Teamwork is more than good communication
Team members must be alert to potential mistakes
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
More than a decade of research in aviation has shown how critical effective teamwork is to flight safety. Both the armed services and commercial aviation organizations have standardized training systems in place for teamwork. What they have found is that teamwork training reduces the risk that crews will make a fatal error or permit a fatal string of errors to unfold because the crew failed to communicate, coordinate, and check each other. The training has significantly improved teamwork, resulting in saved aircraft and lives.
There is a strong potential for comparable benefits in health care services. Functionally, health care has much in common with aviation. It requires effective and often rapid coordination of groups of technical professionals to execute critical technical tasks, demands appropriate sequencing and timely execution of tasks, often demands quick decision making using incomplete information, and imposes high standards of performance and high levels of responsibility and stress on the professionals involved. And just as crews, passengers, and aircraft are placed in danger when aircrew teamwork fails, patients suffer when caregivers improperly coordinate care or fail to help each other prevent clinical errors. Such errors, in their most extreme forms, permanently injure patients and lead to deaths and, in their less extreme forms, uselessly consume time and resources and slow patient recovery.
The health care world is being dramatically reshaped by changes in many factors. Some of the most important of these changes are concerned with shifts in caregivers' attitudes and beliefs. These shifts are being driven by a number of emerging realizations within the health care community:
- The realization that all humans are fallible, that even the most diligent and conscientious clinicians will make mistakes frequently, simply because they are human. Willingness to face such human limitations and seek solutions that are attentive to these limitations has historically been missing in health care.
- The realization that one caregiver's error often can be anticipated and prevented, or corrected by another caregiver. Peer monitoring is beginning to be seen positively as a safety net that protects both the patient and the caregiver.
- The realization that the health care delivery system is complex and poorly designed. The poor design, in combination with the complexity, dramatically increases the risk of error. Caregivers are just beginning to recognize that lack of teamwork creates patient safety risks.
These emerging attitudes and beliefs are influencing changes in health care delivery that ultimately will reduce the error rates associated with care. In particular, caregivers are beginning to realize the benefits of teamwork training. Effective coordination among members of the health care team can improve care delivery performance and reduce the number of clinical errors that occur. To achieve these goals, team members must learn how to actively coordinate and support each other.
After reviewing more than a decade's worth of sentinel events, the Joint Commission identified poor health care team communication as a key factor in many adverse events. The National Patient Safety Goals (NPSGs) of the Joint Commission are particularly focused on improving communication during the hand-offs in care. Health care facilities are expected to have processes for ensuring that relevant patient information is transferred from one caregiver to another during transitions in patient care. This information should include the patient's condition, current problems that are active or potentially active, and the stability or potential instability of vital signs or physiologic status. The recently added NPSG, reconciliation of patient medications during hand-offs, is another example of an attempt to improve communication among members of the health care team. A lot of attention is being paid to improving team communication because of the Joint Commission's focus on improving the flow of patient information among caregivers.
Yet, good communication of patient information is just one of many factors that influence how well the health care team works together to provide safe patient care. Team members must actively coordinate activities with each other to ensure proper and timely completion of tasks. Team members must be willing to step in and help when another member of the team is overloaded. Each team member must have a clear understanding (a common situational awareness) of the status and care plan for each patient assigned to the team and the workload status of each team member. Team members must be alert to potential mistakes and feel empowered to speak up when they have concerns.
Recognizing the existence of teamwork failures is the first step toward making improvements. The checklist in Figure 1 can be used during a root cause analysis to identify teamwork breakdowns that contributed to the sentinel event. The checklist also can be used to evaluate less dramatic, near-miss incidents. Reviewing teamwork behaviors gives the organization a sense of where the problems lie. For example, it might be discovered that the climate is supportive and communication habits are OK, however the team structure is weak because leadership is poorly defined. This would tell clinical leaders where they need to focus their teamwork improvements.
More than a decade of research in aviation has shown how critical effective teamwork is to flight safety. Both the armed services and commercial aviation organizations have standardized training systems in place for teamwork.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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