Teams

The way people work together is central to the safety of healthcare.  

Behaviours of individuals at all levels can play a role in the lead up to incidents or in the prevention of incidents.  Teams are people who are used to working with one another, often the same people.  This is increasingly rare in healthcare where teams come together for a short period of time and then disperse.  

There are three key concepts in relation to teamwork that are important for the safety of patient care.  The first is teaming, the second is individualism and the third is collective competence.

Teaming

Amy Edmondson has described a form of team work as ‘teaming’.  

Teaming is an adjective that describes the art of communicating and coordinating with people across boundaries of all kinds, whether that be across profession, status or geography.  Teaming is needed more and more and in particular has been vital over the course of the pandemic with individuals being redeployed to different departments.

We have known for decades that team work is necessary for delivering safer care.  When people work well together it can reduce the number of errors or incidents.  There are almost no aspects of healthcare that are carried out by individuals acting alone.  Most of our work requires people to communicate with each other and develop effective relationships even if short. In our complex adaptive system working in teams is dynamic, constantly changing depending upon the shift or the type of work.  

For people to be able to ‘team’ they need a sense of belonging; feeling accepted, included, respected, listened to and fully involved.  For teaming to be successful the purpose needs to be stipulated at the outset.  It needs people to seek out everyone’s opinion to build mutual understanding as part of the teaming to get work done.  

Individualism

In safety we are concerned with making our complex adaptive system more reliable and less prone to error.  Rene Amalberti, has argued that the goal of an ultra-safe health care system is fundamentally constrained not by economics or science but by cultural values and system barriers.  Amalberti and his colleagues says that we need to move away from individualism in healthcare and away from individual clinicians determining the degree of risk in their practice, from those that stress their own goals to the exclusion of others’, and from those that embrace variation rather than standardization.  Amalberti often cites that of aviation, in that everyone who flies expects the pilot have the same competence as any other pilot and it should not matter who that pilot is.  In healthcare it is asserted that there is too much variability of competence which means patients seek out different clinicians from others where they are able.

Collective competence

The question should not be whether a particular surgeon is performing well, but whether or not the system that is composed of the surgeon and all the other members of the healthcare team is performing well.  It is the performance of that system, not the skills of any individual member of the team that determines the success or not.  

Actually, in healthcare you want a bit of both.  

You want to combine individual skill with collective ways of seeing and working; the cognitive properties of individuals, plus the tools in the environment and the interactions of each member of the team.