Teamwork: The Road to Respect, Reliability, and Resilience
Everyone in health care is in the business of saving lives,
whether you are a front line caregiver, an equipment supplier, an
environmental engineer, an executive, an analyst, or any other
position that touches the processes, systems, environment, or
evaluation of health care. We are all in the business of
saving lives, and we must function with
reliability every day. It is not “OK” in
health care to do a better job on some days, more than
others. We have to get it right — provide the highest
quality of care, and prevent harm and
medical errors — all day, every day.
But we are human beings, right?
Exactly. That’s why we need a systematic approach that
acknowledges human factors, a quality and safety culture,
and a supportive team environment all humming in harmony. If
you place these three concepts in a Venn diagram, the overlapping
center segment will be high reliability. Becoming a
high-reliability organization (HRO) is among every
provider’s strategic initiatives. But how do we get there?
What does that look like? What does that sound
like? And why aren’t we “there” yet? I believe it
is because we pay more attention to the science (evidence-based
strategies and human factors), than we do to the people we are
asking to practice them — the team.
More attention to the team is conveyed in communication
— speaking, listening, questioning, observing non-verbal
cues, and learning each other’s perceptions. Ineffective
communication is the number one factor at the root of most
medical errors and adverse events, so that is a great place to
focus your steps on your journey to high reliability.
Much of the danger zone in our health care environment lies just
below the surface, like the larger part of an iceberg. We
are wise to be alert to identify and learn from the near misses
that lie just above the surface, so that we prevent more
devastating damage. There are several teamwork training
models available to health care organizations, but they all
revolve around these core concepts: situation awareness, mutual
support, leadership, and speaking up.
Taking five minutes to communicate better, to have an exchange
about what we are seeing and thinking in a given situation,
will not just save time in the long run —it may even prevent
an adverse event. We must take one step back, slow the
momentum in a difficult situation, and listen to our teammates.
You have probably seen pictures or images cleverly designed to
appear as two different things at the same time. These are often
used in teamwork discussions to help participants understand that
two of us may be looking at the very same thing, but we see it
differently. We must take a moment, listen to each other to get
on the same page, with all the pertinent facts, to move forward
with a shared mental model.
Many tools and strategies can be taught and practiced to hone a
team’s skills in supporting each other and maintaining effective
(and life-saving) communication on a daily basis. Let’s
review just five, with an emphasis on communication
“Check Back” facilitates understanding and
allows for the receiver of a message to repeat to the sender
their understanding of an order, a suggestion, or request,
and opens the door for a concern or question in that
exchange. Then the initial sender confirms the
receiver has it right, or takes the opportunity to clarify,
correct, or change the request.
Briefs are essential to help all team members
get on the same page at the beginning of a shift or before a
procedure or intervention. The key is to create an
exchange, not have one person conduct a “report”
while others simply listen. Draw out any
questions or concerns the team members might
have. Encouraging that exchange creates the “safe space”
for another team member to speak up on another day.
Promoting psychological safety in the easy or routine
situations will help to assure it in the difficult
ones. Speaking up saves lives.
Huddles are quick and effective exchanges to
help team members all get up to speed on changes in a patient’s
condition, or on changes in the environment of care. You
want your team members to feel comfortable requesting a huddle,
not always leaving it up to the designated leaders.
Debriefs can be very helpful at close of shift
and need not take more than a few minutes. The team gets a
chance to thank each other, respect each
other, mention whether a piece of equipment needs attention,
comment on whether the workload seemed out of balance (to
be addressed in more detail by a few after the debrief or on
the following day) and best of all, is an opportunity to
describe any “near miss” that occurred.
“Stop the Line” can be the most difficult
strategy, if organizational leadership does not support its
use. This tool takes a little more training so that those
who use it and those who hear it can get on the same
page. The CUS acronym is an effective script for this: “I
am concerned about …, I am
uncomfortable with xyz contributing
factors… I don’t think it is safe to
continue.” The person on the receiving end of that phrase
learns that these three words require him or her to stop,
listen, and discuss the situation to assure a shared mental
model and the best course of action, together. Your team
can develop a different phrase, but make sure it is widely
practiced (soft simulation), so that everyone understands its
These practices will not only help us become HROs by preventing
medical errors, but will also help us pursue the Quadruple
Aim: improving care, promoting health, reducing cost, and
enhancing joy and meaning in work as we learn to function better
as a team. We are not only saving the lives of our patients
every day, we are strengthening each other’s
For more information about team training resources, contact Julia
Slininger, vice president, regional quality network, at (213)