Академический Документы
Профессиональный Документы
Культура Документы
O'Connell 2010
TEAM
Multiple individuals with specific skills and roles, coordinating their activities towards a mutually understood and agreed upon aim the Red Socks the Transplant Team
O'Connell 2010
Keys to Teamwork
Limiting hierarchy to those issues required by scope of practice and responsibility Shared decisionmaking is preferred mode for resolving concerns Civility/collegiality is highly valued and defended
O'Connell 2010
Errors caused by communication and coordination failures Aviation style team training recommended Explicitly calls for teamwork training Communication cited in most sentinel events Team training/crew resource management emerged as solution to many aviation disasters
And we are already having success with this in healthcare ER, OB, anesthesia
O'Connell 2010
Team training represented a move away from autocratic and individualistic styles of aircraft command to one that is more team based, with mutual interdependence and shared responsibility. In a safety context, the teams role is to avoid errors, trap them before they have consequences and minimize the consequences that do result
Musson and Hemlreich (2004) Team training and resource management. Harvard Health Policy Review 5(1) Spring 25-35.
O'Connell 2010
Plan, broadly shared and agreed upon Predict/anticipate Coordinate, Manage resources Recognize and Recover Review, Improve, Disseminate Best Practice
O'Connell 2010
AD hoc teams
Come together for limited time, for specific tasks and then are reformulated
Flight crews, endo suite, OR, multiple clinicians managing a patients care Clear understanding of roles & capabilities Standard operating procedures Briefing/huddle before each event allowing Anticipation and adjustment for specific challenges
O'Connell 2010
Requires
Establish the protocol or plan Communicate to all team members, hold briefings and ad hoc team meetings Team members ask for help in timely manner Check-backs for accurate understanding SBAR as example of information exchange in the team Cross-monitor actions of others Assertive communication skills a concern, clinical information or corrective action Team members accountable for technical and interpersonal behavior (emotional intelligence) Simulate/ practice emergency procedures
O'Connell 2010
Need not wait for best practices in order to agree on standard practice Trade off of autonomy for reliability
How will this best practice/agreed upon practice be negotiated and enforced? (ad hoc?, universal?)
O'Connell 2010
Situational awareness requires broader sharing of information/thought processes & plans Anticipating additional resources that may be needed and priming them Value of the pre-procedure briefing/huddle to plan, anticipate, coordinate and apply to the specific situation in the moment Ex. Mini team meetings could be called by any member throughout the shift
O'Connell 2010
No communication:
No/inadequate referral letter or consult note, discharge summary, progress note, briefing Progress note in chart, referral letter, consult note or one way briefing Conversation in real time intended to clarify, recognize anomalies, surface concerns and make shared decisions
O'Connell 2010
Serial Monologue
Key information repeated to assure accuracy and response between aircraft and tower
Make others aware of the steps they are planning/taking to increase effectiveness of cross-monitoring Requires trust, openness to feedback and flexibility about hierarchy and role
Red Flags
Anomalies and concerns that are recognized before any adverse event
5-7 evident before aircraft incidents RCAs in healthcare routinely find 5+ red flags preceding adverse event Anomalies, deviations from expected are so common that they are not remarkable
Normalization of deviance
O'Connell 2010
Why didnt you/I speak up? What is professional advocacy and assertiveness?
Airlines learned that professional/appropriate assertiveness must be taught and reinforced SBAR with agreed upon escalators Stop the assembly line (Toyota Lean Production)
Otherwise, correctable red flags and errors go uncorrected until harm is imminent
O'Connell 2010
Avoid extremes of Captain of the ship on the one hand, Mutiny on the Bounty on the other
Agreed upon protocols for discussing and resolving disagreements in the moment Agreed upon processes for reviewing situations afterwards
O'Connell 2010
Role of Leadership
Understand, believe in, model and influence
the performance of Team based attitudes, processes, behaviors and incentives
O'Connell 2010
Systems
Skills
Performance
Motivations
Hire, train, reward, promote, transfer and dismiss to build these capabilities
O'Connell 2010