Interdisciplinary Health Care Teams and Health Care Reform

For a good summary of their development, see Brown Theodore M. , “An Historical View of Health Care Teams,” in Agich George , ed., Responsibility in Health Care (Dordrecht: D. Reidel, 1982), pp. 3–21.

Nagi Saad Z. , “Teamwork in Health Care in the United States: A Sociological Perspective,” Milbank Mem. Fund Quarterly, 53 (1975): 75–91.

Rothberg June , “Nurses and Team Practice,” in Lecca P.J. McNeil J.S. , eds., Interdisciplinary Team Practice, Issues and Trends (New York: Praeger, 1985), pp. 23–24.

Brill N. , Teamwork: Working Together in the Human Services (Philadelphia: W.B. Saunders, 1976).

To set this modern understanding of teamwork into the larger context of interprofessional relationships in health care, see Purtilo Ruth , “Support and Challenge in Professional Peer Relationships,” in Purtilo Ruth , Ethical Dimensions in the Health Professions (Philadelphia: W.B. Saunders, 2d ed., 1993), ch. 13. I am grateful to Steven Miles for suggesting the language of “instrumental and moral functions.” It captures aptly the focus of my comments in the above chapter.

For a thorough historical and contemporary treatment of this phenomenon in a collection that includes numerous case studies from many dimensions of health care, see Reiser Stanley J. Anbar Michael , eds., The Machine at the Bedside: Strategies for Using Technology in Patient Care (Cambridge: Cambridge University Press, 1984).

Many have written on the ways in which reliance on technology has affected health care delivery. For a treatment of this issue from the point of view of its effect on the rehabilitation team, see Purtilo Ruth , “Rehabilitation and Technology: Ethical Considerations,” International J. of Technol. and Aging, 4, no. 2 (1991): 163–70.

Cassell Eric , “The Sorcerer's Broom: Medicine's Rampant Technology,” Hastings Center Report, 23 (1993): 32–39.

Shine Kenneth , president of the Institute of Medicine, made this observation in a presentation entitled “Health Care Reform and Academic Health Centers,” which was given at the University of Nebraska Medical Center, Omaha, Nebraska, March 15, 1994.

Clinton Bill , “The Clinton Health Care Plan,” N. Engl. J. Med., 327 (1992): 804–07.

For a discussion of how stresses from the outside can have a deleterious effect on team spirit and function, see Purtilo Ruth B. Meier Robert H. , “Regulatory Constraints and Patient Empowerment,” J. Phys. Med. Rehabil., 72 (1993): 327–30. A portion of the chapter by Cassem Ned , “Treatment Decisions in Irreversible Illness,” in Hackett Thomas Cassem Edwin H. , eds., The Massachusetts General Hospital Handbook of General Hospital Psychiatry (St. Louis: Mosby, 1978), pp. 562–75, is devoted to the effects of team stresses in the intensive care unit.

As one of the architects of the approach, Paul Ellwood makes this claim in “Outcomes Management: A Technology of Patient Experience,” N. Engl. J. Med., 318 (1988): 1549–56.

Personal communication with Miles Steven M.D., March 14, 1994.

The addition of patient satisfaction scales will help to alter this skew in the direction of a higher valuation on moral functions. At present, patient satisfaction scales are imperfectly developed, or are not used at all, in many health services research settings.

For a thorough critique of the major principles that were proposed by the Ethical Foundations Working Group of the Clinton Health Care Task Force, see Gostin Larry , “Foreword: Health Care Reform in the United States—The Presidential Task Force,” Am. J. of Law & Med., 19, no. 1–2 (1993): 1–7.

Hadorn David , “The Problem of Discrimination in Health Care Priority Setting,” JAMA, 268 (1992): 1454–59.

This issue seldom is addressed directly, but it can be implied in several themes, most notably those addressing the need for a shift from specialty to primary care and community-oriented practices. For one example that combines both, see Wright Richard A. , “Community-Oriented Primary Care: The Cornerstone of Health Care Reform,” JAMA, 269 (1993): 2544–47.

Emanuel Ezekiel Brett David , “Managed Competition and the Patient-Physician Relationship,” N. Engl. J. Med., 329 (1993): 879–82.

Epstein Arnold M. , “The Framework of Heatlh Care Reform,” N. Engl. J. Med., 329 (1993): 1666–76 (italics mine). Dr. Epstein is by no means the only one whose writing suggests this role for outcomes research. I chose to cite him because of his ability to influence policy as one of the domestic policy advisors. The sources are too numerous to list here.

For a debate on the value of enterprise liability, see Douglas Peters J. Johnson Kirk B. , “Can Enterprise Liability Ease America's Malpractice Problem?,” ASLME Briefings, no. 8 (1993): 1–3.