June 1, 2008 | American Society of Registered Nurses®
Chronicle of Nursing

Facilitating Patient Safety Through Teamwork

Through cooperative problem-solving, collaboration and communication help the healthcare team learn and grow, share different viewpoints, and find common ground. It fosters brainstorming. Teamwork is required if you want to get better results from less work and if you want to accomplish anything of value. Teamwork does improve patient safety and patient safety depends on teamwork.[1] Healthcare teamwork should focus on providing the highest quality patient care and working together toward this common goal. Teamwork combines the knowledge, skills, and attitudes of each of its individual members which allows for the team to be pro-active in catching errors before they occur, find the root cause of errors, and focus on the patient.

Solid teamwork is fundamental to achieving outcomes and increasing effectiveness.[2] Safety is all about relationships between the team members and their common goals: to reduce errors and provide quality patient care.[3]  Effective teams function through collaboration among patients, families, team members and other teams throughout the healthcare system.[4] Collaboration involves analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to work together is generated.[5] Effective relationships and collaboration are built on trust, but without trust, team collaboration, along with patient safety, is compromised.[6] For example, the conversation and dialogue between the nurse and the physician establishes a safe care plan based on the current status of the patient.[7] When this, and other, important conversations about patient care are misinterpreted, incomplete, blocked, abbreviated, unclear, or absent, patient safety can suffer and an injury may follow.[8] Teamwork and communication enable healthcare professionals to safely and consistently delivery high quality patient care. Breakdowns in communication and teamwork are the leading contributors toward errors in medical treatment.

Effective teams have members who anticipate each other's needs and they can coordinate without the need to communicate overtly - this is vital in high stress, time-restrictive environments.[9] Each member of the team recognizes his/her dependence on the other team members, and knows that together they will be able to solve problems. They also recognize problems before they occur and are able to adapt to change quickly depending on the need of the current situation. Teams should work well in everyday situations, so they can quickly react when crises occur. Effective teams have the ability to avoid or minimize potential for error. To facilitate effective teamwork the following behaviors and actions are necessary for effective performance. They must:

  • Proactively and reactively adapt to changing circumstance.
  • Use information collected from the task environment or situation to make adjustments in treatment plans or procedures.
  • Demonstrate clear and concise closed-loop communication (verify sent messages are both received by the intended party and interpreted by the receiver correctly).
  • Monitor their teammates and provide back-up behavior.
  • Demonstrate strong leadership.
  • Manage conflicts appropriately.
  • Make informed decisions.
  • Promote coordinated action by synchronizing the team's task requirements, material resources, strategies, and responsibilities.[10]
  • Have a shared understanding of how a procedure/plan should be carried out.
  • Enlist the patient's participation as part of the team when appropriate.
  • Anticipate the needs of others.

The report To Err is Human endorses the systems approach to understanding and reducing errors, and that failures are most often due to unanticipated events or factors occurring within multiple parts of the systems, though the human component is a large contributor.  Improving patient safety requires more than relying on the workforce and well-designed work processes; it requires an organizational commitment to vigilance for potential errors and the detection, analysis, and redressing of errors when they occur.[11]

 

 



[1] Salas, E., Sims, D., Klein, C., Burke, S. (July, 2003). Can Teamwork Enhance Patient Safety? Forum, Risk Management Foundation, Harvard Medical Institutions.

[2] Gonzales, C., Rotman, S. (Feb. 18, 2008). Building Block of Teamwork. Advance for Nurses, 9(5), 28-31.

[3] 2

[4] 2

[5] Yoder-Wise, P. (1999). Leading and Managing in Nursing. St. Louis, MO: Mosby, Inc. 2nd Edition, pg. 327.

[6] Reina, M., Reina, D, & Rushton, C. (2007). Trust: The foundation for team collaboration and healthwork environments. AACN Advanced Critical Care, 18(2), 103-108.

[7] Veltman, L., Larison, K. (2007). Pure Conversations: Enhancing communication and teamwork. Journal of Healthcare Risk Management, (27)2, 41-44.

[8] 7

[9] 1

[10] 1

[11] National Academies Press.  Board on Health Care Services. Institute of Medicine.  Creating and Sustaining a Culture of Safety - Keeping Patients Safe: Transforming the work environment of Nurses (2004).

 

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