Teamwork

1
Teamwork

• Robert L. Helmreich, Ph.D.
• The University of Texas
• Human Factors Research Project
• Halifax 4 The Canadian Healthcare Safety
  Symposium
• Edmonton, Alberta
• October 16, 2004

2
Why teamwork matters

• Most endeavors in medicine, science, and industry
  require groups to work together effectively
• Failures of teamwork in complex organizations can
  have deadly effects
• More than 2/3 of air crashes involve human error,
  especially failures in teamwork
• Professional training focuses on technical, not
  interpersonal, skills

3
It is said that getting the diverse groups in
medicine to work together is like herding cats
4
(No Transcript)
5
The Medical Setting
6
Errors Medical Teams Make

• 1. Task Execution Unintentional physical act
  that deviates from intended course of action
• 2. Procedural Unintentional failure to follow
  mandated procedures
• 3. Communication Failure to transmit
  information, failure to understand information,
  failure to share mental model
• 4. Decision Choice of action unbounded by
  procedures that unnecessarily increase risk
• 5. Intentional Noncompliance Violations of
  formal procedures or regulations

7
Barriers to Effective Teamwork

• Status hierarchies
• Nurse-doctor
• Technician - doctor
• Resident Attending
• Fear of embarrassment or discipline
• Suppressing discussion of errors
• Culture
• Organizational national professional

8
Other Barriers

• Tolerance of detrimental behaviors
• Handwriting, nurse-physician conflict
• Variability of practice standards
• Individual variation in medical procedures
• Lack of meaningful training in effective
  communication and teamwork

9
Doctors are from Missouri The Show Me State

• Show me why this is important
• I have better things to do with my time than
  attend some seminar about teamwork and
  communications

10
Making the case for team training
11
Communicate the relevance of effective teamwork
as a threat and error countermeasure

• Sources of threats to safety

12
Threats to Safety in Medicine
Organizational Organizational Culture Scheduling
Staffing Experience levels Work Load Error
policy Equipment issues
System - level National culture Health-care
policy and regulation Payment modalities Medical
coverage
Professional Proficiency Fatigue Motivation Cultur
e (Invulnerability)
Patient Primary illness Secondary illness Risk
Factors Atypical response to treatment Ongoing
management
Expected Events and Risks Unexpected Events and
Risks Well known and expected
13
Data are critical
14
Sources of data on teamwork

• Analysis of adverse and sentinel events
• Confidential, non-jeopardy, near-miss and
  incident reporting systems
• Data showing how positive teamwork prevents error
  and enhances error management
• Teamwork as a threat and error countermeasure
• Local data are most compelling

15
Training to enhance teamwork

• The nature of error and error management
• Culture and communications
• Expert decision-making
• Training in using specific behaviors and
  procedures as countermeasures against threat and
  error
• Briefings
• Inquiry
• Sharing mental models
• Conflict resolution
• Fatigue and alertness management
• Analysis of incidents and accidents
• both positive and negative aspects

16
Organizational initiatives to enhance teamwork

• Define a clear policy regarding human error
• Accept error but not intentional non-compliance
• Institute formal procedures where possible
• Use confidential reporting systems to uncover
  threats and sources of error
• Provide formal training in teamwork and threat
  and error management
• Aviations Crew Resource Management adapted to
  medicine and based on local culture and data

17
The University of Texas Threat and Error
Management Model (TEMM)

• Conceptual framework for formal training in
  threat and error management
• Used for analysis of adverse and sentinel events
  and close calls

18
(No Transcript)
19

• The University of Texas
• Human Factors Research Project
• www.psy.utexas.edu/HumanFactors