Effective health care requires teamwork. Everyone involved must work together for a common goal---helping the patient. In the 1999 report, "To Err is Human: Building a Safer Health Care System," researchers reported that teamwork has a direct effect on patient safety and treatment outcomes. (See Reference 1) Teams that work well together make fewer mistakes, which results in better treatment outcomes. (See Reference 2)
Over the years, various medical disciplines have developed teamwork models for effective teamwork. (See Reference 3). Although these models differ from one another, they all include several key factors that are essential to effective teamwork in delivering quality health care services.
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Effective teams share leadership among all the team members, rather than having one person lead the team. The person in charge at a given moment is the person most qualified for the situation at hand. For example, a respiratory therapist may take the lead in helping a patient who is having trouble breathing because of emphysema or chronic obstructive pulmonary disease (COPD).
Shared leadership means that all team members work together to plan their work, review results and solve problems. It also means that team members coordinate their work and accept responsibility for outcomes without placing blame.
Mutual Performance Monitoring and Backup Support
Effective health care teams monitor their work, making sure that all tasks are completed according to the treatment plan. They anticipate the needs of other team members and step in to help one another when needed. In addition, they coach one another and cross train on certain skills; for example, both the nurse and respiratory therapist on a team know how to clear a patient's airway.
Closed Loop Communication
According to the Risk Management Foundation, 40 per cent of medical errors are caused by communication problems. (See Reference 4) Effective teams prevent communication problems by using closed looped communications. In this model, each verbal communication is addressed to a specific person by name and the person receiving the communication repeats the message back to the sender.
This ensures that the message received is the message that was sent and that one specific person is responsible for responding to the speaker and completing the task. There is no confusion about what is needed or who will do it. For example, in movies and television shows, a surgeon will shout out "hang another unit of blood." But who is supposed to do it. In a closed loop communication, the surgeon would say, "Susan, hang another unit of blood" and Susan would reply "Hanging another unit of blood" and then do it.
Shared Mental Model
Effective health care teams have a shared mental model based on a set of deeply rooted values and assumptions that define the team's work and how the members interact to complete the work. It is demonstrated by anticipating the needs of other team members and adjusting strategies as the situation changes. Essentially, team members are all on the same page regarding the work and goals for the team.
Mutual trust is a key component of the shared mental model. Each team member knows from experience that other team members will perform their tasks, share information, admit mistakes and accept constructive coaching.
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- "Institute of Medicine: To Err is Human: Building a Safer Health Care System," Kohn, L. T. et. al., 1999
- "TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety," King, H., et. al., 2007
- "Medical Teamwork and Patient Safety," Agency for Healthcare Research and Quality, 2005
- "Children's News: New Patient Safety," Children's Hospital Boston, MA, 2007,