3.3 Teams and Teamwork

Kathy Andresen DNP, MPH, RN, CNE

3.3 Teams and Teamwork

IPEC Competency 4: Teams and Teamwork

Now that we have reviewed the first three IPEC competencies related to valuing team members , understanding team members’ roles and responsibilities and interprofessional communication, let’s discuss strategies that promote effective teamwork. The fourth IPEC competency states, “Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable” (Interprofessional Education Collaborative, n.d.). See the following box for the components of this IPEC competency.

Components of IPEC’s Teams and Teamwork Competency (Interprofessional Education Collaborative, 2022.)

Describe the process of team development and the roles and practices of effective teams.
Develop consensus on the ethical principles to guide all aspects of teamwork.
Engage health and other professionals in shared patient-centered and population-focused problem-solving.
Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting patient and community values and priorities/preferences for care.
Apply leadership practices that support collaborative practice and team effectiveness.
Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among health and other professionals and with patients, families, and community members.
Share accountability with other professions, patients, and communities for outcomes relevant to prevention and health care.
Reflect on individual and team performance for individual, as well as team, performance improvement.
Use process improvement to increase effectiveness of interprofessional teamwork and team-based services, programs, and policies.
Use available evidence to inform effective teamwork and team-based practices.
Perform effectively on teams and in different team roles in a variety of settings.

Developing effective teams is critical for providing health care that is patient-centered, safe, timely, effective, efficient, and equitable (Interprofessional Education Collaborative Expert Panel, 2011).

Nurses collaborate with the interprofessional team by not only assigning and coordinating tasks, but also by promoting solid teamwork in a positive environment. A nursing leader, such as a charge nurse, identifies gaps in workflow, recognizes when task overload is occurring, and promotes the adaptability of the team to respond to evolving patient conditions. Qualities of a successful team are described in the following box (O’Daniel & Rosenstein, 2011).

Qualities of A Successful Team (O’Daniel & Rosenstein, 2011)

Promote a respectful atmosphere
Define clear roles and responsibilities for team members
Regularly and routinely share information
Encourage open communication
Implement a culture of safety
Provide clear directions
Share responsibility for team success
Balance team member participation based on the current situation
Acknowledge and manage conflict
Enforce accountability among all team members
Communicate the decision-making process
Facilitate access to needed resources
Evaluate team outcomes and adjust as needed

STEP Tool

STEP is a tool for monitoring the delivery of health care

STEP Tool (AHRQ, 2020)

Status of Patients: “What is going on with your patients?”

Patient History
Vital Signs
Medications
Physical Exam
Plan of Care
Psychosocial Issues

Team Members: “What is going on with you and your team?”(See the “I’M SAFE Checklist” below.)

Fatigue
Workload
Task Performance
Skill
Stress

Environment: Knowing Your Resources

Facility Information
Administrative Information
Human Resources
Triage Acuity
Equipment

Progression Towards Goal:

Status of the Team’s Patients
Established Goals of the Team
Tasks/Actions of the Team
Appropriateness of the Plan – Are Modifications Needed?

Cross Monitoring

As the STEP tool is implemented, the team leader continues to cross monitor to reduce the incidence of errors. Cross monitoring includes the following (AHRQ, 2020):

Monitoring the actions of other team members.
Providing a safety net within the team.
Ensuring that mistakes or oversights are caught quickly and easily.
Supporting each other as needed.

I’M SAFE Checklist

The I’M SAFE mnemonic is a tool used to assess one’s own safety status, as well as that of other team members in their ability to provide safe patient care. See the I’M SAFE Checklist in the following box (AHRQ, 2020). If a team member feels their ability to provide safe care is diminished because of one of these factors, they should notify the charge nurse or other nursing supervisor. In a similar manner, if a nurse notices that another member of the team is impaired or providing care in an unsafe manner, it is an ethical imperative to protect clients and report their concerns according to agency policy (AHRQ, 2020).

I’m SAFE Checklist (AHRQ, 2020)

I: Illness
M: Medication
S: Stress
A: Alcohol and Drugs
F: Fatigue
E: Eating and Elimination

Read an example of a nursing team leader performing situation monitoring using the STEP tool in the following box.

Example of Situation Monitoring

Two emergent situations occur simultaneously on a busy medical-surgical hospital unit as one patient codes and another develops a postoperative hemorrhage. Connie, the charge nurse, is performing situation monitoring by continually scanning and assessing the status of all patients on the unit and directing additional assistance where it is needed. Each nursing team member maintains situation awareness by being aware of what is happening on the unit, in addition to caring for the patients they have been assigned. Connie creates a shared mental model by ensuring all team members are aware of their evolving responsibilities as the situation changes.

Connie directs additional assistance to the emergent patients while also ensuring appropriate coverage for the other patients on the unit to ensure all patients receive safe and effective care. For example, as the “code” is called, Connie directs two additional nurses and two additional assistive personnel to assist with the emergent patients while the other nurses and assistive personnel are directed to “cover” the remaining patients, answer call lights, and assist patients to the bathroom to prevent falls. Additionally, Connie is aware that after performing a few rounds of CPR for the coding patient, the assistive personnel must be switched with another team member to maintain effective chest compressions. As the situation progresses, Connie evaluates the status of all patients and makes adjustments to the plan as needed.

Mutual Support

Mutual support is the fourth skill of the TeamSTEPPS® framework and defined as the “ability to anticipate and support team members’ needs through accurate knowledge about their responsibilities and workload” (AHRQ, 2020). Mutual support includes providing task assistance, giving feedback, and advocating for patient safety by using assertive statements to correct a safety concern. Managing conflict is also a component of supporting team members’ needs.

Task Assistance

Helping other team members with tasks builds a strong team. Task assistance includes the following components (AHRQ, 2020):

Team members protect each other from work-overload situations.
Effective teams place all offers and requests for assistance in the context of patient safety.
Team members foster a climate where it is expected that assistance will be actively sought and offered.

Example of Task Assistance

In the previous example, one patient on the unit was coding while another was experiencing a postoperative hemorrhage. After the emergent care was provided and the hemorrhaging patient was stabilized, Sue, the nurse caring for the hemorrhaging patient, finds many scheduled medications for her other patients are past due. Sue reaches out to Sam, another nurse on the team, and requests assistance. Sam agrees to administer a scheduled IV antibiotic to a stable third patient so Sue can administer oral medications to her remaining patients. Sam knows that on an upcoming shift, he may need to request assistance from Sue when unexpected situations occur. In this manner, team members foster a climate where assistance is actively sought and offered to maintain patient safety.

Feedback

Feedback is provided to a team member for the purpose of improving team performance. Effective feedback should follow these parameters (AHRQ, 2020):

Timely: Provided soon after the target behavior has occurred.
Respectful: Focused on behaviors, not personal attributes.
Specific: Related to a specific task or behavior that requires correction or improvement.
Directed towards improvement: Suggestions are made for future improvement.
Considerate: Team members’ feelings should be considered and privacy provided. Negative information should be delivered with fairness and respect

Strategies for effective communication are found in Appendix C.