Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September

The Team Concept: Who’s Got Your Back?

Jan Rebstock, RHIT, LHRM, CPHRM
10-2-3 Do you feel part of a cohesive, tight knit healthcare team who routinely looks out for each other’s back? You may respond with an unequivocal “yes” or you may be thinking team dynamics could be a whole lot better. Certainly there are many who have participated in interdisciplinary team training sessions over the years and agree with the concept in theory but perhaps haven’t seen much of an improvement in teamwork as a result of the training.   The concept of a team is very broad; it is something that exists anytime a group of people work together for a common purpose. Simply working with a team, however, doesn’t necessarily equate to working “as a team.” The Business Directory definition of team is a very good one and states “a team becomes more than just a collection of people when a strong sense of mutual commitment creates synergy, thus generating performance greater than the sum of the performance of its individual members.” So how does one develop, achieve and sustain this synergy?   Hospitals are a good forum to apply principles of teamwork in an effort to improve patient safety as performance under pressure is routine in many areas.  Over the past several years, attention has been given to how components of aviation’s Crew Resource Management Model (CRM) could be applied in the health care setting.  Perhaps best known, is the application of CRM training skills in the operating room which studies have shown resulted in improved team cooperation and patient outcomes. Components of the CRM model include routine briefings, standard operating procedures and checklists with a key component being the recognition that every member of the team brings a valuable set of skills and knowledge to the group. In order for everyone to feel comfortable in speaking up, the hierarchy is flattened and encouragement given for everyone to speak up, as well as listen to, what everyone has to say. In other words, egos are checked at the door.   One evidence based tool that has gained traction over the past few years is TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). The development of this toolkit, which you can order online, was a collaborative effort between the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ).  This project was designed for healthcare facilities and providers to help improve and develop a culture of patient safety through enhanced communication and other teamwork skills.  It is a formalized approach to integrating the principles of teamwork in phases that address core competencies of team leadership, situational awareness, mutual support and communication.   There are many factors making teamwork an essential element of patient safety; the complex nature and specialization of the delivery of health care, increasing patient co‐morbidities, workforce shortages and safe working hour initiatives. Dr. Paul Schyve, who is a senior advisor with the Joint Commission, has observed: “Our challenge…is not whether we will deliver care in teams but rather how well we will deliver care in teams.”   In looking at various team training models or toolkits, there are several common essential characteristics consistent with effective health care teams and these include:

1. A defined common purpose that includes collective interests and shared ownership.

2. Measurable goals that are focused on the team’s task.

3. Effective leadership that maintains a supportive structure, manages conflict, fosters trust and support and encourages all team members to speak freely.

4. Effective communication that assures adequate, accurate and timely sharing of information among staff and between staff and patients.

5. Cohesive team spirit and commitment.

6. Mutual respect and appreciation of each other’s talents and professional contributions.

When it comes to being a team player, actions speak louder than words.  One doesn’t have to look far to find opportunities to help other team members when workloads are heavy. Being flexible, dependable, a good listener, and supportive of your team builds trust and good working alliances. It’s a good feeling knowing that someone’s got your back when you need it.   References: 1. Why You Need Allies at Work‐http://humanresources.about.com/cs/  workrelationships/a/workallies.htm 2. Ten Ways to Create A Positive Work Environment‐ http://  www.insidejobscoach.com/print_files/te_ways.htm 3. Effective Teamwork in Healthcare: Research and Reality‐ http://  www.longwoods.com/content/18669 4. TeamSTEPPS: Integrating Teamwork Principles into Healthcare Prac‐ tice‐  http://www.psqh.com/novdec06/ahrq.html 5. Factors That Promote Effective Teamwork in Health Care‐ http://  www.ehow.com/list_6778245_factors‐effective‐teamwork‐health‐  care.html 6. Professional Communication and Team Collaboration‐  http://  www.ncbi.nlm.nih.gov/boods/NBK2637 7. Being an effective team player‐ www.who.int/patientsafety/   education/…/who_mc_topic‐4.pdf 8. The Value of being an effective team player‐ http://  www.cleveland.com/employment/plaindealer/index.ssf/2010/06/ the_value_of_being_an_effective_team_player.html 9. Error reduction through team leadership: Applying aviation’s CRM model in the OR