Communicating, coordinating, and cooperating when lives depend on it: Tips for teamwork

ArticleinJoint Commission journal on quality and patient safety / Joint Commission Resources 34(6):333-41 · July 2008with103 Reads
Source: PubMed
Abstract

In health care, others' lives depend on the team operating at a level beyond the sum of its individual parts. A framework (a heuristic) represents a three-pronged approach to teamwork in health care that entails communication, coordination, and cooperation. These fundamental requirements of teamwork represent the constant interaction that team members undertake to become an effective team. Guidelines, tips, and examples show how the framework can be applied to establishing and enabling teams to provide safe, reliable care. The guidelines are as follows: (1) Support precise and accurate communication through a closed-loop communication protocol; (2) diagnose communication errors as you would any illness--Examine the team and look for symptoms, then treat the symptoms through team learning and self-correction; (3) recognize functional expertise by identifying and publicizing topical experts to evenly distribute work load and increase accuracy; (4) institute frequent practice opportunities to keep team skills in good shape because poorly honed skills will limit performance; (5) refine the team's shared mental models (SMMs) by pre-planning to build its implicit coordination skills, adaptability, and flexibility; (6) shape adaptive expertise by fostering a deep understanding of the task to increase team effectiveness; (7) build team orientation by taking steps to increase trust and cohesion to lower stress levels and increase satisfaction, commitment, and collective efficacy; and (8) prepare the team by providing learning opportunities for new competencies that will expose members to feedback and increase the team's overall efficacy. Although not a comprehensive list, the guidelines and tips represent the most essential requirements for effective teamwork.

    • "...ows the development of relationships necessary to facilitate understanding of varying perspectives [21]. Individuals who communicate more with each other become more similar as they increasingly share th..."
      Team stability is defined as the same individuals who come together to work on collaborative tasks [20]. Team stability is important because it allows the development of relationships necessary to facilitate understanding of varying perspectives [21]. Individuals who communicate more with each other become more similar as they increasingly share their beliefs and knowledge [22].
    [Show abstract] [Hide abstract] ABSTRACT: Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians.
    No preview · Article · Jun 2015
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    • "... depends on relationships, which are necessary to facilitate understanding of varying perspectives [63] . Researchers would benefit from implementation theories that propose some plausible paths by which..."
      First, implementation science theories should propose and test the concept of shared understanding when describing communication and acknowledge the relational nature of communication. In a social constructionist paradigm, knowledge emerges from joint interactions or communication and thus depends on relationships, which are necessary to facilitate understanding of varying perspectives [63] . Researchers would benefit from implementation theories that propose some plausible paths by which shared understanding might be obtained.
    [Show abstract] [Hide abstract] ABSTRACT: Poor communication among healthcare professionals is a pressing problem, contributing to widespread barriers to patient safety. The word "communication" means to share or make common. In the literature, two communication paradigms dominate: (1) communication as a transactional process responsible for information exchange, and (2) communication as a transformational process responsible for causing change. Implementation science has focused on information exchange attributes while largely ignoring transformational attributes of communication. In this paper, we debate the merits of encompassing both paradigms. We conducted a two-staged literature review searching for the concept of communication in implementation science to understand how communication is conceptualized. Twenty-seven theories, models, or frameworks were identified; only Rogers' Diffusion of Innovations theory provides a definition of communication and includes both communication paradigms. Most models (notable exceptions include Diffusion of Innovations, The Ottawa Model of Research Use, and Normalization Process Theory) describe communication as a transactional process. But thinking of communication solely as information transfer or exchange misrepresents reality. We recommend that implementation science theories (1) propose and test the concept of shared understanding when describing communication, (2) acknowledge that communication is multi-layered, identify at least a few layers, and posit how identified layers might affect the development of shared understanding, (3) acknowledge that communication occurs in a social context, providing a frame of reference for both individuals and groups, (4) acknowledge the unpredictability of communication (and healthcare processes in general), and (5) engage with and draw on work done by communication theorists. Implementation science literature has conceptualized communication as a transactional process (when communication has been mentioned at all), thereby ignoring a key contributor to implementation intervention success. When conceptualized as a transformational process, the focus of communication moves to shared understanding and is grounded in human interactions and the way we go about constructing knowledge. Instead of hiding in plain sight, we suggest explicitly acknowledging the role that communication plays in our implementation efforts. By using both paradigms, we can investigate when communication facilitates implementation, when it does not, and how to improve it so that our implementation and clinical interventions are embraced by clinicians and patients alike.
    Full-text · Article · Apr 2015 · Implementation Science
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    • "...ess (quality of actions, goal achievement, and error rate). Schraagen, 2000; Salas, Wilson, Murphy, King, & Salisbury, 2008; Thorstensson, Axelsson, Morin, & Jenvald, 2001 ), facing a regularly changing situation, and dealin..."
      Moderated mediation model of the relations between team learning processes, the team situation model (TSM) and team effectiveness (quality of actions, goal achievement, and error rate). Schraagen, 2000; Salas, Wilson, Murphy, King, & Salisbury, 2008; Thorstensson, Axelsson, Morin, & Jenvald, 2001 ), facing a regularly changing situation, and dealing with high task complexity asking for the input of different disciplines. To accomplish the task, the team members sequentially initiate OSCT meetings, between which they coordinate their own units.
    [Show abstract] [Hide abstract] ABSTRACT: The development of a team situation model (TSM), a shared understanding of the current situation developed by team members moment by moment, and its impact on team effectiveness have received minor attention in team research. This study investigates a moderated mediation model including the relationship between the team learning processes of co-construction and constructive conflict, the TSM, and team effectiveness. Forty-seven emergency management command-and-control teams participated in this field study. Their task was to manage a realistic emergency simulation developed and organized by field experts. The multi-rater approach included ratings of team members, researchers, and field experts. Results show that co-construction is related to the TSM under the condition of high constructive conflict. The TSM predicts team effectiveness in terms of the quality of actions at the incident scene.
    Full-text · Article · Feb 2015 · Small Group Research
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    • "...ver, since closed loop communication is described as supporting precise and accurate communication [22] it may serve as a tool to improve patient safety in the EMCC. Whether the use of closed loop commun..."
      The use of follow-up questions and conclusions may be a way of making sense of and sorting out the information given by the caller. However, since closed loop communication is described as supporting precise and accurate communication [22] it may serve as a tool to improve patient safety in the EMCC. Whether the use of closed loop communication is a specific skill developed in an ad hoc way based on the RNs' professional background and experience in managing interactions with callers as argued by Pettinari & Jessop [23] is not determined by this study but a question arises; is it possible to develop assessment protocols supporting problematic communication situations?
    [Show abstract] [Hide abstract] ABSTRACT: IntroductionPrevious studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher¿s (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC).AimThe aim of the study was to identify overall factors influencing the registered nurses¿ (RNs) assessment of calls to the EMCC.MethodA qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis.ResultsOne hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN¿s assessment of calls to the EMCC. The opportunities appeared in the callers¿ symptom description and the communication strategies used by the RN. The barriers appeared in callers¿ descriptions of unclear symptoms, paradoxes and the RN¿s lack of communication strategies during the call.Conclusion Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN¿s use of different communication strategies such as closed loop communication.
    Full-text · Article · Nov 2014 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
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    • "...er, & Wimbush, 2010). Monitoring is another important element of coordination (Klein, 2001; Salas et al., 2008), which includes monitoring changes in the situation, monitoring other members and monitoring progr..."
      Relational coordination is a key characteristic of high-performance and resilient work systems (Gittell, 2008; Gittell, Seidner, & Wimbush, 2010). Monitoring is another important element of coordination (Klein, 2001; Salas et al., 2008), which includes monitoring changes in the situation, monitoring other members and monitoring progress of the plan (Klein, 2001). Collaborative cross-checking is an example of monitoring that can facilitate coordination (Patterson, Woods, Cook, & Render, 2007).
    [Show abstract] [Hide abstract] ABSTRACT: Care coordination is important for chronically ill patients who need assistance from a variety of care professionals, and often transition through different care settings. This paper provides an overview of coordination and its implications for the care of chronically ill patients. Using 12 interviews of different healthcare professionals involved in coordinating care of chronically ill patients, we provide examples of care coordination situations (e.g., patient discharged home with home health services) and identify coordination activities (e.g., communication for arranging resources, building relationships to facilitate information exchange, monitoring patients to plan follow up care) performed by different healthcare professionals.
    Full-text · Conference Paper · Oct 2014
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    • "... ability to bring new members " up to speed " quickly (Leonard et al., 2004; Manning, 2006; Salas et al., 2008). These results lend support to this contention—benefits accrued despite staff changes. ..."
      The interventions were tested under realistic conditions, and still produced positive results. Among the benefits of SBAR and process standardization is the ability to bring new members " up to speed " quickly (Leonard et al., 2004; Manning, 2006; Salas et al., 2008). These results lend support to this contention—benefits accrued despite staff changes.
    [Show abstract] [Hide abstract] ABSTRACT: Hospital communication is more than access to information. Among staff, it is about achieving situation awareness-an understanding of a patient's current condition and likely trajectory. In the multidisciplinary context of providing care, structure, consistency, and repeatability of communication will enable a shared understanding of the patient and plan, leading to improved patient satisfaction and outcomes. This was tested using the Situation-Background-Assessment-Recommendation (SBAR) protocol, a re-admissions risk assessment and daily interdisciplinary rounds (IDR) in the medical/surgical units of a hospital. The impact of these interventions on patient satisfaction, Foley catheter removal compliance, and patient re-admission rates was assessed. Over the 3 year period, Foley compliance improved from 78% to 94%, and re-admissions decreased from 14.5% to 2.1%, both significant. Patient satisfaction trended positively, but was not significant. These results support the value of SBAR and IDR, and are advocated to improve situation awareness and maintain focus on key patient data.
    Full-text · Article · Mar 2014 · Western Journal of Nursing Research
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