Teamwork in Health Care
From an early age we are instilled the importance of teamwork. The lessons may come from a soccer field, a classroom group project, or even a song on Sesame Street. Regardless of our future careers, we are all likely to experience some sort of teamwork requirement, even if it is as simple as getting along with your co-workers. Teams working in a hospital or other healthcare setting may consist of several physicians, nurses, medical assistants, referral coordinators, pharmacists, therapists, and students among others.
Such large teams can provide comprehensive care for complex and chronic illnesses, but when they fail to work well together, they can harm patients (Thomas, 2011). Team training in healthcare initially took its cue from commercial aviation and the military. The training would focus on communication skills such as briefings, speaking up, monitoring and repeating back critical communication and information (Thomas, 2011). These teamwork skills have translated into important tools for the health care setting, including what is commonly known as a “time out”.
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A time out is now mandatory prior to any type of patient procedure. Usually a nurse leads a time out to verify the right patient, as well as the correct procedure, site, consent and any concerns such as allergies. This simple pre-procedure policy helps in initiating a conversation among team members and reduces error. Such systems are a must when the World Health Organization estimates that one in 10 hospital admissions leads to an adverse event and one in 300 admissions in death (WHO, 2012).
There are other tools used in the health care setting, such as SBAR communication which is mandatory for any type of reporting off patient information. SBAR stands for: Situation, Background, Assessment, and Recommendation (The Joint Commission, 2012). Simple communication tools help improve the quality of care and safety of patients. Infrequent team behaviors have been proven to increase the risk of major complications or even death in a high-risk, high-technology work environment (Mazzocco, 2009).
Some teams may need to assemble very quickly and work extremely efficiently, such as in cases of trauma or resuscitation of a patient. Therefore, a greater effort needs to be implemented on teaching health care workers on improving teamwork in the work place. Improved teamwork would not only improve patient care, but also make the work place more enjoyable. However, most importantly it will improve patient safety. Because of increasing costs of health care, hospitals are always seeking ways to make cuts and save money where they can.
One way they have been going about doing this is to decrease staff. Where nurses used to have four patients, now they have five or six. Health Care professionals and now working longer shifts than ever; an 8 hour shift has turned into a 12-16 hour shift. With the higher stress workload, it’s important to be able to count on co-workers when you need them. So if we all know the importance of teamwork, then what is the problem? The intense labor among health care professionals means that no single type of profession can deliver complete care alone.
Yet “there is little to no formal training in teamwork skill development in undergraduate or postgraduate health professional education programs” (Leggat, 2007). Most team work skills are learned on-the-job. Since we know patient outcomes depend on effective interdisciplinary teamwork, there needs to be better preparation of health professionals, starting when agreement of which qualities makes a good team. Competencies for effective teamwork are perceived to be different for management and clinical teams, and there are differences in perceptions of teamwork between male and female health care managers (Leggat, 2007).
Teamwork can also be disrupted by different styles of management, status differences, poor communication, and competitive demands on different departments. During my own personal experience in nursing, I have had the opportunity to witness teamwork at its best, and shamefully, teamwork at its worst. During a shift on a neuro critical care floor, I was assisting a nurse turn and change a patient. Nearly every time we shifted the patient, an alarm would sound. Within moments there was a voice on the other side of the curtain asking if help was needed.
Next time the alarm sounded; there was the helpful voice again. It never failed. How comforting for the nurse this must feel, and ultimately, better outcomes, as well as safety for the patient. At the other end of the spectrum, I have watched as a nurse asks for help, and is turned down multiple times. I have heard the awful phrase, “that’s not my job. ” I have seen patients code, and the nurse spends the next hour caring for that patient including resuscitation, and transferring to an intensive care unit. No one takes the initiative to check on the nurses patients while she is gone, not even the charge nurse.
Clearly this is not a positive or safe work environment for anyone. Teamwork can decrease work load and prevent burnout among health care workers. With the ever-growing cost of health care in the United States, efficiency needs to be at its best, and there is no room for increasing numbers of errors. The value of teamwork is not something that can just be talked about, but rather needs to be instructed. Each member of a team needs to know his roles and responsibilities and what is expected of him during certain situations.
Team members also need more education on how to work with others of different statuses and cultures. The best patient care is collaborative care, where all members of the patients’ multidisciplinary health team work together to provide the patient with the best holistic care available. A lack of teamwork leads to disorganization, and gaps in communication that will lead to medical errors and contribute to patient morbidity and mortality.
Leggat, S. (2007). Effective healthcare teams require effective team members: defining eamwork competencies. BMC Health Services Research, 7(17), doi: 10. 1186/1472- 6963-7-17. Mazzocco, K. , et al. (2009). Surgical team behaviors and patient outcomes. The American Journal of Surgery, 197, 678-685, doi: 10. 1016/j. amjsurg. 2008. 03. 002. The Joint Commission. (2012). http://www. jointcommission. org/ Thomas, E. (2011). Improving teamwork in healthcare: current approaches and the path forward. BMJ Quality & Safety, 20, 647-650, doi: 10. 1136/bmjqs-2011-000117. World Health Organization. (2012). http://www. who. int/en/