Acting as a team can reduce mistakes, replication and unnecessary additional procedures, writes Dr Rosalyn Chaloner, case manager at Medical Protection, emphasising the importance of good teamwork in healthcare, and the key principles which facilitate it.
She writes:
Acting as a team and collaborating are skills which are often overlooked in clinical training, despite their vital importance in managing a patient’s health. If we act as separate entities, treatment may be replicated, or unnecessary additional procedures may be done when they may have been performed during another procedure. Simple mistakes may turn into much graver ones if they are not identified and corrected.
The importance of collaboration
Take, for example, a patient having an operation. Before surgery can take place, the patient should be examined by the surgeon and then the anaesthetist. Furthermore, if the patient has other co-morbidities, a physician may need to assess the patient pre-operatively.
The patient should be monitored before surgery by the nursing team to ensure the patient has the optimal vital information before the procedure. This information may be used by the anaesthetist if complications occur. Blood samples may be taken and tested by laboratory staff and may be reviewed by a pathologist to ensure the necessary organs are functioning optimally.
When the surgery eventually occurs, the surgeon will be in the lead and work with the anaesthetist with the crucial assistance of the surgical assistants and nurses. After surgery, the patient needs to be transferred to a recovery ward, where intense monitoring takes place by the recovery nursing staff and anaesthetist.
Then the patient moves to either an intensive care unit or a ward to be cared for by that unit’s staff and the surgeon or physician.
Even the most seemingly auxiliary task, like counting swabs, is essential for the patient’s best outcome.
The following Medical Protection case demonstrates what can happen when teamwork fails.
Dr T, a general surgeon, sought assistance from Medical Protection with a matter involving a retained swab, where post an incisional hernia repair, a swab was unfortunately left inside the patient’s abdomen. Dr T relied on the surgical nurse to count the swabs used and ensure they were all accounted for at the end of the surgery.
Unfortunately, there was no one double-checking this nurse’s work or assisting her, and a swab was left inside the patient for three months, resulting in treatment for severe abdominal sepsis. The matter escalated into a claim against both Dr T and the hospital.
It should never be forgotten that all clinical staff involved in a patient’s care are human and can make mistakes. Therefore, to minimise the risks and negative consequences, it is best that every member of the team understands what operation was performed and the expected major complications.
It is also imperative that the recovery, ICU, high care and ward staff know how to operate any post-operative drains or monitoring devices to prevent complications, or at least promptly identify a complication so that action can be taken immediately to prevent negative outcomes. In other words, adequate academic and practical training for all members of the clinical team is crucial to ensure patient safety.
In another Medical Protection matter, both an anaesthetist and a general surgeon sought assistance after a surgical drainage bag was not activated post a right endarterectomy. This led to the patient having to be resuscitated, and further surgery, after a haematoma formed on the patient’s neck, compressing the airway.
Communication also key
Intertwined with collaboration is good communication. If communication is lacking or unclear, mistakes may be made, despite our best intentions.
Take an inexperienced nurse working in a recovery ward. Is it reasonable to expect this nurse to know how to deal with patients who have had many surgeries, each with different complications and different equipment which may be used post-surgery, which need to be managed precisely to ensure good patient outcomes?
Even in larger hospitals, where recovery teams may be split up and only treat one or two medical specialties, there still may be new equipment used that needs to be learned about or different surgical techniques used rather than those with which the nurses have become comfortable over the years.
Teaching and learning
In treating patients, all assumptions must go out of the window regarding what someone in the team does or does not know. Ego, while useful in creating the confidence needed to perform risky procedures, should also be minimised. No one should be above being taught something, even if they think they have all the knowledge necessary in that specific instance.
All practitioners should be open to teaching colleagues who are part of their clinical team. Naturally, this teaching and learning would be in the best interests of the patient. We need to understand that learning is and always will be constant, especially in healthcare. A professor or consultant will have a lot of specialised knowledge but others may still have wisdom to impart, from a medical student to a hospital porter.
The HPCSA Booklet 1 concerning general ethical guidelines sets out the importance of acknowledging the limits of our professional knowledge and competence under section 8 paragraph 8.1.2.
In an ideal world, a conversation should be had – with the entire team involved – about what will be done with a particular patient, why and how, and what complications to look out for. Feedback from the team should be received in a welcoming manner regarding the proposed treatment plan and how to improve it. It is recognised that this is easier said than done in practice.
In alignment with the above, the HPCSA’s Booklet 1 states the following with regard to working with colleagues under paragraph 6.2:
“Healthcare practitioners should:
6.2.1 Work with and respect other health professionals in pursuit of the best healthcare possible for all patients.
6.2.2 Not discriminate against colleagues, including but not limited to healthcare practitioners applying for posts, because of their views or their race, culture, ethnicity, social status, lifestyle, perceived economic worth, age, gender, disability, communicable disease status, sexual orientation, religious or spiritual beliefs, or any condition of vulnerability.”
The HPCSA’s Ethical Rules of Conduct for registered health practitioners states the following, relating to practising with colleagues:
“Performance of professional acts by a medical practitioner or medical specialist
1. A medical practitioner or medical specialist –
(b) shall not fail to communicate and co-operate with medical practitioners, medical specialists and other health practitioners in the diagnosis and treatment of a patient;”
Treatment teams who work together and who teach and learn from each other, can protect both the patient and themselves from major mishaps, as one member of the team may identify a potential problem where another may not. As healthcare practitioners, we are all fallible beings who can make mistakes and need each other to ensure a molehill does not become an insurmountable medico-legal mountain.
This ethos can greatly assist in the healthcare world where complexities can occur beyond our wildest imaginations and where charges as serious as culpable homicide are an unfortunate present-day reality.
In healthcare training, the importance of teamwork may often not be emphasised as strongly as it ought to be. It is commonly something that is learnt on the job once academic training is complete.
Professional hierarchy is deeply ingrained in most healthcare centres. And what happens while those in power are unavailable?
Every healthcare professional involved in a patient’s clinical care (and not just the most qualified person on the team) is important in ensuring that the patient thrives.
While it may be impractical for the hierarchy to be altogether removed – as it is important to know where to turn to, with a complicated patient or when an issue needs to be resolved – if it is over-emphasised, it may lead to communication between team members being an impossibility. A culture of admitting mistakes and respect for every person’s viewpoint is vital.
The lack of time to practise the kind of teamwork discussed in this article is a recognised issue in the healthcare system. However, if we each commit to the principles of good communication, collaboration, and teaching and learning, the potential benefits could be significant: greater efficiency, fewer mistakes, a more open learning culture and ultimately safer patient care.
See more from MedicalBrief archives:
Easing workplace stress demands teamwork
A dose of humility for doctors, nurses leads to better healthcare
Difficult interactions with colleagues
Arrogant surgeons must attend ‘ego classes’ or be banned