There is considerable overlap in the roles of various healthcare professionals, such as nurse practitioners writing orders. These changing roles can present challenges to the team in terms of role allocation and acknowledgment.
Overcoming:
Establish clear roles and responsibilities on the team and ensure everyone knows and understands them. Cross-train if you may need to play a dual role or cover as needs change. Always introduce yourself and state your role.
The nature of health care is changing in many ways, including increased delivery of care for chronic conditions in community care settings and the transfer of many surgical procedures to outpatient centers. These changes require the development of new teams and the modification of existing teams.
Overcoming:
Managers should Identify the purpose and shared goals of the team and assist with resource allocation, workload requirements, and support. They should also assist in clarifying roles and responsibilities of team members.
Health care is strongly hierarchical in nature, so that teams can range from counterproductive to well- functioning, effective teams in which all members' views are considered. Many factors can affect a person’s hierarchical position on a team, including area of specialty, sex, personality (introvert, extrovert, passive, or aggressive), and foreign vs. native education or training. Aviation identified this as a key issue and used Crew Resource Management (CRM) training to level out the hierarchal gradient between the captain and the co-pilot of the flight deck. They have since expanded this procedure to flight attendants, mechanics, and others involved in flight operations. Today it is expected that co-pilots and crew will speak up with concerns and that the captain will listen to and act on the concern regardless of seniority or experience. CRM program has created a strong safety culture, an awareness of human error, and the need for reliability. The same principles are being used increasingly in healthcare.
Overcoming:
Using the two-challenge rule, CUS, and DESC techniques will help flatten the hierarchy and allow your concerns to be heard, understood, and acknowledged. If an effective system such as this is not operating, go up the chain of command.
Many health-care professions, such as nursing, dentistry, and medicine, are based on the autonomous one-to-one relationship between provider and patient. While this relationship remains a core value, it is challenged by many concepts of teamwork and shared care.
Overcoming:
A common purpose with shared goals should assist in the development of the team. Different professions are taught various ways to communicate within their profession but not always across professions. Standard communication techniques will help; discussing how to communicate with each other about the plan of care will create synergy. Mutual respect and trust will help bond the team, and diversity will lead to innovation and better patient outcomes. Primary care physicians and specialists create Standard Care Agreements, for instance, that clarify the roles and responsibilities of each party, for example, that primary care will get various tests before sending a patient to a specialist and how each handoff will occur.
As discussed previously, health-care teams are often transitory in nature, coming together for a specific task or event (e.g. cardiac-arrest teams).
Overcoming:
Simulation training, mock codes, and standard communication will transcend some of these issues, along with role clarity and introducing yourself on the scene and stating your role. Other standard training such as Cardiopulmonary Resuscitation, Advanced Cardiac Life Support, and Pediatric Advanced Life Support will help minimize these issues.
Float staff can also create instability on a unit and present potential risks. You can mitigate that risk by having standard equipment, standard protocols, orientation to the floors that staff may float to, or designated PRN or float staff for each unit.
Reviews of high-profile incidents, such as aviation disasters, have revealed three main types of teamwork failings that contribute to accidents: unclear definition of roles, lack of explicit coordination, and other forms of miscommunication.
Overcoming: Methods such as Team STEPPS™ and CRM and teamwork principles will minimize these effects within a safety culture.
Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM
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