner
diperlukan untuk Rekomendasikan, dan Perception
Shared decision mempromosikan efikasi Negosiasikan) Survey– Primary
making diri pasien. - Wawancara Motivasi Care
• Modified
Continuity of Care
Index (MCCI)
Perawatan dirancang • Qualitative
untuk mempromosikan interviews
kesinambungan • Learner
perawatan; fokus Perception
kurikulum pada Survey– Primary
hubungan - Home visits Care
Sustained pembelajaran - “Lost Opportunities” • PACT continuity
relationship longitudinal curriculum encounter
• Longitudinal
semi-structured
Perawatan berbasis interviews
tim, efisien, dan • Team
terkoordinasi; fokus Development
kurikulum pada Measure
pengembangan - University of Toronto • Readiness for
Interprofessional kepercayaan, hubungan Centre for IPE Interprofessional
collaboration kolaboratif. - Huddle-Coaching Program Learning Scale
Perawatan dirancang
untuk mengoptimalkan
kesehatan populasi;
kurikulum fokus pada
penggunaan • Clinical
metodologi perbaikan outcomes
terus-menerus dalam • Quality
mendesain ulang - Curriculum of Inquiry Improvement
perawatan untuk - Panel Management Knowledge
Performance mencapai hasil yang - All sites looking at Application Tool
improvement berkualitas. emergency room visits (QIKAT)
Persyaratan mendasar untuk kerja tim,
komunikasi, dan kepemimpinan

 Kesetaraan dan kolegialitas di antara berbagai disiplin ilmu merupakan

karakteristik penting dari praktik kolaboratif yang berhasil.
 Para profesional yang bekerja bersama harus berbagi tujuan, sasaran, dan
kegiatan yang sama yang relevan dengan praktik.
 Memahami dan menghargai peran yang dimainkan oleh profesional lain
memfasilitasi pengembangan kolaborasi interprofessional.
 Komunikasi yang baik di antara berbagai disiplin ilmu harus dilakukan, dan
nilai diskusi kelompok di antara siswa dari berbagai disiplin ilmu harus
ditekankan.
PENINGKATAN KOMUNIKASI DALAM TIM

 Instant message capability (group wa, telegram dll untuk komunikasi

antar 1 tempat area kerja)
 lack of hierarchy (urutan anggota berdasarkan wewenang atau
jabatannya dalam area kerja),
 Proximity (kedekatan dalam hubungan komunikasi antara tim dan
pasien)
KEMUNGKINAN INDIKATOR DALAM
KEPUASAN PENYEDIA DAN TIM

 Team Meetings (melakukan overview perawatan pada tim kerja di suatu tempat
praktik)
 Shared Improvement Projects (membagi informasi perawatan yang telah
dilakukan kepada tim lain)
 Core Outcomes Displayed (berkaitan dengan layanan kesehatan, dapat berfungsi
sebagai penjaga gerbang antara layanan kesehatan primer dan anggota
komunitas)
PENINGKATAN KETERAMPILAN TRANSFER
DATA ANTARA KLINIK DAN LOKASI
LAINNYA

 Scheduled Notification Or Communications (pembagian hasil informasi

laboratorium antara klinik dengan lab atau sebaliknya klinik 1 dengan klinik
lain)
 Cross-training (peningkatan pelatihan dalam transfer data di layanan primer ke
tempat rujukkan perawatan lebih lanjut)
Peningkatan Kepatuhan Pasien Terhadap
Pengobatan dan Rencana

 Decision aids (alat untuk membantu orang terlibat dalam keputusan perawatan Kesehatan,
berupa sumber tertulis atau video untuk digunakan secara online atau secara langsung)
 Check-out staff (Untuk mempelajari langkah-langkah dasar yang harus diambil oleh staf
kantor bagian pelayanan pada saat keberangkatan pasien dari salah satu klinik Kesehatan,
untuk memeriksa pasien tersebut di luar jadwal janji temu mereka)
 Appropriate educational materials (meningkatkan penggunaan produk obat yang aman dan
efektif, menyediakan semua informasi yang relevan mengenai produk oba, informasi yang
jelas mengenai risiko-risiko spesifik dan jelaskan secara ringkas tindakan apa yang diperlukan
untuk mencegah dan meminimalkan risiko-risiko tersebut)
Thank You