Teamwork and Communication Errors in Healthcare

NB: We do not resell your papers. Upon ordering, we do an original paper exclusively for you.

NB: All your data is kept safe from the public.

Table of Contents

Introduction
Medical error
The problem of ineffective team work
The solution of the problem of communication errors
Conclusion
Notes

Introduction

This paper states that medical errors have a number of underlying causes, including the fallibility of medical personnel, uncertainty of medical knowledge and imperfection of organizational systems, and pays special attention to the negative outcomes of communication errors in healthcare, pointing at bypassing the traditional disciplinary and hierarchical boundaries as the measures which are necessary for improving the patient outcomes and the working environment for caregivers.

Medical error

The concept of avoidable harm caused by healthcare service providers has been discussed since the time of Hippocrates who defined the primary goal of medicine as doing no harm about 2,400 years ago. Called iatrogenic harm, the medical errors were considered as an inevitable product of modern medicine and one of its top five problems.¹

The year 1999 has become a turning point in estimating the impact of medical mistakes, drawing the public and media attention to the existing problem and offering the measures for improving the patient safety. The publication of the report To Err is Human: Building a Safer Health System by the Institute of Medicine (IOM) became a significant contribution to the patient safety literature. ²

This report expanded the existing theoretical framework of medical errors and catalyzed the national movement towards improving the safety of healthcare by initiating important changes in culture and training for the medical workers.³

The efforts of IOM to fill the gaps between theory and practice of ensuring the patient safety were valuable because the existing terminology contained a great number of confusing and overlapping concepts.

In modern patient safety literature, the concept of medical error is defined as an act of doing wrong things or the failure of doing the right things in medical care resulting in a negative outcome of the chosen intervention or even the high potential of such an outcome. ⁴The concept of safety is defined as freedom from hazard and is in inverse relationship with the risks.

The breaches in safety and ethics of healthcare are the main underlying causes of the medical errors which result in needless suffering for patients and service providers.⁵ To define the level of safety, the balance between the likelihood of doing good or harm by implementing certain measures and the availability of choices should be considered in every individual situation.

With the complexity of terms and processes, measuring the errors, safety and corresponding outcomes of treatment can be rather difficult. Thus, medical errors can do or do no harm to the patients’ condition, while the patients can experience harm from medical care even if no medical errors occurred. For this reason, it is important to distinguish between preventable and non-preventable adverse effects.⁶

Taking into account the fact that undesirable patient outcomes can be caused by a variety of reasons, some safety experts give preference to the term preventable adverse effects as the main target of the safety field.⁷

This term is not only politically correct but also defends caregivers, shifting the emphasis on the role of organizational systems in preventing the iatrogenic harm. However, another group of safety experts considers the term of preventable adverse effects as inappropriate and useless for catalyzing the changes in patient safety.

Due to the variety of definitions and measurement systems, the data on the rates of medical errors and their impact differs from hospital to hospital. According to the estimates of the safety experts, the risks of flying in an airplane are lower than experiencing harm from being a patient in a hospital.⁸

Another group of researchers stated that an average hospitalized patient experiences approximately one medical error a day.⁹The financial impact of these errors is profound.

According to the data of the 1999 IM report, the costs of the preventable adverse effects only were between 17 billion and 29 billion dollars.¹⁰Still, the largest harm of the medical errors is on the patients’ health and anxiety of caregivers who are the second victims of the unsafe organizational systems.

Taking into account the frequency and the negative implications of medical errors on both patients and caregivers, it can be stated that moral and ethical considerations of patient safety play an important role in improving the organizational systems for minimizing the risks of experiencing harm due to their imperfection.

The problem of ineffective team work

With the present-day pace of technological progress and the increased complexity and number of mediations and procedures, the appropriateness and safety of the provided health care services depend upon the effectiveness of teamwork.

Taking into account the amount of professional knowledge and skills required for providing patients with appropriate treatment, it can be stated that the quality and safety of health care cannot be controlled by individual physicians anymore.

The ineffective teamwork and communication errors are costly for hospitals and patients. The main underlying causes of these mistakes include the extreme hierarchies of healthcare organizations and the lack of team training. As to the first parameter of the management style, it can be stated that structure and hierarchies are important for preventing chaos within the organizations, but going to extremes, it can do harm.

The extreme hierarchies are rooted in the cultural and circumstantial problems with bypassing the traditional schemes.¹¹The psychological distance between workers and their supervisors can make nurses withhold critical information and tell leaders only what they want to hear. The distance between a leader and the assisting personnel is defined as an authority gradient which is rather high in healthcare. ¹²

The steepness of the hierarchical structure of the hospitals can reduce the effectiveness of their work. On the one hand, self-assured physicians may implement an autocratic management style and make decisions without much regard to opinions of other specialists.

However, it can deprive them of valuable information which is required for improving the system. On the other hand, the problem is with workers who believe that leaders are not even interested in their opinions and do not feel comfortable to express their concerns. These large authority gradients can decrease the effectiveness of intervention plans.

The institutional changes are needed in hospitals where the physicians are self-employed while nurses work for the hospital for improving their relationship and reducing the steepness of the authority gradient.¹³The second underlying cause of communication mistakes in medical care is the lack of training and the fluidness of teams due to the realities of the health care facilities.

Currently, medical teams are often composed of people who see each other for the first time and are not prepared for playing specific roles.¹⁴There are a variety of circumstances forcing medical personnel into such a situation, including the staff shortages, unexpected sickness of some specialists and changes to arrangements. Still, the main problem is with the lack of attention to the importance of effective teamwork in medical care.

The high level performance in healthcare requires complex interactions between the specialists working in a team and dependent upon each other.¹⁵The authority gradient, the steepness of hierarchies and team training are the main factors which should be reconsidered for shifting the emphasis from individual physicians’ responsibility towards the improvement of organizational structures.

Recognizing the importance of teamwork in healthcare instead of putting the main emphasis on individual responsibility is important for minimizing the risks of professional mistakes. The evidence shows that multidisciplinary teams can improve the performance of the health care practitioners significantly.¹⁵

With the present-day amount of medical knowledge, one person cannot obtain all the necessary information from all spheres required for selecting the appropriate intervention strategies and applying them into practice. The healthcare teams are recognized as a crucial component required for providing safe and ethical healthcare.

Disregarding the importance of dampening the authority gradient in the hospital setting in general, strong leadership is important for these teams.¹⁶Moving towards the patient-centered model of healthcare, these teams need to cross the traditional boundaries of hierarchies and traditional disciplines.¹⁷

The united efforts of surgeons, anesthetists, physiotherapists, nurses and administrators would be beneficial for serving the best patients’ interests through improving the performance of the medical personnel. Though the fluid health care teams are often criticized as the obstacle for the effective teamwork, the fixed teams depending upon the individuals who have the experience of working together can be dangerous as well.¹⁸

The main disadvantages of the fixed teams in which certain groups of specialist get accustomed to working together include creating the informal hierarchies inside of the teams, making the incorrect assumptions and suffering from the so-called groupthink.¹⁹

Thus, it can be stated that involving multiple providers, and the multidisciplinary healthcare teams require creating specialized protocols for defining the roles of each specialist but not relying on human factor of the same individuals working together.

Recognizing the importance of effective teamwork for preventing the medical communication errors, it can be stated that health care service providers should cross the traditional hierarchical and disciplinary boundaries for improving their performance and ensuring the patient safety.

The solution of the problem of communication errors

Taking into account the fact that communication problem is the underlying cause of serious medical errors, proper measures need to be imposed for enhancing the effectiveness of teamwork, including training of specialists and employing strategies in the working process.

Recognizing the importance of teamwork for ensuring the safety and quality of health care, medical workers can adopt the experience of the aviation communication training called Crew Resource Management. ²⁰As opposed to healthcare in which the importance of teamwork has been ignored, modern pilots and other members of the staff have been trained as teams for decades.

Borrowing the concept of standard aviation procedures can be valuable for the healthcare.²¹ The main principle of this strategy is dampening the authority gradient for creating the environment in which every member of the team feels comfortable to raise issues and express concerns.

Another significant advantage of this approach is developing standard operating procedures so that every member understands his/her specific role in achieving the common goal.²²

Despite the fact that the implementation of crew resource management allowed diminishing the authority gradients and enhancing the safety culture of airlines, certain limitations of using the aviation analogy for healthcare need to be taken into consideration.²³

Along with dampening the authority gradient, balancing the no-blame culture and the error reports as a part of accountability are the measures which need to be imposed by hospital settings.²⁴

It is important to acknowledge that the studies on transforming the healthcare safety culture are at their starting point, and further research is required for selecting the most effective strategies for applying these findings into practice.²⁵

The strategies which can be implemented by health care teams for dampening the authority gradients and crossing the traditional hierarchical boundaries can vary from simple techniques to more complex forms. Along with simulation exercises during which the real-life working situations are imitated, health care teams can use certain strategies at the beginning and after completing clinical encounters.²⁶

The simplest technique which can be used by the leader before the beginning of a certain procedure is introducing him/her, admitting personal weaknesses inherent to all humans and saying that every member is welcome to express concerns in case if something goes wrong.²⁷This simple technique can be valuable for creating proper atmosphere and improving the team performance during the procedure.

The team performance can also be improved through the implementation of special techniques after the procedure is over, such as debriefing, for example.²⁸This strategy involves all the members of a health care team into discussion of the completed procedure for pointing at what was wrong and right about the behaviors of each participant.

To enhance the effectiveness of debriefing, all the participants should recognize the importance of critical speaking and expressing certain concerns as well as accepting the fact that everyone, including the leader is fallible. Efforts of every participant are the important attributes to the compensation for the fallibility of healthcare professionals and other causes of medical errors.²⁹

Additionally, the effectiveness of teamwork can be increased in the course of the procedure through the implementation of certain strategies, including the use of SBAR (situation, background, assessment and recommendations) messages and/or CUS (concern, uncomfortable, safety) words.³⁰

Team training is required for teaching the members of the teams not only to use these techniques in appropriate situations but also to react to them accordingly and avoid overusing them.

The solution of the problem of the communication problems requires a complex approach and hard work of all team members which starts before the beginning of the procedure and continues during the clinical encounter and even after its completion.

Conclusion

In general, it can be concluded that the quality of team performance is crucial for ensuring the safety of healthcare. A complex approach to team training is required for enhancing the team performance and serving the best interests of the patients.

The changes in the hospital culture are crucial for dampening the hierarchy and improving the organizational systems and enhancing the effectiveness of the medical teams by creating the working environment in which every worker can raise concerns and make a contribution to meeting the shared objective.

Notes

Bill Runciman, Alan Merry, and Merrilyn Walton, Safety and Ethics in Healthcare: A Guide to Getting It Right (Burlington: Ashgate Publishing Company, 2007), 1.
Robert Wachter, Understanding Patient Safety (New York: McGraw-Hill, 2008), 3.
Ibid., 36.
Ibid., 4.
Runciman et al, Safety and Ethics in Healthcare, 116.
Ibid., 4.
Ibid., 6.
Runciman et al, Safety and Ethics in Healthcare, 2.
Wachter, Understanding Patient Safety, 10.
Runciman et al, Safety and Ethics in Healthcare, 94.
Wachter, Understanding Patient Safety, 173.
Runciman et al, Safety and Ethics in Healthcare, 100.
Wachter, Understanding Patient Safety, 128.
Runciman et al, Safety and Ethics in Healthcare, 237.
Wachter, Understanding Patient Safety, 104.
Ibid., 169.
Runciman et al, Safety and Ethics in Healthcare, 163.
Wachter, Understanding Patient Safety, 104.
Ibid., 104.
Ibid., 101.
Runciman et al, Safety and Ethics in Healthcare, 245.
Ibid., 237.
Wachter, Understanding Patient Safety, 102.
Ibid., 209.
Ibid., 103.
Runciman et al, Safety and Ethics in Healthcare, 240.
Wachter, Understanding Patient Safety, 104.
Ibid., 105.
Runciman et al, Safety and Ethics in Healthcare, 109.
Wachter, Understanding Patient Safety, 106.

Click Here To Order Now!