The Doctor’s Advocate | Second Quarter 2018
An Ounce of Prevention

Team Synergy: A Critical Core Competency for Safe Care

Lisa McCorkle, MSN, MBA, Patient Safety Risk Manager, Department of Patient Safety and Risk Management

This quarter, Lisa McCorkle highlights customized, evidence-based training that builds on communication and teamwork skills to enhance patient safety and quality care.

—Darrell Ranum, JD, CPHRM, Vice President,
Department of Patient Safety and Risk Management

Many studies have shown that system failures in delivering healthcare account for more errors than individual failures. More than 70 percent of medical errors are attributable to dysfunctional team dynamics.1 A recent study observed that disrespect among team members resulted in higher surgical complications.2 Effective teamwork plays a key role in delivering high-quality and safe care and in minimizing adverse patient outcomes. Developing teamwork skills takes time and often requires a culture change, but teamwork training is a good starting point.

Cindy Wright, clinical director of Ohio ENT & Allergy Physicians, Ohio’s largest independent otolaryngology and allergy group, was familiar with team training in hospitals and felt strongly that Ohio ENT & Allergy Physicians could benefit from a program. The group employs 33 physicians, 21 nonphysician practitioners, and approximately 181 staff in 11 locations.

Our discussions centered on the elements that encourage good office environments with high-functioning teams. Ms. Wright provided several examples of situations the group had experienced, including patterns of interaction that demonstrated a lack of peer support, a reluctance to speak up about potential patient safety concerns, and communication styles that differed among clinicians.

We offered teamwork training through our individualized Team-Building INSIGHT to help the group build effective teamwork skills. The program is a value-added service that uses the TeamSTEPPS® proven framework developed by the Agency for Healthcare Research and Quality (AHRQ).*

The TeamSTEPPS framework provides a modular format with three phases:

  1. Assessing specific opportunities for improvement.
  2. Developing an action plan, training the team, and implementing TeamSTEPPS interventions.
  3. Sustaining and spreading the improvements in teamwork performance.

The training uses a “train-the-trainer” model to provide office practice staff instructors with the skills and coaching needed to train other staff members.

*Adapted with permission from TeamSTEPPS, Agency for Healthcare Research and Quality; Rockville, MD,

Executive Support

Successful transformational change, such as changing an organization’s culture, is a long-term process that requires the approval and participation of executive leadership. Ms. Wright and The Doctors Company’s patient safety risk manager met with the group’s CEO and CFO to examine how ineffective teamwork affects patient safety and potentially leads to medical liability claims. They also discussed how evidence-based teamwork training improves the delivery of safe care. Both the CEO and CFO were supportive, and the executive board approved the training.

Safety Culture Assessment

Our Practice Safety Culture INSIGHT tool provided a baseline measurement to validate the need for teamwork improvement. The survey results showed a positive response to only 60 percent of the teamwork questions. Other groups in the AHRQ Medical Office Survey on Patient Safety Culture Comparative Database averaged a positive response of 87 percent. The database includes results from more than 1,500 medical offices.

Teamwork Perceptions and Education

The physicians and clinical staff of Ohio ENT & Allergy Physicians participated in an overview CME program on teamwork benefits and the TeamSTEPPS approach. Six clinical staff members were selected as leaders and champions for initial training and coaching.

Prior to the team training, each staff member completed a short TeamSTEPPS Teamwork Perceptions Questionnaire, a survey that establishes the level of employee agreement with a set of teamwork-related questions. Specific categories include team function, leadership, situation monitoring, mutual support, and communication. The questionnaire furnished a pretraining baseline score. Results in each category were a positive response of 68 percent or less, again confirming that staff perceived opportunities for improvement.

Incorporating Teamwork Principles

The team created “HERO,” an acronym representing Helpful, Engaged, Respectful, and On-Task, to personalize the organization’s efforts toward teamwork. Naming the program empowers the group to develop ownership for their learning and assists in influencing behavior change.

The Ohio ENT & Allergy Physicians’ offices are implementing tools such as briefs and debriefs to discuss patient care in the office, short end-of-day meetings to review the next day’s schedule and anticipate potential issues, and a check-back/closed-loop communication to improve communication between medical assistants and physicians. “Shout-out” boards provide opportunities to share positive recognition of team members’ efforts. Another communication board outlines changing topics of interest. The group has implemented cross-training with staff to enhance mutual support. When orienting new staff, a team leader reviews the TeamSTEPPS principles.

The group faced challenges to implementing these changes, including simultaneously implementing an electronic health record that involved changes to workflow. The physicians were supportive of the teamwork program and participated early in the process by attending a one-hour program. They are also encouraged to complete a refresher course titled Teamwork Training! An Overview of TeamSTEPPS, an on-demand CME program that is readily available at

A Continuing Journey

“Implementation of teamwork changes and tools is an ongoing process,” said Ms. Wright. She also noted that the administrative team believes TeamSTEPPS has been a valuable advancement for the organization. Sustaining a team-oriented culture and deepening the team and patient safety behaviors require constant effort. It is important to recognize progress by celebrating successes.

Ms. Wright anticipates repeating the Practice Safety Culture INSIGHT survey in the future and is hopeful that an improved score will reveal how well the culture change has taken root. With the recent addition of seven physicians and several new staff members, Ms. Wright realizes that the journey will continue toward hardwiring a culture change.

In a new age of value-based care and publicly reported outcomes, having a synergistic team is critical, and it represents a minimum, baseline level of performance. Deeply embedding teamwork as a valued core competency and expected behavior will be necessary for practices to achieve outstanding quality and safe care results.

The Doctors Company supports members in their efforts to improve teamwork. Learn more about Patient Safety INSIGHT services at

Special thanks to Cindy Wright, BS, RRT, RCP, RPSGT, Clinical Director, Ohio ENT & Allergy Physicians, and to Ohio ENT & Allergy Physicians in Columbus, Ohio.

“Physicians often view their most important interactions as the one-on-one time with patients. Our business is caring for patients, and caring for one another as co-workers makes us better caregivers. Poor communication among staff, administration, and physicians can lead to employee discontent. TeamSTEPPS provides valuable guidelines and outlines improving communication. Good communication is critical to Ohio ENT & Allergy Physicians’ ability to provide good care. As a physician leader, I value the concepts outlined by the TeamSTEPPS training, recognize their importance to our success, and am committed to improved implementation.”

—James D. Lowery, MD, Board President, Ohio ENT & Allergy Physicians

Complimentary Online CME

Communication breakdown is a contributing factor often identified in our studies of malpractice claims. Like Ohio ENT & Allergy Physicians, many practices are turning to the principles, tools, and techniques inherent in teamwork to strengthen communication, redesign workflow, and optimize performance and outcomes in their practice. Learn more about how teamwork contributes to performance improvement in medical practices with our CME course, Teamwork Benefits: How Practices Build Effective Teams, at


  1. Studdert DM, Brennan TA, Thomas EJ. What have we learned from the Harvard Medical Practice Study? In: Rosenthal MM, Sutcliffe KM, editors. Medical Error: What Do We Know? What Do We Do? San Francisco, CA: Jossey-Bass; 2002:3-33.
  2. Cooper WO, Guillamondegui O, Hines OJ, et al. Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. JAMA Surg. 2017;152(6):522-529.

The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.

Second Quarter 2018

Director's Forum
Physician Burnout: Defining the Problems, Revealing the Solutions

An Ounce of Prevention
Team Synergy: A Critical Core Competency for Safe Care

Government Relations Report
Judicial Review of Medical Liability Legislation

New CME/CE Courses Added Every Month

Innovations in Patient Safety
Improving Documentation of Patient Communication

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Industry and Company News

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