The Doctor’s Advocate | Third Quarter 2015
An Ounce of Prevention
Teamwork—an essential part of a safety culture—has come to the forefront as the most effective way of catching individual errors before they occur and of mitigating system failures. Studies have shown that implementing team training in the OR is associated with a significant decrease in surgical mortality. 1,2
The team approach in the OR is not new. For years, any group working together in the OR suite has been described as an “OR team.” It is not, however, easy to develop a high-functioning team with a culture of teamwork and communication. It becomes even more challenging when factoring in each team member’s different personality, skills, agenda, style, and objective.
The team approach depends on each member’s ability to:
The first step in developing a cohesive team is to recognize that teams are better equipped to handle challenges within a department. Decisions made through teamwork are significantly better than the decisions of a single person. Individuals who have been responsible for handling problems and making decisions in the past will usually have the most difficulty in embracing this concept. When something adverse occurs in the OR, it is not usually a small or isolated problem; it is a problem that has a significant effect on everyone in the room. Since any single negative event can potentially affect all members of the OR team adversely, the entire team should participate in resolving the problem.
Improving patient safety through emphasis on the team approach requires an understanding of the factors that make a team successful. An effective team recognizes and accepts the following principles:
An important part of teamwork in the OR is the ability to communicate. When was the last time you heard something like this in the operating room:
Effective team communication requires the exchange of concise and relevant information between team members. It demands good listening skills, with participants joining the conversation only after they have a thorough understanding of the issues.
Standardizing communication practices facilitates stronger team communication. Tools, such as a preoperative team communication checklist, can be implemented to promote information exchange and team cohesion. Before starting a procedure, brief the team so each member knows the common goals and his or her exact role. Cover the status and stability of the patient, clearly delineate team members’ roles, and discuss the team’s immediate plans, as well as potential pitfalls to those plans.4
Maintain vigilance by promoting situational monitoring among team members. When team members actively scan and assess what’s going on, they gain information about the situation and can identify deviations. Conveying this information to fellow team members can prevent small errors from becoming big errors. Part of this approach includes a statement by the surgeon encouraging communication, such as, “If you see, suspect, or feel that something is not right, please speak up.”
Communicating in a closed-loop fashion ensures the entire team is aware of what is occurring, and helps in retaining the shared mental model. Acknowledging comments and questions ensures that communications have been heard and understood. Repeating back essential information confirms that the sender’s message has been received.
Communication and teamwork within a safety culture remain the foundation for preventing harm and are two of the most important facets of patient safety. Organizations must address risk perception, leadership involvement, assertive staff communications, consistent process implementation, teamwork, and human factors. Adopting a safety culture make them better able to reduce errors and protect patients.
Communication and group dynamics continue to be the subjects of intense research and study. The team approach is not new, but its value and definition are changing. Good communication, along with a focused team approach in dealing with problems, can make a positive difference in any outcome
Using teamwork to resolve OR problems and concerns can foster a better understanding of the problem and ensure a more unified, informed approach to problem resolution. The result is a safer and improved environment for all surgical patients and OR staff.
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.
Third Quarter 2015
Minimizing Surgical Errors
An Ounce of Prevention
Teamwork in the OR
Government Relations Report
Why Handling Medical Malpractice Like Workers’ Comp Won’t End Lawsuits
Young Physicians Patient Safety Awards Announced
The Back Page
Industry and Company News: Third Quarter 2015