Professional Collaboration and Team Collaboration, communications

Professional Collaboration and Team Collaboration, communications Professional Collaboration and Team Collaboration, communications After reading “Professional Collaboration and Team Collaboration,” summarize two reasons that collaboration is important to health care. How is your workplace different from the example in the article? Cite the article for support. Reference as appropriate Must be 250-300 words Must be APA format See attachement odanielm_twc.pdf Chapter 33. Professional Communication and Team Collaboration Michelle O’Daniel, Alan H. Rosenstein Background In today’s health care system, delivery processes involve numerous interfaces and patient handoffs among multiple health care practitioners with varying levels of educational and occupational training. During the course of a 4-day hospital stay, a patient may interact with 50 different employees, including physicians, nurses, technicians, and others. Effective clinical practice thus involves many instances where critical information must be accurately communicated. Team collaboration is essential. When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, and overlooked changes in status.1 Lack of communication creates situations where medical errors can occur. These errors have the potential to cause severe injury or unexpected patient death. Medical errors, especially those caused by a failure to communicate, are a pervasive problem in today’s health care organizations. According to the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCHAO), if medical errors appeared on the National Center for Health Statistic’s list of the top 10 causes of death in the United States, they would rank number 5—ahead of accidents, diabetes, and Alzheimer’s disease, as well as AIDS, breast cancer, and gunshot wounds.1 The 1999 Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System, revealed that between 44,000 and 98,000 people die every year in U.S. hospitals because of medical errors.2 Even more disturbing, communication failures are the leading root cause of the sentinel events reported to the Joint Commission from 1995 to 2004. More specifically, the Joint Commission cites communication failures as the leading root cause for medication errors, delays in treatment, and wrong-site surgeries, as well as the second most frequently cited root cause for operative and postoperative events and fatal falls.1 Traditional medical education emphasizes the importance of error-free practice, utilizing intense peer pressure to achieve perfection during both diagnosis and treatment. Errors are therefore perceived normatively as an expression of failure. This atmosphere creates an environment that precludes the fair, open discussion of mistakes required if organizational learning is to take place. In the early 1990s, Donald Berwick wrote about patients needing an open communication system instead of experiencing adverse events stemming from communication failures.3 More than a decade later, this concept still has profound implications on our method of health care delivery. As such, this chapter will review the literature on the important role of communication and team collaboration in helping to reduce medical errors and increase patient safety. 1 Patient Safety and Quality: An Evidence-Based Handbook for Nurses Research Evidence What Are Communication and Team Collaboration? Webster’s Dictionary defines communication as “the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs.” It is important to consider that communication is not just verbal in form. One study states that 93 percent of communication is more affected by body language, attitude, and tone, leaving only 7 percent of the meaning and intent based on the actual words said.4 Whereas the spoken words contain the crucial content, their meaning can be influenced by the style of delivery, which includes the way speakers stand, speak, and look at a person.1 However, critical information is often transmitted via handwritten notes, e-mails, or text messages, which can lead to serious consequences if there is miscommunication. Professional Collaboration and Team Collaboration, communications ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Collaboration in health care is defined as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care.5, 6 Collaboration between physicians, nurses, and other health care professionals increases team members’ awareness of each others’ type of knowledge and skills, leading to continued improvement in decisionmaking.7 Effective teams are characterized by trust, respect, and collaboration. Deming8 is one of the greatest proponents of teamwork. Teamwork, he believes, is endemic to a system in which all employees are working for the good of a goal, who have a common aim, and who work together to achieve that aim. When considering a teamwork model in health care, an interdisciplinary approach should be applied. Unlike a multidisciplinary approach, in which each team member is responsible only for the activities related to his or her own discipline and formulates separate goals for the patient, an interdisciplinary approach coalesces a joint effort on behalf of the patient with a common goal from all disciplines involved in the care plan. The pooling of specialized services leads to integrated interventions. The plan of care takes into account the multiple assessments and treatment regimens, and it packages these services to create an individualized care program that best addresses the needs of the patient. The patient finds that communication is easier with the cohesive team, rather than with numerous professionals who do not know what others are doing to mange the patient.9 Table 1 is a compilation of some of the components found in the literature of a successful teamwork model.10–14 It is important to point out that fostering a team collaboration environment may have hurdles to overcome: additional time; perceived loss of autonomy; lack of confidence or trust in decisions of others; clashing perceptions; territorialism; and lack of awareness of one provider of the education, knowledge, and skills held by colleagues from other disciplines and professions.15 However, most of these hurdles can be overcome with an open attitude and feelings of mutual respect and trust. A study determined that improved teamwork and communication are described by health care workers as among the most important factors in improving clinical effectiveness and job satisfaction.16 Table 1. Components of Successful Teamwork • • • • Open communication Nonpunitive environment Clear direction Clear and known roles and tasks for team members 2 Communication & Teamwork • • • • • • • • • Respectful atmosphere Shared responsibility for team success Appropriate balance of member participation for the task at hand Acknowledgment and processing of conflict Clear specifications regarding authority and accountability Clear and known decisionmaking procedures Regular and routine communication and information sharing Enabling environment, including access to needed resources Mechanism to evaluate outcomes and adjust accordingly Extensive review of the literature shows that communication, collaboration, and teamwork do not always occur in clinical settings. For example, a study by Sutcliff, Lewton, and Rosenthal17 reveals that social, relational, and organizational structures contribute to communication failures that have been implicated as a large contributor to adverse clinical events and outcomes. Another study shows that the priorities of patient care differed between members of the health care team, and that verbal communication between team members was inconsistent.16 Other evidence shows that more than one-fifth of patients hospitalized in the United States reported hospital system problems, including staff providing conflicting information and staff not knowing which physician is in charge of their care.Professional Collaboration and Team Collaboration, communications 18 Over the past several years, we have been conducting original research on the impact of physician and nurse disruptive behaviors (defined as any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical or sexual harassment) and its effect on staff relationships, staff satisfaction and turnover, and patient outcomes of care, including adverse events, medical errors, compromises in patient safety, poor quality care, and links to preventable patient mortality. Many of these unwanted effects can be traced back to poor communication and collaboration, and ineffective teamwork.19–22 Unfortunately, many health care workers are used to poor communication and teamwork, as a result of a culture of low expectations that has developed in many health care settings. This culture, in which health care workers have come to expect faulty and incomplete exchange of information, leads to errors because even conscientious professionals tend to ignore potential red flags and clinical discrepancies. They view these warning signals as indicators of routine repetitions of poor communication rather than unusual, worrisome indicators.23 Although poor communication can lead to tragic consequences, a review of the literature also shows that effective communication can lead to the following positive outcomes: improved information flow, more effective interventions, improved safety, enhanced employee morale, increased patient and family satisfaction, and decreased lengths of stay.1, 24–26 Fuss and colleagues27 and Gittell and others28 show that implementing systems to facilitate team communication can substantially improve quality. Effective communication among staff encourages effective teamwork and promotes continuity and clarity within the patient care team. At its best, good communication encourages collaboration, fosters teamwork, and helps prevent errors. Barriers to Effective Communication Health professionals tend to work autonomously, even though they may speak of being part of a team.29 Efforts to improve health care safety and quality are often jeopardized by the communication and collaboration barriers that exist between clinical staff. Although every organization is unique, the barriers to effective communication that organizations face have 3 Patient Safety and Quality: An Evidence-Based Handbook for Nurses some common themes. Table 2 indicates some common barriers to interprofessional collaboration that we have learned from our research and focus groups with hospitals across the country. Table 2. Common Barriers to Interprofessional Communication and Collaboration • • • • • • • • • • • • • • • • • Personal values and expectations Personality differences Hierarchy Disruptive behavior Culture and ethnicity Generational differences Gender Historical interprofessional and intraprofessional rivalries Differences in language and jargon Differences in schedules and professional routines Varying levels of preparation, qualifications, and status Differences in requirements, regulations, and norms of professional education Fears of diluted professional identity Differences in accountability, payment, and rewards Concerns regarding clinical responsibility Complexity of care Emphasis on rapid decisionmaking The barriers indicated in Table 2 can occur within disciplines, most notably between physicians and residents, surgeons and anesthesiologists, and nurses and nurse managers.30, 31 However, most often the barriers manifest between nurses and physicians. Even though doctors and nurses interact numerous times a day, they often have different perceptions of their roles and responsibilities as to patient needs, and thus different goals for patient care. One barrier compounding this issue is that because the United States is one of the most ethnically and culturally diverse countries in the world, many clinicians come from a variety of cultural backgrounds. In all interactions, cultural differences can exacerbate communication problems.1 For example, in some cultures, individuals refrain from being assertive or challenging opinions openly. As a result, it is very difficult for nurses from such cultures to speak up if they see something wrong. In cultures such as these, nurses may communicate their concern in very indirect ways. Culture barriers can also hinder nonverbal communication. Professional Collaboration and Team Collaboration, communications For example, some cultures ascribe specific meaning to eye contact, certain facial expressions, touch, tone of voice, and nods of the head. Issues around gender differences in communication styles, values, and expectations are common in all workplace situations. In the health care industry, where most physicians are male and most nurses are female, communication problems are further accentuated by gender differences.32 A review of the organizational communication literature shows that a common barrier to effective communication and collaboration is hierarchies.33–37 Sutcliff and colleagues’ research17 concurs that communication failures in the medical setting arise from vertical hierarchical differences, concerns with upward influence, role conflict, and ambiguity and struggles with interpersonal power and conflict. Communication is likely to be distorted or withheld in situations where there are hierarchical differences between two communicators, particularly 4 Communication & Teamwork when one person is concerned about appearing incompetent, does not want to offend the other, or perceives that the other is not open to communication. In health care environments characterized by a hierarchical culture, physicians are at the top of that hierarchy. Consequently, they may feel that the environment is collaborative and that communication is open while nurses and other direct care staff perceive communication problems. Hierarchy differences can come into play and diminish the collaborative interactions necessary to ensure that the proper treatments are delivered appropriately. When hierarchy differences exist, people on the lower end of the hierarchy tend to be uncomfortable speaking up about problems or concerns. Intimidating behavior by individuals at the top of a hierarchy can hinder communication and give the impression that the individual is unapproachable.1, 38 Staff who witness poor performance in their peers may be hesitant to speak up because of fear of retaliation or the impression that speaking up will not do any good. Relationships between the individuals providing patient care can have a powerful influence on how and even if important information is communicated. Research has shown that delays in patient care and recurring problems from unresolved disputes are often the by-product of physician-nurse disagreement.39 Our research has identified a common trend in which nurses are either reluctant or refuse to call physicians, even in the face of a deteriorating status in patient care. Reasons for this include intimidation, fear of getting into a confrontational or antagonistic discussion, lack of confidentiality, fear of retaliation, and the fact that nothing ever seems to change. Many of these issues have to deal more with personality and communication style.40 The major concern about disruptive behaviors is how frequently they occur and the potential negative impact they can have on patient care. Our research has shown that 17 percent of respondents to our survey research in 2004-2006 knew of a specific adverse event that occurred as a result of disruptive behavior. A quote from one of the respondents illustrates this point: “Poor communication postop because of disruptive reputation of physician resulted in delayed treatment, aspiration, and eventual demise.”19 Leaders in both medicine and nursing have issued ongoing initiatives for the development of a cooperative rather than a competitive agenda to benefit patient care.5, 39, 41, 42 A powerful incentive for greater teamwork among professionals is created by directing attention to the areas where changes are likely to result in measurable improvements for the patients they serve together, rather than concentrating on what, on the surface, seem to be irreconcilable professional differences. The fact that most health professionals have at least one characteristic in common, a personal desire to learn, and that they have at least one shared value, to meet the needs of their patients or clients, is a good place to start. Professional Collaboration and Team Collaboration, communications Practice Implications Known Benefits of Communication and Team Collaboration A large body of literature shows that because of the complexity of medical care, coupled with the inherent limitations of human performance, it is critically important that clinicians have standardized communication tools and create an environment in which individuals can speak up and express concerns. This literature concurs that when a team needs to communicate complex information in a short period of time, it is helpful to use structured communication techniques to ensure accuracy. Structured communication techniques can serve the same purpose that clinical practice guidelines do in assisting practitioners to make decisions and 5 Patient Safety and Quality: An Evidence-Based Handbook for Nurses take action. Research from aviation and wilderness firefighting is useful in health care because they all involve settings where there is a huge variability in circumstances, the need to adapt processes quickly, a quickly changing knowledge base, and highly trained professionals who must use expert judgment in dynamic settings. Research shows that in these disciplines, the adoption of standardized tools and behaviors is a very effective strategy in enhancing teamwork and reducing risks.1, 17, 43–54, 60, 61 Crew Resource Management (Aviation). Experts in aviation have developed safety training focused on effective team management, known as Crew Resource Management (CRM). Improvements in the safety record of commercial aviation may be due, in part, to this training. Realizing that 70 percent of commercial flight accidents stemmed from communication failures among crew members, CRM sought to standardize communication and teamwork. The concept originated in 1979, in response to a NASA workshop that examined the role that human error plays in air crashes. CRM emphasizes the role of human factors in high-stress, high-risk environments. John K. Lauber, a psychologist member of the National Transportation Safety Board, deemed CRM as “using all available sources—information, equipment, and people—to achieve safe and efficient flight operations.”44, 45 CRM encompasses team training as well as simulation, interactive group debriefings, and measurement and improvement of aircrew performance. This represents a major change in training, which had previously dealt with only the technical aspects of flying. It considers human performance limiters (such as fatigue and stress) and the nature of human error, and it defines behaviors that are countermeasures to error, such as leadership, briefings, monitoring and cross-checking, decisionmaking, and review and modification of plans. From a practical standpoint, CRM programs typically include educating crews about the limitations of human performance. Trainees develop an understanding of cognitive errors and how stressors (such as fatigue, emergencies, and work overload) contribute to the occurrence of errors. Operational concepts stressed include inquiry, seeking relevant operational information, advocacy, communicating proposed actions, conflict resolution, and decisionmaking. CRM is now required for flight crews worldwide. The development and implementation of CRM in aviation over the last 25 years offers valuable lessons for medical care. Sexton and colleagues51 compared flight crews with operating room personnel on several measures, including attitudes toward teamwork. This landmark study included more than 30,000 cockpit crew members (captains, first officers, and second officers) and 1,033 operating room personnel (attending surgeons, attending anesthesiologists, surgical residents, anesthesia reside …Professional Collaboration and Team Collaboration, communications Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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