Patient Pathways

Learning Objectives

As a result of participating in this activity, learners will:

1. Collaborate as a team to decode information and establish an agreed plan to follow.
2. Organize the team around each member’s successful completion of a common goal or pathway.
3. Support team members who struggle with tasks essential to success.

Description

This activity requires the creation of a floor mat divided into a grid of spaces.  Each space must be large enough for a team member to stand comfortably.  We developed this mat using a common tarp and created a grid using a yard stick and permanent marker.  Be careful when using this mat to prevent tripping hazards.  We have had success taping the mat to the floor with wide painter's or duct tape.

1. Assemble students into teams of 5-6 using some method to ensure diversity/interprofessionalism on each team.
2. Using a paper diagram of the mat, facilitators draw a course from one edge to the other. This is the pattern the team members must discover and follow, and it is kept hidden from view of the team. The pathway moves through contiguous spaces left, right, forward, back, or diagonally, and do not always move toward the other side of the mat.
3. Team members stand on the floor next to the mat for this activity. The mat has been made taut and taped down, but caution members of the team about tripping hazards. Starting at the beginning, team members, in rotation step into a square. The facilitator will indicate success or failure based on the pre-established pathway. If the player is on a correct square, they may attempt to move to the next task by stepping on another space. As long as they are successful, they may keep moving forward. Should they step on a space that the facilitator indicates is wrong, their turn ends, and they step off the mat. The next team member must now follow the correct pathway established by the earlier player(s). If they step on a wrong space, their turn ends.
4. The team must work together to guide all team members from one side of the mat to the other. The team succeeds only when all team members have successfully navigated the pathway.
5. Risk can be elevated in this game by having team members stand back to the mat while others are participating, necessitating clear communication (handoffs) from player to player. This game may also be played in silence or the player on the mat may also be blindfolded.

Recommendations

This activity requires previous preparation of a grid with squares large enough that participants can easily stand one person per square.  This can be done by taping a grid to the floor or by drawing a grid on a surface such as a mat or a tarp.

Size

Small Group

Equipment

Minimal Equipment - An established grid (please see the notation under recommendations) and a paper diagram of the grid.

Time

One Hour

Modifications

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Lesson

Team Membership

Belonging to a team means that nobody wins until everybody wins. In this version, team members may not speak. They may not enter the mat space unless it is their turn. They may coach one another through the use of non-verbal signals only.

Debrief Questions

1. What went well?
2. What barriers were created by the inability to speak to the player?
3. How important is it for team members to be paying attention to what is going on, even when they do not bear direct responsibility for the task (such as not being the player on the mat?)

Clinical Application

1. How do patients or providers experience the no speak rule in their encounters?
2. What is the impact on patient outcomes if communication is compromised?
3. How can an overload of patients impact the ability of providers to focus on one patient’s needs?

Bloom's Taxonomy

Analyze/Apply
Evaluate/Create

TeamSTEPPS domain

Communication
Leadership

IPEC Competency

VE 4
RR 1
CC 1, 4, 5 & 7
TT 5 & 11

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Lesson

Mutual Support

Sometimes team members are working at a disadvantage, such as lack of knowledge or experience, anxiety, or distractions. Team members must support that person to success. In this version, one or more team members has been blindfolded and they require help to get through the task. Again, nobody is on the mat except the player whose turn it is. Team members may coach verbally, but may not touch the team member. It may be helpful to call a huddle part way through this exercise to encourage the team to develop a plan for feedback.

Debrief Questions

1. Blindfolded players: How did team members encourage you (if at all) to complete your required part of the challenge?
2. How did players who were blindfolded experience being totally dependent on other players for directions?
3. What should teams do when they realize that one or more members may be struggling?
4. Are there more helpful and less helpful ways to communicate with struggling team members? What are they?

Clinical Application

1. In what ways might we consider a patient blindfolded in their care plan? What can providers do to prevent this from happening?
2. How might a patient’s unfamiliarity with their own condition or the proposed care plan impact their ability to be adherent?
3. If you were a provider with the equivalent of a blindfolded patient, what do you think would be the most important thing for you to do?

Bloom's Taxonomy

Analyze/Apply
Evaluate/Create

TeamSTEPPS domain

Communication
Leadership
Mutual Support

IPEC Competency

VE 4, 7 & 8
RR 2, 5 & 6
CC 1, 4-7
TT 8, 9 & 11

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Lesson

Communication

In this simplest version of this game, all team members are able to see, and players may speak to one another. Again, only one player is on the mat at a time, and you may not touch the player in any way. This version can be played against a time constraint, as well.

Debrief Questions

In our culture, we tend to focus on individual performance, yet on a collaborative team, members win or lose as a unit.

1. How did those who finished the task feel when watching others struggle?
2. What kinds of communication strategies were used? Did you change strategies based on the player, or did you utilize one universal approach?

Clinical Application

1. How might the need to meet with patients in a time-constrained situation (such as insurance reimbursement) challenge a provider and patient outcomes?
2. How helpful is it for everyone on the team to be able to watch everything going on in a patient care plan? Are there times when not everyone needs to know everything?

Bloom's Taxonomy

Analyze/Apply
Evaluate/Create

TeamSTEPPS domain

Communication
Situation Monitoring

IPEC Competency

VE 7
RR 2 & 3
CC 1, 4-7
TT 5, 7, 8 & 11

Summary

Providing care to patients or completing complex tasks often requires that we retrace the work of others and build upon it. In this activity, team members collaborate to find a solution and support on another in implementing a plan.

Contact

For more information about how to utilize games, low-fidelity simulation, and interactive learning to teach concepts of teamwork and collaboration, contact Better.Teams@rosalindfranklin.edu

Related Tags

collaboration, collaboration process, common goal, communication, feedback, low barrier, mutual support, outcomes, rotational leadership, shared mental model, situation monitoring, teams and teamwork