Teamwork as a Tool for Patient Safety

The Core Curriculum Concept

Each module is designed to help instructors develop and meet the course objectives within a 50-minute teaching opportunity, but flexibility is encouraged to customize the content or delivery methods to fit your goals and schedules. The use of local data, systems, and cases is encouraged wherever appropriate. While each module is offered in a linear format, that is only one delivery option (there is no "right way"). We encourage you to add, delete, rearrange, and customize the accompanying materials, tools, and references to meet the needs of your particular audience. If you need assistance, either technical or instructional, please contact the CRICO/RMF Patient Safety Education Program Director.

Whatever you create from the Core Curriculum materials will be unique, and of interest to your colleagues. Please use the feedback links located throughout the site to share with us, and future instructors, what worked, what didn't, how your audience responded, and any suggestions for an optimal learning opportunity.

Overview

Effective communication among teams of caregivers can make the difference between an optimal outcome and an adverse event. Defining and applying "effective communication," however, is not always clear. This course focuses on two techniques that have been found successful in health care:

  1. improving collaboration through briefings, and
  2. promoting appropriate assertiveness within teams.

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Rationale

Teamwork and small group leadership skills may be critical to success in high-risk work environments, independent of technical proficiency

  • Medical care, research, and administration require groups to work together effectively
  • Teamwork failures can have serious impact on patient safety
  • Learning team work skills, especially communication skills, will reduce patient risks

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Objectives

  1. Describe how teamwork improves patient care
  2. Understand the role of misperception in communication as a barrier to patient safety
  3. Explain communication within the team unit and the roles of leader and member within the team structure.
  4. Describe a model for addressing these problems.

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Essay

This brief synopsis may be helpful as a handout to attendees prior to or at the beginning of your program. download

A 2002 Harvard study on the impact of team factors on patient safety in the operating room found that negative team factors contributed to delays in 40 percent of all cases studied and 30 percent of adverse events. On the plus side, positive team factors helped to limit the impact of 20 percent of adverse events identified. While that study was confined to the surgical arena, team-related problems occur in all health care settings.

More and more, health care is delivered by teams of caregivers. Even outpatients can expect to interact with multiple caregivers who need to communicate that patient's information clearly. If communication among team members falters, the patient's well-being can be at risk. Thus, a key to maintaining optimum patient safety is learning and practicing good team communication skills.

In some care settings, a small group of providers consistently work together, addressing common problems. Over time, they develop (good and bad) team communication habits and skills. In other settings, teams form differently for each patient, providers (some who may not even know each other) come together for a single care event and then disperse. Since they have less opportunity to develop their teamwork communication skills as a unit, they are more likely to do so individually. What is important across all types of teams is constructive leadership, and a common understanding of communication pitfalls and the skills and techniques needed to avoid them.

Communication Pitfalls

Three types of team communication breakdowns are at the root of most errors that impact patient safety:

  • Different interactive styles: individuals from different backgrounds or health care disciplines are likely to have different communication styles. Failure to accommodate for multiple styles among members of the same health care team can lead to misunderstandings.
  • Role conflict or confusion: when any member of a health care team is uncertain about the specific role he or she is expected to fill, or is confused about the role and responsibilities of other team members, communication is likely to suffer.
  • Chain of command unclear: uncertainty or anxiety that hinders conveyance of important patient information from any team member to another puts the patient at risk.

Techniques for Avoiding Communication Pitfalls

After discovering that two-thirds of air crashes involve failures in teamwork, the air transportation industry began focusing on crew resource management (CRM) training to improve team communication. Two key communication components of CRM are: improving collaboration through briefings, and promoting appropriate assertiveness within teams.

Adapting these CRM techniques in health care means

  1. looking at the communications that take place during transitions in a patient's care, for example, admission from an outpatient setting, nursing shift change, prior to an invasive procedure, and
  2. training all providers in the assertiveness techniques needed for voicing concerns regarding the patient's status, treatment protocol, or care plans.

Beyond This Module

Of course, successful teamwork is as complex as the individuals who need to work together, and this module can only begin to cover some of the basics. Opportunities for understanding and improving teamwork skills abound within health care, and perhaps more so in other industries (air transportation, public safety, manufacturing) as well as other aspects of life (sports, family, social organizations). Any teamwork skills improved upon will ultimately benefit the patients we all care for.

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