M Babar Qureshi
Human resource development (HRD) – the development of the people who deliver health
care – has been identified as one of the key pillars of eye health delivery. HRD is
one of the essential building blocks of the World Health Organization (WHO) Global
Action Plan: ‘Towards universal eye health’. The importance of HRD is also recognised
beyond eye care, as can be seen in the WHO Health Systems approach.
Historically, eye care delivery was mainly the responsibility of ophthalmologists.
It soon became clear, however, that in order to effectively reduce avoidable blindness,
other types of health care workers would need to be developed, trained and deployed
to work with and support ophthalmologists. A team approach would therefore be essential.
In recent years, eye care team development has become an important part of the advocacy
and action plans of most global eye health agencies and regional bodies. The International
Agency for the Prevention of Blindness (IAPB) and the International Council of Ophthalmology
(ICO) both have international committees on HRD, and IAPB has also formed regional
HRD committees. One of their key tasks has been to identify gaps and plan HRD for
individual groups of eye health providers – including ophthalmic nurses, ophthalmic
clinical officers, and optometrists/refractionists – in a way that supports the development
of the eye care team as a whole.
A ophthalmic clinical officer observes a community health worker examining a patient's
eyes so that he can offer helpful feedback and support, if needed
The composition of an eye care team varies from region to region and country to country,
and it will also differ depending on whether the team is working in a national eye
care programme or in a rural eye clinic. The goal is the same, however: to provide
high quality eye care to the satisfaction of the patient.
ABOUT THIS ISSUE
Elmien Wolvaardt Ellison
Editor: Community Eye Health Journal.
This issue is about teamwork for eye care, and about how eye teams can function more
effectively to address blindness and improve eye health in the communities where the
need is greatest.
Our authors look at the various people involved: ophthalmic nurses, ophthalmic clinical
officers, ophthalmologists, optometrists, the surgical team, and managers. But there
are many more people whose enthusiastic and skilled participation is essential for
both good clinical outcomes and a good patient experience: low vision and rehabilitation
workers, teachers, community health workers, equipment technicians, receptionists,
cleaners, drivers, and outreach workers – to name but a few.
A good indicator of a team that is functioning well is that people are enjoying working
together. What can be better than doing worthwhile work with people you respect and
appreciate, and who each bring unique skills, perspectives and energy to the team?
But great teamwork does not always come naturally. This issue therefore looks at the
importance of establishing a culture of teamwork right at the start, when people are
undergoing training. We focus on good leadership, which is needed to keep team members
focused on what is important, on the goals the team wants to achieve, and on good
planning and management, all of which helps to support and facilitate teamwork. There
is advice on how to function within a team and improve the effectiveness of the team.
Other articles look at various groups of eye health workers, the challenges they face,
and how these are being addressed to improve teamwork.
We hope you will enjoy this issue and that you will be inspired to make positive changes
where you work.
Leadership: a crucial component of teamwork
Teams need leaders who are knowledgeable, skilled, highly motivated, and who aim to
offer high quality, sustainable eye care services. A good leader will consult with
the team, take their opinions on board, and create a vision and goals that are genuinely
shared by everyone; this means that the team members will feel personally motivated
to achieve these shared goals. Good leaders are able to champion the team's vision
and goals with energy and enthusiasm, inspiring their team members to keep going during
difficult times. She or he will share credit and be able to manage the negative fall-out
if things go wrong.
The team leader sets the tone for the team and is responsible for maintaining the
team's values and the team culture’, i.e. what behaviour is acceptable and what is
not. The team leader can and should model the correct attitudes and behaviour for
the rest of the team. For example:
showing professional respect for the skills and limitations of each member of the
eye team
demonstrating professional dilligence
being willing to listen to others
making decisions based on a collective and evidence-based approach (rather than for
personal gain)
treating people fairly, whatever their cultural background, gender, sexual orientation
or health/disability.
By being fair, available, and communicative, the team leader can ensure that there
is good communication among the rest of the team and that working relationships are
positive.
Leaders also have a facilitative role: ensuring that the team has everything they
need to achieve their goals, such as appropriate (and functioning) equipment, a reliable
supply of medicines and consumables, good systems and protocols, and a clean and safe
environment in which to work. Managers (see page 30) can support the team leader in
this role.
A good leader also keeps the professional growth of the team in mind by proactively
seeking career development for the team and ensuring that everyone has a clear job
description, detailing their roles and responsibilities. Team members should understand
where their job fits into the health system and what their opportunities for career
progression are.
Being a good team member
The team needs to be able to support the leader in achieving high performance and
quality of service, delivered to the satisfaction of the patients they serve. Team
members must be professionally competent in their field of work, diligent and committed,
and should view their leaders as mentors and facilitators.
It makes sense to develop the attitudes and skills needed for successful teamwork
from the outset, during training (see page 28). A curriculum geared towards teamwork
will encourage and train eye care workers to:
identify themselves as team members
communicate clearly and respectfully
develop critical thinking and problem solving skills
make decisions and respect the decisions of others
support and complement the work of others
trust other members of the team
give clear and prompt feedback
motivate themselves and others
keep learning.
These ideas and skills should be included in the curriculum and taught both explicitly
(during course work) and implicitly (through the example set by leaders during practical
training). Changing the curriculum is always a challenge, but this can be overcome
through advocacy and sharing succesful examples of a curriculum focused on the team.
Task shifting
To enhance the quantity and quality of an eye service, task shifting has been used
with a lot of success. Task shifting means delegation of tasks within the team to
complement one another. This can take place informally (at the level of the institution)
or formally (i.e. at ministry of health level, with the creation of a new role such
as that of cataract surgeon).
One of the best examples of task shifting has been the use of mid-level personnel,
optometrists and nurses to undertake many of the tasks which the ophthalmologist used
to do in the past, thereby giving the ophthalmologist more time for specialised tasks
or surgery that only she or he is qualified to perform. Mid-level eye care workers
are also task shifting their previous activities to community health staff and teachers
who now are being actively involved in primary eye care, screening and referral of
eye patients, and must be included in the definition of the eye care team.
Focusing on our patients
The concept of teamwork has been perfected by successful manufacturing companies,
where people with different skills come together to make a car or other product which
is then marketed, sold, and supported with after-sales service. Teams in health care
may face many additional challenges, including funding and wider health systems issues.
We deal with human beings and their sight; therefore we should do our best to provide
not just great service, but also to offer a positive experience to our patients. For
many of them, there is no second chance, so we must ensure that a high quality service
is delivered the first time. Teamwork can help by enhancing the efficiency and quality
of our work, both of which are essential to improve the vision and quality of life
of our patients.