Several months ago, I committed the mistake that strikes fear in the heart of every businessperson who is a frequent flyer: I missed a flight. No bad weather. No huge traffic jams on the way to the airport. I simply had in my mind that the flight left one hour later than it actually did. I glanced at the Eastern time zone label on my Outlook calendar instead of the Central time zone.
So your thought at this point probably parallels my initial reaction … How could I be so stupid!? To soothe my bruised ego, I reminded myself that on this particular day I was juggling even more issues and priorities than usual, got sidetracked by a last minute request that I had to respond to immediately, and was mentally preoccupied by a family issue that concerned me.
In short, my afternoon was very similar to a frontline healthcare professional’s typical day on a patient care unit. But there was one major, important difference. The personal price I would pay for my mistake – several hundred dollars to get the last seat on the last flight out that evening – paled in comparison to the potential price a clinical professional can pay for errors: the emotional burden of a patient’s physical harm or even loss of life.
Making care safe for patients – and caregivers
During the past decade, a number of the most forward-thinking healthcare systems across the country have embraced “High Reliability Organization” (“HRO”) theory as a path to developing safer cultures that minimize and contain errors. One of the most liberating aspects of HRO theory is the assumption and acceptance that because we are human and imperfect, we will make mistakes. Across the five core HRO principles, one organizational characteristic in particular emerges as requisite for achieving higher levels of reliability and safety — teamwork. Interestingly, I don’t think it’s a coincidence that one of the most highly correlated patient experience factors to overall satisfaction also is “how well staff worked together as a team.”
Most healthcare providers publicly avow that teamwork is a priority and a core organizational value. But how often do our actions and decisions indicate otherwise? Following are several key questions for leadership teams to consider in assessing whether better teamwork is indeed a priority in the organization.
Do we model effective teamwork from the top down?
During my career, I’ve been a member of a leadership group that functioned well as a team and one that didn’t. Sometimes, to my amazement, that dysfunction was keenly recognized and directly transmitted to the frontline. Executive teams are made up of high-performing, often competitive individuals (frequently with healthy egos) who have risen largely by their own personal accomplishments. Unless teamwork is specifically identified as a non-negotiable expectation and openly discussed by the group, it often doesn’t happen naturally.
Have we prioritized privacy over safety and teamwork?
No one would argue that important gains have been made over the past 20 years with regard to patient and family privacy in healthcare institutions. But the larger and larger private rooms that sometimes necessitate longer, more isolated hallways away from common nurses’ stations mean that caregivers more often are flying solo, with less inherent collaboration among colleagues.
In his breakthrough book Why Hospitals Should Fly, author and patient safety expert John Nance depicts a new, safer patient unit design that might best be described as “retro.” In his circular pod format, rooms face a common caregivers’ station where nurses, doctors and support staff could see all patients from a central vantage point. Increases in patient privacy, Nance argues, should not be at the cost of patient safety. Is the circular pod design too radical a solution? Perhaps. But seriously contemplating its advantages may bring to the surface unintended patient safety compromises resulting from a heightened focus on patient privacy.
Is better interpersonal communication an organizational priority?
Over the past decade, healthcare organizations have spent billions upgrading electronic documentation and record-keeping systems to increase access to information. While these investments are an important step, their implementation too often is thought of as the answer to perfecting communication across the care team. In reality, blind reliance on electronic communication can have a detrimental impact on critical face-to-face interactions that are essential for good teamwork. A physician I was working with in one institution that had implemented a new electronic health record reluctantly described its impact on the culture this way: “It’s almost as if we turned on the EHR and everyone stopped talking to each other.” Patients and caregivers deserve the advantages of better electronic communication, but it can’t replace the constructive give-and-take of face-to-face interactions.
In today’s fast-paced, stress-filled world, strong teamwork has never been more important to ensure a safe environment of care for both patients and the compassionate professionals who have dedicated their careers to taking care of them. If patient safety is indeed a top priority, healthcare organizations must add an important question to their decision-making and investment considerations: How does this decision impact teamwork?