Effective team leadership coordinates the team members’ work, promotes appropriate task distribution, evaluates effectiveness, and inspires highlevel performance The leader facilitates team problem solving rather than providing the solution The team leader communicates the goals, clarifies roles and available resources; provides ongoing situational awareness of the environment; and sets expectations that encourage the other key team behaviors Effective team leaders provide feedback in real time Mutual Performance Monitoring Mutual performance monitoring is the shared understanding among team members regarding roles and responsibilities so as to allow for active monitoring of one another’s performance for collective success As information is gathered, it is shared which helps prevent errors Thus, open communication and sharing of ideas between all team members whose role and expertise touches the patient during that encounter are equally important Back-Up Behaviors Back-up behavior is anticipating your team members’ needs, balancing workloads, assisting with other member’s tasks when needed, and correcting errors or oversights in a supportive way Team members need to help and support each other to accomplish the best for the patient Adaptability Adaptability is the capability of the team members to adjust their strategies for completing tasks on the basis of changing circumstances or feedback from the patient or the work environment This requires an overall perspective of the team task including recognition of changes that are occurring and how these changes will potentially alter individual team member roles For example, the team must recognize cues when a patient is deteriorating and nimbly work together to develop and carry out a new treatment plan Team Orientation Team orientation is a preference for working with others The team member prioritizes team goals over individual goals, which enhances individual performance through coordination and receipt of feedback from other members Hierarchy is flattened; the common goal is more important than any individual’s contribution or performance Facilitating Teamwork There are three mechanisms that facilitate teamwork: shared mental models, closed-loop communication, and mutual trust Salas notes that teams which employ the five competencies of teamwork, while making sure to utilize the three coordinating mechanisms, should outperform those teams that not TABLE 4.1 ACHIEVING A SHARED MENTAL MODEL a Individual Group Environment Know the patient care plan Active listening Closed-loop communication Read back Verify Mutual performance monitoring Self-monitoring Brief (before) Debrief (after) Huddle (during) Documentation Hand-overs Call out Visual management tools Checklists Distraction control Technology aids Communication boards a Team members, patient and family are on the same page Shared Mental Models Structures must be put into place to support team work SBAR (S ituation, B ackground, A ssessment, R ecommendation) and I-PASS (Illness severity, P atient summary, A ction list, S ituational awareness and contingency plan, S ynthesis by receiver) are examples of structured communication tools to standardize hand-offs and reduce error Clinical standards can guide care for chief complaints, specific diseases, procedures, or care processes Communication boards can assure the patient/family understands the current care plan Table 4.1 lists some other strategies for team guidance Closed-Loop Communication Closed-loop communication verifies the exchange of information between the sender and the receiver An example of this is the use of I-PASS at hand-overs where the receiver is asked to repeat back the information that they heard from the sender and ask for clarification Mutual Trust Each team member has separate and important knowledge, technical skills, and perspective—information must flow easily between team members The traditional hierarchical culture of medicine is a significant barrier to this Surveys administered to physicians and nurses demonstrate different perspective on teamwork Difficulty speaking up, lack of input into decision making, collaboration with physicians, and conflict resolution are issues often reported by nurses These attitudes reflect poor teamwork which is associated with job satisfaction, fatigue and burn-out, errors and potentially poor patient outcomes High-status team members must use inclusive behaviors—actively soliciting information from team members to assure that the team is getting the best information The importance of psychological safety cannot be underestimated Simply put, psychological safety describes an environment where people can speak up freely, share their ideas and their concerns and create a free exchange of knowledge Mutual trust and respect are required; members then actually feel responsible to express their concerns; they are not fearful and not see it as a risk-taking behavior There is a well-documented tendency for people in the work place to choose silence over candor Evidence has documented that units characterized by high-quality relationships and supportive leadership and expectations for excellence actually report higher error rates High-functioning teams not make more errors, they just report them in order to learn from them to avoid them in the future Psychological safety is a characteristic of the workplace; organizational culture provides the operating conditions that define norms of interaction and thus has an opportunity and a responsibility to promote effective teamwork TABLE 4.2 STRATEGIES FOR BUILDING STRONG INTERDISCIPLINARY TEAMS ... perspective—information must flow easily between team members The traditional hierarchical culture of medicine is a significant barrier to this Surveys administered to physicians and nurses demonstrate