Patient Safety: A Primer - Article #5 - Multidisciplinary Teamwork

A key strategy to support your learning about patient safety is to reflect on basic concepts and how you can apply these concepts in your daily practice. This article is the fifth in a series highlighting a key patient safety topic.

What are the Key Factors that Promote Effective Teamwork in Multidisciplinary Healthcare Teams?

Teams can take many forms in healthcare:

• as a part of a work unit or community team;
• quality/process improvement teams;
• ad hoc teams, e.g., teams charged with understanding when things could go well and go wrong in the organization; and
• specialty care teams (e.g., code teams, community intravenous program, rapid response teams).

Teams Need a Playbook! 

Effective communication and teamwork is essential for the delivery of high quality, safe patient care in all healthcare settings[1].  Healthcare teams are often composed of a variety of disciplines, resulting in a rich combination of expertise, knowledge and skills. Just like sports teams, interdisciplinary teams, or “collaborative care”[2] teams, need to define and review strategies to help the team meet its goals and function in the best way possible.

1. Determine team membership by the needs of the patient
2. Define strategies to actively engage patients and families as members of the team
3. Understand the objectives of healthcare and services from the perspective of the patient/person (the client)
4. Build team members’ skills in the use of the “equipment” (tools and resources) to effectively carry out the team’s goal. See
5. Share accountability and decision-making with all team members

No single healthcare discipline is responsible for the delivery of care to a patient. How each person interacts with team members will contribute to the delivery of high quality, safe care. Effective teamwork is built on five key elements [3]:

•  communication
•  team training (e.g. TeamSTEPPS Canada™)[4]
•  coordination
•  leadership
•  engaging patients and families

Team functioning can be enhanced by:

•  clarifying roles
•  being familiar with the natural stages that your team will move through
•  developing your team
•  managing conflict
•  using quality improvement processes to improve team functioning, such as the “plan-do-study-act” process

Below are tips and strategies to enhance team functioning in each of these five areas:

Tips/Strategies to Enhance Team Functioning
Clarify roles	know your role and the roles of others perform role in a respectful manner communicate role, knowledge, skills, and judgment using appropriate language access others’ skills and knowledge when needed consider the roles of others in determining your professional and interprofessional role
Be familiar with the natural stages that your team will move through	Four stages of team formation and development[5] Forming: when group members are learning to deal with one another, during which time minimal work is accomplished. Storming: a time of stressful negotiation of the terms under which the team will work together, a trial by fire. Norming: a time in which roles are accepted, team feeling develops, and information is freely shared. Performing: when optimal levels are finally realized in productivity, quality, decision-making, allocation of resources, and interpersonal interdependence.
Develop your team	develop a set of principles for working together that respects the ethical values of members facilitate discussions and interactions among team members participate, and be respectful of the participation of all team members in shared decision-making regularly assess team functioning with team members including patients/clients/families respect team ethics, including confidentiality, resource allocation, and professionalism
Manage conflict	recognize that conflict occurs, and there is value in the potential positive nature of conflict identify common situations that are likely to lead to disagreements or conflicts, including role ambiguity, power gradients, and differences in goals know and understand strategies to deal with conflict set guidelines for addressing disagreements effectively work to address and resolve disagreements, including analyzing the causes of conflict and working to reach an acceptable solution establish a safe environment in which to express diverse opinions develop a level of consensus among those with differing views, allowing all members to feel their viewpoints have been heard regardless of the outcome be aware of the potential impact of “silo thinking” on team development
Use quality improvement processes to improve team functioning	regularly assess key factors known to affect team functioning, and share the information with all team members engage all team members in the “plan-do-study-act process” be innovative when opportunities for improvement are identified, and look to other industries for improvement ideas, e.g., the hospital team who developed a low cost, low tech method to signal to team members across units and the patient/family that the patient had multiple same-day appointments.   This improved efficiency and helped the patient feel more in control of their healthcare journey.

There are many references and websites available on multidisciplinary healthcare teams and patient safety. For more information, see www.mips.ca, Resources and Tips or call 1-866-927-6477.

Learn to be safe!

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[1] Canadian Interprofessional Health Collaborative (CIHC).  CIHC National Competency Framework. 2010.  Available at: http://www.cihc-cpis.com/publications1.html

[2] Winnipeg Regional Health Authority, Accessed March 5, 2020 https://www.wrha.mb.ca/professionals/collaborativecare/index.php

[3]  Salas E, Almeida SA, Salisbury M, King H, Lazzara EH, Lyons R, et al.  Improving Patient Safety through Teamwork and Team Training What are the critical success factors for team training in health care?  Joint Commission Journal on Quality and Patient Safety.  2009; 35 (8): 398-405.

[4] For more information, go to https://www.patientsafetyinstitute.ca/en/education/TeamSTEPPS/Pages/default.aspx

[5] Larsen K, McInerney C, Nyquist C, Santos A, Silsbee D, Faerman S.  Learning organizations (Part 2).   13 May, 1996; University of Albany. Available at: http://www.leader-values.com/Content/detail.asp?ContentDetailID=187