Teamwork has been a buzzword around the business culture for some time. Leading businesses know that well performing teams are the key to profits in a business. However, teamwork takes on a whole new level of importance in life or death situations such as military combat, airline travel, and healthcare. In 1999, the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System, which was a revealing review of the U.S. medical care system and the inadequacy of safety practices used in the treatment of patients. The IOM report estimated that medical errors result in 44,000 to 98,000 deaths annually—more than automobile accidents (43,458), breast cancer (42,297), or AIDS (16,516). Since then, there have been a number of initiatives and task forces to address this problem, including the development and research of team based training to improve patient safety.
While the focus on teamwork in healthcare has brought improvement, there is still work to be done. The study, “Medical Errors Involving Trainees: A Study of Closed Malpractice Claims from 5 Insurers,” appeared in the October 22, 2007, issue of the Archives of Internal Medicine. The lead author, Hardeep Singh, M.D., M.P.H., noted, “Our study confirms the relationship of poor teamwork to preventable errors and quality of care.” The Agency for Health Research and Quality (AHRQ) Director Carolyn M. Clancy, M.D. stated about this study, “This study reminds us that we have a lot to do to ensure that hospitals are providing appropriate supervision to trainees and implementing team-training programs, both in the inpatient and outpatient setting.”
In addition to the obvious importance of teamwork for patient safety, there is also a critical need for effective teamwork to create the efficiencies needed to deal with increased patient volumes and decreasing reimbursements. Physicians today need to make sure they have expert teams, not just teams of experts. Expert teams aren’t created overnight. It’s a process and takes purposefulness and commitment. Teams typically begin in the formation stage where people are learning, leaders are directing, and people are getting to know one another. Unfortunately, this is usually followed by the storming stage where clicks can development, a great deal of supervision is required, and disagreements can ensue. While many teams get permanently bogged down in the storming stage, better performing teams will enter a norming stage. In this stage, the team starts to actually work together as a team, goals and directions become clear, and the overall performance improves. Truly high performing teams will enter a performing stage where team members all exhibit leadership, self-motivation is high, and the team members all have strong skills and knowledge. The reality is that most teams will move up and down this spectrum as they progress and decline in their teamwork.
For some, discussions about teamwork and team building conjures up images of warm and fuzzy games and retreats. Working on teamwork can be seen as a waste of time and money and not “real work.” The reality is quite different. From 1955-2008 there were over 300 empirical articles on teamwork studying over 10,000 teams. For example, a study by Eduardo Salas, Diana R. Nichols and James E. Driskell Small Group Research 2007; 38; 471 entitled “Testing Three Team Training Strategies in Intact Teams: A Meta-Analysis” found unequivocally that team training improved performance.
There are a number of training methods that can be used to deliver results including: cross-training, event-based approach to training, scenario-based training, self-correction training, stress exposure training, team adaptation training, and team leader training. The reality is that physician team settings vary dramatically from emergency room, to general surgery, to primary care physicians. The key is adapting your training to your specific environment. For those considering team training, it can be a waste of time and money unless the design and delivery of the training is based on scientific principles, the physicians take ownership, teamwork is rewarded and encouraged, and there is feedback loop to debrief and measure success. True team development should focus on building the knowledge, skills, and attitudes of your team members and should be an ongoing process.
The handwriting is on the wall. There is no doubt that quality of care will continue to be scrutinized with greater intensity, particularly with the shift to electronic medical records. The link between pay and quality of care is only going to get stronger. Physicians will have to continue to do more with less. There will be increase pressure to see more patients and be highly efficient. At EMHC, we are continuously striving to stay up-to-date on the quality of our patient care. While more studies need to be done, we have enough data from the commercial airline industry and the military to show us that we need to strive for better teamwork in healthcare to improve safety. Since many physicians are also entrepreneurs, they must keep an eye on the bottom line and the work of business has shown us undoubtedly that it’s hard to be profitable with a poorly performing team. In the near future developing your healthcare team won’t be a luxury, but a necessity.