Case Study: Team Development
Read the following case examples of the same team in two different phases of
development. Answer the summary questions for both at the end of the second.
In the second case study, the team is more experienced. Keep in mind which
disciplines are interacting and who takes a leadership role.
You might want to review the Drinka Model of Team Development first.
Geriatric Interdisciplinary Team at Initial Meeting
(Case developed by Mehrnaz S. Gill, M.S.)
Today is the first day of the geriatric interdisciplinary team case meeting.
The team members include John, the physician (MD); Helen, the advanced nurse
practitioner (NP); Joe and Julie, second-year residents (R); Debra, the
pharmacist (Ph); Mary, the social worker (SW); and Jeff, the clinic coordinator (CC).
This meeting will be the first of mandatory weekly team meetings.
John (MD) is hoping to begin the meeting promptly at 7:30 a.m. because he has
to round at 9:00 a.m. and the team has a long list of patients to discuss.
However, some of the team members are late. The meeting finally begins at 7:45
a.m. John (MD) begins the meeting by thanking everyone for coming and reminding
them that the meetings will begin promptly at 7:30 from now on. Debra (Ph)
quietly tells Jeff (CC) that it is very difficult for her to get to the meeting on
time since she has a forty-five–minute drive. Jeff comments that he does not
know why he has to be at the meeting at all and that it will probably be a waste
of his time. John (MD) tries to ignore the side conversation between Debra
and Jeff and asks Helen (NP) to present the first case, Mrs. James. Helen passes
out a patient information sheet on the first patient.
Mrs. James, a fairly new patient at the clinic, is an eighty-seven–year–old
woman with hypertension, coronary artery disease, and poor vision. The initial
screening questionnaire and home interview made by the team social worker, Mary,
identifies her as widowed for three years and living alone in a clean one-story
home. She is taking seven medications and gives conflicting reports regarding
how she is taking them. Mary (SW) notes that Mrs. James seems somewhat
forgetful, confused, and depressed. John (MD) asks the team members for their input.
Joe (R), is somewhat hesitant about expressing his opinion. Based on the patient’s initial physical and psychosocial assessment, he suggests that she may be
suffering from some type of dementia. Debra (Ph) suggests taking a closer look at
her medication and that "drug interaction may be having an adverse effect on
her cognition." Mary (SW) believes that loneliness and lack of social
interaction may be the cause of her depression and confusion. John (MD) asks Helen (NP)
about Mrs. James’s vision problems and asks about getting glasses. Helen (NP) and Mary (SW)
are both confused about who should handle this task. John (MD) suggests further
evaluation of Mrs. James for discussion at next week’s meeting and asks Joe (R) to present the next case. Helen (NP) would like to
discuss this case further, but decides not to say anything.
What behaviors indicate which phase this team is in?
Geriatric Interdisciplinary Team Meeting after Several Months
(Case developed by Mehrnaz S. Gill, M.S.)
The team has been meeting weekly for several months. The team members are the
same as above.
The case meeting of the geriatric interdisciplinary team begins promptly at
7:30 a.m. Various team members present the patient cases, while Jeff (CC) writes
the problem lists on the blackboard. Julie (R) presents the last case, Mr.
Jones, is a seventy-five–year–old African-American man with arthritis, coronary
artery disease, and diabetes who has been insulin dependent for the past three
years. He also has poor vision and hearing difficulties. He is on five
medications and is noncompliant with requirements to use his glucometer to check his
blood sugar. He lives in his own house with his unemployed daughter and two
grandchildren.
Pointing to the blackboard, Helen (NP) expresses her concern about Mr. Jones’ noncompliance with using his glucometer. Debra (Ph) asks, "Does he know how
to use it?" Helen responds that she has shown him how to use it and has left
written instructions; however, communication is hard since he has difficulty
with his hearing and vision. John (MD) suggests that Helen (NP) show Mr. Jones’s daughter how to use the glucometer so that she can assist him. Helen
responds, "I have, but she does not seem very cooperative. I’m not sure if she really cares about her father’s health." Mary (SW) is quite surprised by Helen’s (NP) comments and says that Mr. Jones’s daughter is very devoted to him, but is still grieving over the death of her
husband. Helen asks Mary to speak with Mr. Jones’s daughter about this matter. Joe (R) asks about whether Mr. Jones is taking
his medication properly. Debra (Ph) says that she has been working with Helen
(NP) on monitoring his medications and has provided him with a large print
weekly pillbox.
John (MD) expresses his concern about Mr. Jones’s driving and comments that Mr. Jones "has been late or missed several of his
appointments." Jeff (CC) comments that he has had to reschedule Mr. Jones
several times and that it has become a problem. Joe (R) asks, "Does this have
anything to do with his failing eyesight?" John (MD) responds, "I recommend further
evaluation to determine whether he has cataracts, glaucoma, or if this is
related to his diabetes."
It is almost 9:00 a.m., and John, Joe, and Julie have to leave to round. Helen
(NP) asks them to stay a few more minutes in order to address the last issue
on Mr. Jones’s problems list. She is very concerned about Mr. Jones’s increasing hearing difficulties and asks Mary, the social worker, to look
into hearing aids for Mr. Jones. The cost is a factor, so she asks Mary about
different options to cover the cost of the hearing aid. Mary agrees to look into
it. John (MD) asks Mary (SW) to wait since he would like to refer Mr. Jones
to a specialist for his hearing problems. This will be discussed further at the
next meeting.
What behaviors indicate which phase this team is in?
