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Background

Joining a growing list of researchers and business experts who promote team-based health care, Harvard Business School professor, Michael Porter, and co-author Elizabeth Teisberg, suggest in a recent JAMA article that the best chance the health care industry has for significant advancement in delivering safer care is to reinvent itself. And the new centralized services model they recommend would rely on patients being treated by coordinated teams of clinicians who continually monitor their combined performance. But, while the theory has gained wide acceptance, clinicians and administrators know that team-based care does not, by default, eliminate patient safety risks. Successful implementation requires proper team design and ongoing teamwork training.

Errors linked to inadequate teamwork skills—most commonly breakdowns in communication and coordination of care—are a recurring factor in medical malpractice claims. Over the past 10 years, 349 malpractice cases filed against CRICO-insured providers reflected some form of team dysfunction; nearly two-thirds involved a high-severity injury. The teamwork-related cases name 598 physician defendants and 102 nurses, and account for more than $200 million in incurred losses.

Our Recommendation

Clinical colleagues who come together to form either static or ad hoc teams work together better when they share an understanding of teamwork practices and expectations. Patients (and health care organizations) are better served when all providers have common teamwork language and skills. When everyone on the team shares the same mental model and knows how to conduct a handoff [pdf], escalate a concern, cover a colleagues duties in a crisis, etc., the opportunity for the team to fail is significantly diminished. To meet that goal, hospitals and other health care organizations need to support the framework in which those health care teams form and perform.

In the Harvard medical community, teamwork training has become a key component of patient safety improvement efforts. For example, virtually all obstetrics practitioners have undergone comprehensive skill enhancement via Team Training  or simulation. In the near future, a similar initiative will be undertaken by all CRICO-insured Emergency Departments.


April 1, 2007
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