Risk Tip | Teamwork—an essential part of a safety culture—has come to the forefront as the most effective way of catching individual errors before they occur and of mitigating system failures. In the OR, for example, studies have shown that implementing team training is associated with a significant decrease in surgical mortality.^1,2 The team approach is not new, but its value and definition are changing. Good communication, along with a focused team approach in dealing with problems, can make a positive difference in any outcome.

A healthy culture focused on safety and effective communication is essential to developing a high-functioning team. It becomes challenging when factoring in each team member’s different personality, skills, agenda, style, and objectives. The team approach depends on each member’s ability to:

• Anticipate needs of others.
• Adjust to each other’s actions and the changing environment.
• Have a shared understanding of how a procedure should happen in order to identify when errors occur and how to correct for these errors.³

The first step in developing a cohesive team is to recognize that teams are better equipped to handle challenges within a department. Decisions made through teamwork are significantly better than the decisions of a single person. Individuals who have been responsible for handling problems and making decisions in the past will usually have the most difficulty in embracing this concept. When something adverse occurs, it is not usually a small or isolated problem; it is a problem that has a significant effect on everyone in the room. Since any single negative event can potentially impact all members of the team adversely, the entire team should participate in resolving the problem.

Characteristics of an Effective Team
Improving patient safety through emphasis on the team approach requires an understanding of the factors that make a team successful. An effective team recognizes and accepts the following principles:

1. Each team member contributes his or her individual talent, skill, and experience and acknowledges other team member contributions.
2. When issues are complex, there is often more than one right way to solve a problem.
3. The team’s combined decision is greater than the needs of its individual members.
4. Any team decision must be just and ethical.
5. Once problem solving is complete and a decision has been reached, the decision must be implemented and monitored for effectiveness.
6. The team must be ready and open to changing its action if the resolution proves ineffective.
7. Each team member is accountable for the team’s decisions, even if it was not his or her first (or individual) recommendation.
8. Open communication is necessary to promote empowerment in getting the job done and accepting team decisions.

Effective Team Communication
An important part of teamwork is the ability to communicate, especially in the OR. When was the last time you heard something like this in the operating room?

• “I haven’t worked with this piece of equipment in a long time.”
• “Last time, this machine wasn’t working correctly.”
• “I'm worried about the blood loss.”
• “This is an older patient; make sure the room is warm.”
• “Keep the heart rate lower; this patient had a previous MI.”

Effective team communication requires the exchange of concise and relevant information between team members. It demands good listening skills, with participants joining the conversation only after they have a thorough understanding of the issues.

Standardizing communication practices facilitates stronger team communication. Tools, such as the team brief or “huddle,” can be implemented to promote information exchange and team cohesion. Huddles allow the team to meet briefly on a daily basis to discuss patients’ needs and determine what tasks need to get done and by whom. Maintain vigilance by promoting situational monitoring among team members. When team members actively scan and assess what’s going on, they gain information about the situation and can identify deviations. Conveying this information to fellow team members can prevent small errors from becoming big errors. In the OR, part of this approach includes a statement by the surgeon encouraging communication, such as, “If you see, suspect, or feel that something is not right, please speak up.”

Communicating in a closed-loop fashion ensures the entire team is aware of what is occurring and helps to retain the shared mental model. Acknowledging comments and questions ensures that communications have been heard and understood. Repeating back essential information confirms that the sender’s message has been received.

Conclusion
Communication and teamwork within a safety culture remain the foundation for preventing harm and are two of the most important facets of patient safety. Organizations must address risk perception, leadership involvement, assertive staff communications, consistent process implementation, teamwork, and human factors. Adopting a safety culture reduces errors and better protects patients.

Using teamwork to resolve problems and concerns can foster a better understanding of the problem and ensure a more unified, informed approach to problem resolution. The result is a safer and improved environment for all patients and staff.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

References

1. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693-1700.
2. Young-Xu Y, Neily J, Mills PD, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical morbidity. Arch Surg. 2011;146(12):1368-1373.
3. Agency for Healthcare Research and Quality, TeamSTEPPs Fundamentals Course, Module 1.