As discussed in other Risk Management courses, preventable harm in U.S. healthcare leads to more than 250,000 deaths annually. This harm includes hospital-acquired infections, surgical errors, medication errors, patient falls, and diagnostic errors. These outcomes are a by-product of the complex interactions in the socio-technical care delivery system. There is a growing body of evidence linking teamwork and communication failures to technical failures in the operating room, resulting in adverse events. One study demonstrated that team skills scores for situation awareness correlated with technical errors. In cardiac surgery, investigators linked technical errors with teamwork and communication failures with flow disruptions.
Communication and flow of information between healthcare professionals and patients can be complicated because various team members' individual responsibilities are very widespread. As a result, patients often must repeat the same information to multiple care team members, which can lead to lack of trust in providers. Miscommunication has been correlated with delays in diagnosis, treatment, and discharge, as well as failure to follow up on test results.
Communication failures remain the leading cause of serious adverse events. These failures can be independent causes or contributing factors that underlie other forms of harm. Transitions in care (i.e., between care units, shift changes, or facilities) or other situations involving a handoff are high-risk for communication failures that directly cause harm. These critical interactions can apprise the receiver of vital information regarding the patient’s status and plan of care; if miscommunicated, they can lead to delays in treatment, errors, or inappropriate therapies. One study indicated that 28% of surgical adverse events are associated with transitions of care. Interactions between team members can contribute to specific harms.
The teamwork and coordination challenges that face us have often been neglected in organizational systems. There is a strong tendency to work in silos and ignore integration and coordination across an organization, much less across the continuum. However, the Center for Medicare and Medicaid Services (CMS) Innovation Center, as part of the Affordable Care Act, has initiated some attempts at collaboration across the continuum. The Bundled Payments for Care Improvement consisted of models of care (e.g., Comprehensive Care for Joint Replacement) that linked payments for multiple services beneficiaries received during an episode of care. It aligned incentives for providers—hospitals, post-acute care providers, physicians, and other practitioners—allowing them to work closely together across all specialties and settings. These models aimed to increase quality and care coordination at a lower cost to Medicare. The hospital received the total payment, which was split between the care providers, such as rehabilitation facilities, physicians, etc. This practice incentivized people to provide quality care at a lower cost by lowering the length of stay and integrating services, rethinking how they provide care by looking at the overall process rather than just their individual part.
Now, more than ever, we have an obligation to strive for improvement in the practice of inter-professional team-based healthcare. Teamwork and communication are now two of the competency domains advanced by the Interprofessional Education Collaborative that identify attitudes, knowledge, and behaviors desirable for interprofessional healthcare teams to provide safe patient care. Learning the fundamentals of teamwork and collaborative care in health profession schools reduces the silos in education and prepares students to be effective team members.
Effective teamwork can immediately and positively affect patient safety. The importance of effective teams is increasing for these reasons:
Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM
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