By Don Sadler

The coaches and players on professional and college football teams know the importance of teamwork to achieving their goal of winning a championship. Teamwork within a health care facility is just as important to achieving the goal of delivering exceptional patient care and achieving high levels of patient satisfaction.

However, many health care facilities fall short when it comes to creating a culture where teamwork thrives, notes Dr. Thomas Blasco, MD, MS. Blasco is the senior medical director and co-founder of Surgical Directions, which specializes in helping hospitals improve procedural services.

“At many hospitals there is relatively little cooperation between departments such as the OR, anesthesia, SPD, scheduling, patient prep and post-op recovery,” says Blasco. “This results in problematic patient throughput, inefficiency and low-quality patient care.”

The Dangers of Silos

Surgical Directions Executive Vice President Lee Hedman says that one of the reasons why some health care facilities fall short in the area of teamwork is the fact that hospital patient care is “siloed” and poorly coordinated.

“These silos create a domino effect for patients and surgeons that can lead to poor patient outcomes,” says Hedman.

Different silos have different objectives when it comes to the OR, Hedman notes.

“For example, surgeons want an OR when they want it, while nurses and anesthesia want ORs full between certain hours,” she says. “Administration, meanwhile, wants ORs running 24/7 with well-paying patients while utilizing staff on straight time.”

Ellice Mellinger, MS, BSN, RN, CNOR, senior perioperative education specialist with the Association of periOperative Registered Nurses (AORN), lists a few more obstacles to effective teamwork between departments in the perioperative environment.

  • Ineffective processes or systems that delay or disrupt work processes.
  • Employees in different departments not knowing each other’s roles or what work is being performed.
  • A lack of communication between employees in different departments and a lack of respect between these employees.

Mellinger believes that this lack of communication and teamwork may play a role in the high patient mortality rates that occur due to medical errors. “Researchers have estimated that between 180,000 and 400,000 deaths occur each year as a result of medical errors,” she says.

“If there is poor communication and teamwork between departments, the handoff of critical steps can be missed,” Hedman adds. “This can threaten both patient and employee safety.”

It Starts with Improved Turnover Times

According to Hedman, improved turnover time is the best measure of the success of an operating room’s effort in developing improved teamwork and a more collaborative culture. “It sounds simple, but it’s not,” she says. “There are three levels of intervention: leadership/governance, management and process.”

Blasco points out that the traditional leadership and management model of the OR has defaulted to a nursing director given the responsibility of “running the OR.”

“Without the collaborative support of the administration or physicians, and surgeons especially, this model does not adequately address the needs of the OR,” he says. “It leads to a distant and often wary relationship between hospitals and surgeons.”

The best way to overcome these obstacles to improved teamwork is to develop a new multi-disciplinary leadership model that guides and supports front-line management. Blasco recommends creating a surgical services executive committee, or SSEC, to break down silos and improve teamwork in the health care environment.

The SSEC should be comprised of representatives from surgical, perioperative nursing, anesthesia and senior hospital leadership (or the C-suite) and be chaired by the medical director(s) of perioperative services, a surgeon and/or an anesthesiologist.

“This committee, functioning as a ‘board of directors’ of the surgical services, will have oversight over OR access and operations while sponsoring and directing frontline management activity,” says Blasco.

“Creating a SSEC brings all parties to the table where they can discuss operational issues as a collaborative group and break down traditional silos,” adds Hedman. “Surgeons are able to take ownership of operations and hold their peers accountable. Also, decisions are driven and progress is measured by analytics and metrics.”

Positive Examples of Strong Teamwork

On the positive side, Mellinger says she has been fortunate to work at health care facilities where teamwork was evident among multiple departments.

“I have been an active participant in many intra- and interdisciplinary teams whose goals were to enhance teamwork and perioperative patient care,” she says. “And in my current role at AORN, I have communicated with hundreds of perioperative professionals who are passionate about improving teamwork and providing safe patient care.”

One of Mellinger’s favorite examples of strong teamwork is when health care team members across departments work together to ensure proper sterilization of reusable surgical instruments.

“Multiple departments must work together to ensure that patients are provided sterile instruments for use in their surgery,” Mellinger says. “Some employees in these departments are indirect patient care providers, but each has an equally important role in the delivery of optimal patient care.”

Mellinger stresses the importance of each department using evidence-based practices and guidelines.

“When clinical practices are based on evidence rather than on clinical tradition or ‘how we’ve always done things,’ there’s an opportunity for productive communication and teamwork to solve problems and improve clinical practices,” she says.

Standardizing communication processes is also critical to improving teamwork. Mellinger cites safe surgery and procedure checklists like the AORN Comprehensive Surgical Checklist and the Surgical Safety Checklist as examples of standardized communication, along with hand-off communication tools like Situation, Background, Assessment, Recommendation (SBAR).

Putting TeamSTEPPS in Place

Some health care organizations are implementing a program developed with input from the Department of Defense as part of their efforts to improve teamwork. Referred to as TeamSTEPPS, this evidence-based framework is designed to improve health care professionals’ teamwork and communication skills as they relate to improving patient safety.

TeamSTEPPS was developed jointly by the Department of Defense’s Patient Safety Program and the Agency for Healthcare Research and Quality (AHRQ). According to the AHRQ, TeamSTEPPS is scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.

Mellinger says that TeamSTEPPS is designed to teach Master Trainers a framework of skills they can take back to their health care organizations and share with personnel there.

“The goal is to implement and evaluate new patient safety initiatives, or to change, evaluate or enhance existing initiatives,” she says.

“TeamSTEPPS is a positive move in hospitals to improve communication and teamwork through site readiness, training and implementation,” adds Hedman.

According to Mellinger, there is evidence that implementing TeamSTEPPS programs and tools in perioperative services and adhering to evidence-based guidelines can help prevent retained surgical item (RSI) events.

“RSIs are devastating patient events that can result in a wide range of negative patient outcomes,” says Mellinger.

These include injuries and infections, readmission to the hospital, reoperations to remove the item, increased length of hospital stay, emotional harm and even death.

There are a number of different ways health care professionals can implement TeamSTEPPS tools and strategies to improve teamwork and patient safety, says Mellinger. These include learning how to be an effective team member, speaking up about patient safety concerns, communicating professionally to resolve conflicts, and increasing efficiency in perioperative process.

AORN has produced a video titled, “Perioperative Team Dynamics and Communication” with an accompanying study guide that incorporates some of the TeamSTEPPS tools and strategies. The video is available through the AORN Perioperative Nursing Video Library at tinyurl.com/periop101VL.