Matt Boyd

Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare

Modern healthcare is delivered by multidisciplinary, distributed healthcare teams who rely on effective teamwork and communication to ensure effective and safe patient care. However, we know that there is an unacceptable rate of unintended patient harm, and much of this is attributed to failures in communication between health professionals. The extensive literature on teams has identified shared mental models, mutual respect and trust and closed-loop communication as the underpinning conditions required for effective teams. However, a number of challenges exist in the healthcare environment. We explore these in a framework of educational, psychological and organisational challenges to the development of effective healthcare teams. Educational interventions can promote a better understanding of the principles of teamwork, help staff understand each others roles and perspectives, and help develop specific communication strategies, but may not be sufficient on their own. Psychological barriers, such as professional silos and hierarchies, and organisational barriers such as geographically distributed teams, can increase the chance of communication failures with the potential for patient harm. We propose a seven-step plan to overcome the barriers to effective team communication that incorporates education, psychological and organisational strategies. Recent evidence suggests that improvement in teamwork in healthcare can lead to significant gains in patient safety, measured against efficiency of care, complication rate and mortality. Interventions to improve teamwork in healthcare may be the next major advance in patient outcomes.

A systematic review of simulation for multidisciplinary team training in operating rooms.

Summary Statement Current simulation training initiatives predominantly occur in uniprofessional silos and do little to integrate different disciplines working in the operating room (OR). The objective of this review was to determine the current status of work describing simulation for full OR multidisciplinary teams including barriers to conducting OR multidisciplinary team training and factors contributing to successful courses. We found a total of 18 articles from 10 research groups. Various scenarios and simulators were used, and training sessions were generally perceived as realistic and beneficial by participants despite rudimentary integration of surgical and anesthetic models. Measures of performance involved a variety of both technical and nontechnical ratings of the simulations. Challenges to conducting the simulations included recruitment, model realism, and financial costs. Future work should focus on how best to overcome the barriers to implementation of team training interventions for full OR teams, particularly on how to engage senior staff to aid recruitment.

Making a Difference Through Improving Teamwork in the Operating Room: A Systematic Review of the Evidence on What Works

Surgical patients are at risk of harm from avoidable adverse events, many of which are at least in part attributable to failures in teamwork and communication. We undertook a systematic review of studies of interventions to improve teamwork and communication in the operating room (OR) that measured an outcome important for patient care in the clinical environment. We found good evidence to support several interventions: structured approaches to information sharing between OR team members; ongoing programmes of team training; and organisational changes to support team function. Many studies demonstrated improved team function in the clinical environment, improved OR processes, and/or improved patient outcomes. This review identified successful approaches to improving teamwork and communication in the OR and provided recommendations for practice.

Validation of a measurement tool for self-assessment of teamwork in intensive care

BACKGROUND Teamwork is an important contributor to patient safety and a validated teamwork measurement tool could help healthcare teams identify areas for improvement and measure progress. We explored the psychometric properties of a teamwork measurement tool when used for self-assessment. We hypothesized that the tool had a valid factor structure and that scores from participants and external assessors would correlate. METHODS Forty intensive care teams (one doctor, three nurses) participated in four simulated emergencies, and each independently rated their teams performance at the end of each case using the teamwork measurement tool, without prior training in the use of the tool. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and compared factor structure between participants and external assessors (using previously reported data). Scores from participants and external assessors were compared using Pearsons correlation coefficient. RESULTS EFA demonstrated items loaded onto three distinct factors which were supported by the CFA. We found significant correlations between external and participant scores for overall teamwork scores and the three factors. Participants agreed with external assessors on the ranking of overall team performance but scored themselves significantly higher than external assessors. CONCLUSIONS The teamwork measurement tool has a valid structure when used for self-assessment. Participant and external assessor scores correlated significantly, suggesting that participants could discriminate between different levels of performance, although leniency in self-assessed scores indicated the need for calibration. This tool could help structure reflection on teamwork and potentially facilitate self-directed, workplace-based improvement in teamwork.

Read-back improves information transfer in simulated clinical crises

Background Safe and effective healthcare is frustrated by failures in communication. Repeating back important information (read-back) is thought to enhance the effectiveness of communication across many industries. However, formal communication protocols are uncommon in healthcare teams. Aims We aimed to quantify the effect of read-back on the transfer of information between members of a healthcare team during a simulated clinical crisis. We hypothesised that reading back information provided by other team members would result in better knowledge of that information by the receiver than verbal response without read-back or no verbal response. Method Postanaesthesia care unit nurses and anaesthetic assistants were given clinically relevant items of information at the start of 88 simulations. A clinical crisis prompted calling an anaesthetist, with no prior knowledge of the patient. Using video recordings of the simulations, we noted each time a piece of information was mentioned to the anaesthetist. Their response was coded as read-back, verbal response without read-back or no verbal response. Results If the anaesthetists read back the item of information, or otherwise verbally responded, they were, respectively, 8.27 (p<0.001) or 3.16 (p=0.03) times more likely to know the information compared with no verbal response. Conclusions Our results suggest that training healthcare teams to use read-back techniques could increase information transfer between team members with the potential for improved patient safety. More work is needed to confirm these findings.

Just ask Siri? A pilot study comparing smartphone digital assistants and laptop Google searches for smoking cessation advice

Objective To compare voice-activated internet searches by smartphone (two digital assistants) with laptop ones for information and advice related to smoking cessation. Design Responses to 80 questions on a range of topics related to smoking cessation (including the FAQ from a NHS website), compared for quality. Setting Smartphone and internet searches as performed in New Zealand. Main outcome measures Ranked responses to the questions. Results Google laptop internet searches came first (or first equal) for best quality smoking cessation advice for 83% (66/80) of the responses. Voiced questions to Google Assistant (“OK Google”) came first/first equal 76% of the time vs Siri (Apple) at 28%. Google and Google Assistant were statistically significantly better than Siri searches (odds ratio 12.4 and 8.5 respectively, p<0.0001 in each comparison). When asked FAQs from the National Health Service website, or to find information the Centers for Disease Control has made videos on, the best search results used expert sources 59% (31/52) of the time, “some expertise” (eg, Wikipedia) 18% of the time, but also magazines and other low quality sources 19% of the time. Using all three methods failed to find relevant information 8% (6/80) of the time, with Siri having the most failed responses (53% of the time). Conclusion Google internet searches and Google Assistant were found to be significantly superior to the Siri digital assistant for smoking cessation information. While expert content was returned over half the time, there is still substantial room for improvement in how these software systems deliver smoking cessation advice.

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention

Background Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. Objective To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. Methods An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). Results For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, “Scenario A”), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ

Economic evaluation of border closure for a generic severe pandemic threat using New Zealand Treasury methods

11.0 billion, USD

The long history of health inequality in New Zealand: occupational class and lifespan in the late 1800s and early 1900s

7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of “Scenario A”, or 2.75% of the country’s population dying) giving a net benefit of NZ

Colorectal Cancer Screening: How Health Gains and Cost-Effectiveness Vary by Ethnic Group, the Impact on Health Inequalities, and the Optimal Age Range to Screen

54 billion (USD