Teamwork Training May Improve Patient Safety
In order to change a hospital culture with teamwork training, create opportunities for team members to practice what they learn, then celebrate success as a way to promote progress, she added.
Barriers to good teamwork include inconsistency in team activity, lack of information sharing, hierarchy, defensiveness, varying communication styles, overwork, misinterpretation of cues, and confusion about one's role. The TeamSTEPPS strategies of better communication through briefs and huddles, as well as through feedback, patient advocacy, and mutual support, can combat these problems, Ms. King said, and result in mutual trust, improved performance, and patient safety.
Developing a team mentality is easier said than done. “We all train separately, and we come together and are expected to work together,” she acknowledged.
But physicians can learn the concept of better teamwork as a way to improve patient safety, said Dr. Alison Clay, who participates in TeamSTEPPS at Duke University in Durham, N. C.
TeamSTEPPS at Duke began in the pediatric ICU and it has spread to the operating room. “We are taking it to different parts of the hospital,” said Dr. Clay, an internist with appointments to the departments of surgery, and of internal medicine and pulmonary critical care at Duke. The program is likely to move next to the hospital wards and hospitalists and attending physicians, and then to clinics, she said.
The program starts with lectures and conversation and then proceeds to use of simulations and a debriefing to assess how the participants worked as a team.
Dr. Clay has participated in the TeamSTEPPS curriculum, and she has trained to coach others in teamwork building in her role as the capstone course director for fourth-year medical students. “We are committed to teamwork training for all the medical and nursing students,” she said.
Dr. Clay has a unique perspective on patient safety: She was a victim of a medical error at Duke when she arrived at the emergency department as a patient and went into respiratory arrest after being given a medication meant for the patient across the hall.
For more information about TeamSTEPPS or to review and order materials, visit www.ahrq.gov/qual/teamstepps
Key Skills for Team Effectiveness
The TeamSTEPPS approach is an evidence-based framework that is designed to improve team performance in all areas of health care.
According to AHRQ, the framework integrates four key skill areas:
▸ Leadership. This means the ability to coordinate team activities by ensuring that the team's action are understood, that new information is shared, and that team members have the resources needed to do their jobs.
▸ Situation monitoring. This involves actively scanning and assessing the elements of a situation to get more information, gain a deeper understanding, or maintain awareness to support the function of the medical care team as a cohesive unit.
▸ Mutual support. Team members must be able to anticipate and support team members through knowledge of common goals and recognition of the team members' responsibilities and workload, and being willing to help where needed to improve patient care.
▸ Communication. Team members must exchange information clearly and accurately.
The TeamSTEPPS materials incorporate specific strategies to ensure clear and accurate communication, including the SBAR (Situation, Background, Assessment, and Recommendation) technique for communicating critical information that requires immediate attention, and the use of “call outs” and “check backs” as techniques for team members to stay informed, especially in critical care settings.
