Effective Communication and Teamwork in Promoting Patient Safety

Teamwork is the ability to work together toward a common vision, the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results! ~ Andrew Carnegie

Teamwork in healthcare setting is the ongoing process of interaction between team members as they work together to provide care to patients .It depends on a willingness to cooperate, coordinate, and communicate while remaining focused on a shared goal of achieving optimal outcomes for all patients.

Breakdown in communication or a lack of teamwork can contribute to adverse events and adverse patient outcomes. The opportunity for clinical information to be consistently passed on or handed over between and within teams of health care professionals, relies on individual knowledge, skills and attitudes of team work generally, and communication specifically.

The transfer of professional responsibility and accountability from one care giver to another is an important process in Patient safety.

For any organisation to achieve its mission and vision there is need in ensuring  teamwork as nobody is an Island and there is no ‘I’  in teamwork.

A review of the report from The Joint Commission International(JCI)’  sentinel event database which  shows the root causes of sentinel events over time estimated that Ineffective communication accounts for more than 70% of medical errors.. The reporting is voluntary and it is a small proportion of the actual events, between 2004- 2nd quarter of 2011 the database shows that the major cause of sentinel events was leadership accounting for 653 cases (69.7%) from a total of 936, leadership accounts for 710 cases ( 87.6%) from a total of 810 and communication-486 in a total of 531 cases(91.5%) in 2009, 2010, January through second quarter of 2011 respectively.

Ineffective or insufficient communication among team members is a major contributing factor to adverse events in healthcare as revealed by a growing body of literature on safety and error prevention.  Patient harm, increase length of stay and ineffective resource use are some of the results of communication failures in acute settings.

No doubt there are challenges to effective communication which primarily may not be due to individuals.

These challenges include but are not limited to the following:

• Health care is complex and with the professionals coming from different specialties providing care at different times in a day.

• The healthcare curricula for healthcare givers focus mainly on individual technical skills, neglecting teamwork and communication skills (This is hardly ever taught in schools).

• Care givers have their own disciplinary view and therefore prioritise the patient needs based on their view.
• Pyschological safety (open, safe communication) is lacking in most healthcare organisations which is as a result of restraint and inhibition in communication due to hierarchical structure with power distances between physicians and other healthcare professionals.
• Healthcare professionals have different communication styles which result in ineffective communication due to differences in training and education.

So what is the way forward having found that communication or teamwork are major defects in healthcare that can compromise patient safety?

The Agency for Healthcare Research and Quality and Department of Defence in the United States did a multiyear research on how to improve communication and came up with an evidence based approach- Team STEPPS.

Team STEPPS is evidence based framework useful in training of care givers to improve teamwork and communication in healthcare. Knowledge, Skills and Attitude are basic competencies that must be possessed by a healthcare giver to be able to function effectively in various teams. These competencies serve as foundation for Team STEPPS.

Team STEPPS includes: Leadership, mutual support, situation monitoring and Communication.

Leadership: A leader is person that coordinates and directs the other members of the team. He encourages the other team members to do quality work and achieve the target that is set.

• Synchronize and combine individual team member contributions
• Seek and evaluate information that impacts team functioning
• Clarify team member roles

Communication: is important for the success of any team. It is the exchange of information between a sender and receiver regardless of medium

It involves following up with team members to ensure message was received,  Acknowledging that a message was received and Clarifying with the sender of the message that the message received is the same as the intended message sent.
Mutual support: The shared belief that team members will perform their roles and protect the interests of their teammates. This includes information sharing and willingness to accept mistakes and feedback.

Situation monitoring: The ability to develop common understandings of the team environment and apply appropriate task strategies in order to accurately monitor teammate performance.  Identify mistakes and lapses in other team members’ actions and provide feedback regarding team member actions in order to facilitate self-correction.

In Conclusion, Effective team work is about: good leadership, good communication and defining clear cut roles.

References

1. Kumar et al: Improving communication and teamwork in healthcare settings
2. The Joint Commission International Sentinel events. Available at:
3. www.jointcomission.org/sentinel_events June 2011
4. C Dingley,K Daugherty,Mary K Derieg  et al: .Improving Patient Safety through Provider communication strategy enhancements.
5. Heidi B King, J Battles,P Baker et al. Team STEPPS: Team strategies and tools to enhance Performance and Patient Safety 2007
6. Joint Commission on Accreditation of Healthcare Organizations. 2005 National Patient Safety Goals. Available at: www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/. Accessed February 6, 2008.