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WORK IN A TEAM ENVIRONMENT

Proficient teamwork and communication skills do not come naturallythey need to be
learned and continuously practiced. The consistent application of these skills can be impeded by
the realities of day-to-day office practicehigh workload volumes, patients with multiple care
givers, and the complexity of the steps involved in care processesand by habits of training and
culture that actually discourage teamwork and communication. However, investing in your staff
with education and training in proven teamwork and communication techniques will reap
numerous rewards including safer care to your patients, greater patient and staff satisfaction.

STEP ONEBUILD AN EFFECTIVE TEAM

Being an effective team member will have an immediate and positive effect on patient
safety in your practice. Fortunately, researchers studying high-stress, high-risk and complex
work environments such as medicine, aviation and the military, have identified important team
behaviors, skills and attitudes.

GENERAL TEAMWORK PRINCIPLES

The primary goal of teamwork is to make the best and most timely use of information,
skills, and resources by teams of health care providers for the purpose of enhancing the quality
and safety of patient care.

A team is a group of two or more individuals with specific roles that relate to one another
and who share a common goal.

Team members are highly interdependent in accomplishing their goals. Their interactions
have a strong effect on patient care outcomes.

Well-functioning teams possess a number of important characteristics. They are

comprised of team members who:

share a clear vision of their work, which they all value;

have clearly definedroles and responsibilities;
understand and take advantage of the expertise
distributed among their members;
exchange information, knowledge, and skills, irrespective of
the profession and work background of their members;
coordinate activities necessary to complete tasks, and
easily adapt to task demands by sharing information and resources;
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have strong team leadership;

engage in a regular discipline of feedback in a blame-
free fashion;
share a strong sense of collective trust and
confidence;
create mechanisms to cooperate and coordinate; and
manage and optimize performance outcomes to keep
patients safe

BUILDING A HIGH-PERFORMING TEAM

Effective team members understand each others roles and responsibilities. They are able
to predict each others needs. Conflict is managed early on and effectively. Each team member
has a strong sense of being accountable to other members of the team and to the patients they
serve. Acquiring the desirable aforementioned characteristics and behaviors will take time,
training and practice to become a part of the day-to-day routine in the office. Individuals need to
learn to work together as a team.

When mastered and conscientiously practiced by all patient safety team members as well as
other practice staff, these four basic principles help build high- performing teams and create a
safer office:

1. Leadership
2. Mutual performance monitoring
3. Mutual support
4. Situational awareness

LEADERSHIPSUPPORTING THE TEAM

Although each member of the team is valued for their contribution to the whole, each team
needs a leader. An effective team leader:

1. organizes the team by selecting the rightpersonnel

to serve on the team;
2. articulates clear goals through input of fellow team
members;
3. makes decisions, again, through collective input of team
members;
4. empowers members to speak up and challenge
when appropriate;
5. actively promotes and facilitates good communication;
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6. holds each himselfor herself and fellow team members

accountable; and
7. skilfully manages conflict resolution between team
members.

Team leaders also do not fit into the traditional medical hierarchy. Team leaders identify
opportunities to share leadership roles, as appropriate, to underscore the reality of shared
responsibility for the teams outcomes.

Effective leaders will:

1. Use resources efficiently;

2. Balance the workload within the team;
3. Delegate tasks as appropriate;
4. Conduct daily huddles, briefs and debriefs, weekly meetings; and

5. Encourage team members to speak freely and ask questions.

MUTUAL PERFORMANCE MONITORINGKEEPING TRACK OF YOURSELF AND

OTHERS

Mutual performance monitoring means that team members are aware of their
surroundings and the performance of others. This important patient safety principle requires
individuals to keep track of other team members activities while carrying out their own. By
practicing mutual performance monitoring, staff members will be more likely to notice potential
errors or missteps by other team members before they occur.

Team members who practice mutual performance monitoring:

1. observe the communication and performance of other team

members;
2. recognize when a team member makes a mistake;
3. are aware of other team members surroundings;
4. offer relevant information before it is requested;
5. have an accurate understanding of their teammates workload; and

6. are aware of their own surroundings6.

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MUTUAL SUPPORTSUPPORTING THE NEEDS OF OTHERS

Mutual support is the ability to support other team members needs through knowledge
about their workload and responsibilites. Medical practices are busy and often unpredictable. In
addition to fluctuations in workload and normal day-to-day operations, individuals are subject to
changes in their lives. High-performing teams recognize that both types of circumstances affect
team members. Team members who actively seek and willingly provide help to each other are
practicing mutual support.

Mutual support means that team members:

1. provide task-related support and try to protect each

other from work overload;
2. provide timely, constructive feedback in a positive way that is
free from blame;
3. advocate effectively for the patient;
4. use techniques to resolve conflict such as advocacy and
assertion, and
5. foster a climate where people actively seek assistance and where
assistance is willingly provided.

SITUATIONAL AWARENESSENSURING THAT EVERYONE IS ON THE SAME

PAGE

Situational awareness relates to how team members identify problems and define
solutions to them. This principle acknowleges the dynamic nature of an office practice, requiring
that each team member be actively aware of their surroundings and the activities that transpire
throughout the day. By practicing situational awareness, each team member will know the
current conditions affecting the teams work and be able to share relevant facts with the entire
team.

Situational awareness also promotes a shared mental model that:

1. helps ensure that teams know what to expect and, when necessary, to be
able to quickly regroup to get everyone on the same page;
2. fosters communication to ensure that patient care is synchronized;
3. enablesteam members to predict and anticipate better; and
4. creates commonality of effort and purpose.
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BARRIERS TO EFFECTIVE TEAMWORK

It is helpful to be on the lookout for factors that can disrupt good teamwork and derail team
development. Some of the common teamwork barriers are:

1. inconsistency in team leaders

2. lack of time to meet and interact as a team
3. hierarchy
4. defensiveness
5. not speaking up
6. conventional thinking
7. varying communication styles
8. unresolved conflict
9. distractions
10. fatigue
11. heavy workload
12. misinterpreting cue
13. lack of role clarity
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APPLYING TEAMWORK PRINCIPLES TO PATIENT SAFETY

CREATE A SENSE OF URGENCY

It is important to make the case within your practice for effective teamwork. Good
candidates for creating a sense of urgency about the need for an ongoing patient safety team
include:

closed or open malpractice claims;

stories about near misses;
adverse incidents;
patient and employee satisfaction surveys; and
staff concerns about quality and patient safety

STEP TWOENHANCE TEAM COMMUNICATION

Good communication is at the heart of patient safety. Because patients today are cared for
by multidisciplinary teams rather than a single person, accurate and timely communication is
central to optimal patient care and safety. Like teamwork, good communication is not a given;
rather, effective communication comprises a set of skills that need to be learned and continually
reinforced through practice. When critical information about their condition or care does not get
to the right person at the right time, patients can suffer the consequences.

Potentially harmful communication mishaps include:

1. providing care with incomplete or missing information;

2. executing poor patient hand-offs with relevant clinical data not clearly
communicated;
3. failing to share and communicate known information, such as when a team
member knows there is a problem but is unable to speak up about it; and
4. assuming the right outcome and safety of care.3

To facilitate optimal information exchange and problem-solving, team members should:

1. use standardized terminology;

2. use standardized patterns of communication;
3. use concise communication; and
4. confirm and cross-check information.9
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PROVEN COMMUNICATION TECHNIQUES

SBARSituation, Background, Assessment, Recommendation

The SBAR technique helps team members accurately share information, ensuring that
both the sender and receiver of information place the appropriate focus on what is being
communicated. SBAR focuses the communication on essential information related to the
patients condition and the communicators recommendation on needed action.

Situation: What is going on with the patient?

Background: What is the clinical background or context?

Assessment: What do I think the problem is? I think the problem is very likely related to
Mr. Jones heart and cardiovascular system.

Recommendation: What would I do to correct it?

CUSConcerned, Uncomfortable, and Safety Issue

CUS is shorthand for a three-step process that assists people in stopping the activity when they
sense or discover a safety breach. All members of the team need to be familiar with this
technique and understand the implications when a fellow team member says:

1. I am Concerned.
2. I amUncomfortable.
3. This is a Safety Issue.

DESC ScriptDescribe, Express, Suggest, Consequences

The DESC Script describes a constructive process for resolving conflicts, where the goal is to
reach consensus:

1. Describe the specific situation or behavior and provide concrete evidence

or data.
2. Express how the situation makes you feel and what your concerns are
3. Suggest other alternatives and seek agreement
4. Consequences should be stated in terms of impact on established team
goals or patient safety.
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STEP THREEINVOLVE THE PATIENT AS PART OF THE TEAM

Why Involving the Patient is Important When patients are informed and involved in all
aspects of their own care, they help ensure a safer care experience for themselves. At the most
basic level, patients and their families must be actively encouraged to question any procedure or
process that does not look or seem right to them. But there are compelling reasons that patients
and their families (as well as other caregivers who may not be related to the patient) should be
actively involved at multiple levels of the care process:

1. Patients and their families help organizations develop new

perspectives, as patients experience gaps and fragmentation in systems firsthand.
2. Patients and their families keep health care professionals and
organizations honest and grounded in reality.
3. Because they are recipients of care, patients, by conveying their
opinions and feelings, can inspire and energize staff to commit to change.
4. Input from patients and families can help improve quality and
safety as well as staff satisfaction.

Potential Barriers Between Patients and Providers Research literature and everyday practice
tell us that poor or inadequate communication between patients and families (as well as other
caregivers who may not be related to the patient) can lead to poor quality care and adverse
incidents. Thus, clear communication between Patient Safety Team members and their patients is
paramount in providing safe

Because they are recipients of care, patients, by conveying their opinions and feelings, can
inspire and energize staff to commit to change patient care. At the most fundamental levels, a
patients communications responsibility centers on:

1. clear communications with their physician;

2. understanding instructions that are given to them; and
3. following through on those instructions.

Earlier in this section, you learned that to facilitate optimal information exchange and
problem-solving in the office practice setting, practice staff should:
1. use standardized terminology;
2. use standardized patterns of communication;
3. use concisecommunication; and
4. confirm and cross-check information.9
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Keep these points in mind as you consider the quality of communications between you and
arguably the most important member of the Patient Safety Team: the patient. Bear in mind that
patients are:
1. generally unfamilar with terminolgy;
2. may not use standardized patterns of communication;
3. unlikely to communicate concisely; and
4. often reluctant to confirm and crosscheck information you have
given them.

As a caring team member intent on enhancing patient safety, it is up to you to:

1. learn to identify barriers that impede effective communication

between patient and care giver and care giver and patient;
2. identify and remedydeficits within your practice when it comes to
communicating with patients, and
3. take action to remedypatients informational deficits where you can and
develop techniques to accommodate patient issues that cannot be remedied.

Five Steps to Improving Interpersonal Communication With Patients

1. Slow down. Communication can be improved by speaking slowly and by spending just a
small amount of additional time with each patient. This will help foster a patient-
centered approach to the clinician-patient interaction.
2. Use plain, non-medical language. Explain things to patients like you would explain
them to your grandmother.
3. Show or draw pictures. Visual images can improve the patients recall of ideas.
4. Limit the amount of information providedand repeat it. Information is best
remembered when it is given in small pieces that are pertinent to the tasks at hand.
Repetition further enhances recall.
5. Use the teach-back technique. Confirm that patients understand by asking them to
repeat back your instructions.

Cultural Considerations

Cultural beliefs influence how patients:

1. perceive their health;

2. seek health care;
3. interactwith health professionals; and
4. complywith prescribed treatments.
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HOW TO HAVE A PLEASANT WORKING ENVIRONMENT

1. Be pleasant
This is obvious, but pleasantness is not a quality that everyone can boast of. Some people find it
difficult to smile, pay a compliment or even accept one. However, this does not negate your
obligation to be as pleasant as possible.
2. Be a team player
Whether you work on an assembly line or a corporate setting you are part of a team. This holds
for the person at the bottom of the ladder as well as the one at the top. Being a team player helps
you demonstrate your abilities while at the same time allows you to learn from others.
3. Appreciate each others differences
No two people are alike. One person may love to hang around after work swapping family
stories, another may be out of the parking lot on the stroke of the hour. That does not mean that
both types cannot work together when necessary.
4. Pull your weight
If you are the type of person who leans on others to take the brunt of the work, then you are
cheating the company and yourself. Cheating myself? Yes, because you are not using your
abilities to the fullest, and are therefore stunting your professional growth.
5. Decide what you want out of the company
Are you an owner or a renter? Think of your home. If you own it you are likely to pay more
attention to it than if you were renting. It's the same with your job. Owners take pride in their
jobs and do all they can to promote it and themselves. Renters? Well, they are just waiting to
move on to the next opportunity.
6. Do not be a spy
Most companies expect you to report anyone whom you see violating the rules. However,
chances are that the person is more likely to stop breaking the rules if you pull him aside, let him
know what you observed, and that his habit can affect everyone in a negative way. If he persists
in doing it, then by all means blow the whistle.
7. Be reliable
This has as much to do with your speech as with your actions. Say what you mean and mean
what you say. If you promise to show up for a meeting at a certain time, make sure and be there.
If you promise to assist with a project, don't back down at the last minute.
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Other tips:
1.. Be helpful without being a Cinderella.
2. Encourage others, especially newcomers.
3. Learn as much as you can.
4. Demonstrate your skills without being a show-off.

HOW TO WORK WELL IN A TEAM ENVIRONMENT

Here are some simple tips to help you work well in a team environment:
1. Understand your role in the team.
2. Respect the schedule that is set for the team and contribute effectively towards meeting the
deadline.
3. Treat other team members with respect and support them in whatever way you can.
4. It is always important to remember that you are part of a team and the efforts in achieving
the end result are not just yours.
5. If you are leader of the team or have to step into the leadership role in the absence of the
team leader, ensure that the responsibilities are communicated well to all team members.
6. Teaming is a collaborative effort towards achieving a goal.
7. Avoid any type of gossiping or passing negative remarks about the team members.
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DEVELOPING THE BEST WORKFORCESOFT SKILLS

Communication Skills
Most employees now do not learn from how to books. Instead they watch and listen.
Demonstrate to your team how to speak respectfully to others, make eye contact with the person
you are speaking to, keep your posture tall, and keep your body relaxed. Explain how it improves
communication and business skills.
Teamwork Skills
Many people say they love teamwork but struggle to work in a team environment. It can be
difficult to speak out and explain yourself to others, as well as really listen to those around you.
Build a teamwork environment by demonstrating how to speak with others. Do not give all the
work to the most capable individual; spread the work out among team members.
Feedback Skills
Learning to listen to and accept criticism about your job performance can be difficult. Talk to
your team members about how they are doing and emphasize ways to improve rather than
criticize what they are doing. Many team members will tune out negative feedback and instead
look for more positive responses. Be clear about how they are actually doing.
Multitasking Skills
Do a search on how to improve your ability to work effectively and you will find half a dozen
articles suggesting avoid multitasking. But any good business person needs to keep several tasks
going at the same time such as answer the phone, find a customer file, and notify another team
member of a potential business opportunity.
Positive Attitude Skills
Flexible people are usually optimistic. Building optimism comes from having the flexibility to
turn things into positively. Having a sense of humor and cheering others up improves the
atmosphere in your office. Wear a smile. Compliment your coworkers for a job well done.