As clinicians we communicate with other clinicians in person, in the patient record, in handover documentation and in other charts. We also have discussions during ward rounds, in meetings with treating team members, at handovers, and in informal conversations. All of these tasks require skilful clinical communication1.
Teamwork impacts on patient wellbeing
A supportive health service team culture has been associated with higher functional wellbeing for patients post discharge2.
Communication is a critical element in effective teamwork. A well-functioning team fosters an environment where we can ask questions and be ‘respectfully assertive’ with other team members, no matter the role or position, whenever a patient appears at risk3, 4. Good team member communication processes support clinicians, translating into better individual interactions.5
Effective teamwork does not just happen; it requires skill development, practice and a supportive environment. Excellent individual skills do not guarantee effective team performance in delivering care4, 6.
Team meetings can be used effectively to organise and learn6. Even brief one to five minute team meetings at handovers (and within shifts if required) to assess and organise are important4.
Items to address in team meetings to improve patient care include:
- identifying team members and leaders
- establishing or re-establishing situational awareness
- assigning or re-assigning responsibilities and tasks
- making team decisions
- discussing problems
- reviewing lessons we have learned.4, 6
Individual teamwork actions are the most common teamwork activities. Failures in four individual teamwork actions have been most implicated in medical errors4. The following are the four clinical teamwork skills that most reduce medical errors:
- Know what protocol or plan is being used. This should be clear to everyone on your team.
- Advocate for your patients. Assert your opinion or a correction to team members if you believe a patient is at risk. Leaders have a responsibility to create an environment where this is possible.
- Understand the care plan and prioritise tasks for your patients accordingly.
- Cross-monitor the actions of team members for simple errors and act to correct if required. Leaders should create an environment where this is an acceptable practice.
Documentation helps us monitor interventions to minimise functional decline in our patients and communicate with the team.
In addition to following local documentation policy and procedures, consider the following actions to provide the information needed by the team7.
Record observations and actions accurately; clearly state the facts, what you saw, heard, smelt, felt and did.
- Record enough information so that another clinician can continue care, include what preceded an event or change in care if that information is relevant to continuing care (for example, if a code grey is called for an older person with dementia, the events preceding the code grey are important for other clinicians to know how to deliver safe and effective person-centred care).
- Document information about medications completely. Write medication names in full.
- Document every assessment while the older person is in your care. This establishes a baseline, a record and a timeline of the person’s health.
- Document as soon as possible to ensure important details are recorded and facts are not lost or shaded by subsequent events. Timely documentation also aids in treatment.
1. Australian Commission on Safety and Quality in Health Care, National Statement on Health Literacy, 2014, [Accessed 17 February 2015].
2. Shortell, S.M., Jones, R.H., Rademaker, A.W., Gillies, R.R., Dranove, D.S., Hughes, E.F.X., Budetti, P.P., Reynolds, K.S.E., Huang, C-F. Assessing the Impact of Total Quality Management and Organizational Culture on Multiple Outcomes of Care for Coronary Artery Bypass Graft Surgery Patients', Med Care, 2000. 38: 207-17.
3. Clinical Communique [electronic resource]: Department of Forensic Medicine Monash University Victorian Institute of Forensic Medicine, 2 (2015).
4. Risser, D. T., M. M. Rice, M. L. Salisbury, R. Simon, G. D. Jay, and S. D. Berns, The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department, Annals of Emergency Medicine, 1999. 34: 373-83.
5. Safran, D. G., W. Miller, and H. Beckman, Organizational Dimensions of Relationship-Centered Care: Theory, Evidence, and Practice, Journal of General Internal Medicine, 2006. 21: S9-15.
6. WHO Guidelines for Safe Surgery: 2009: Safe Surgery Saves Lives, 2009.
7. Hunter, S., M. Bauer, D. Fetherstonhaugh, M. Winbolt, and R. Nay, Module 2: Communication of Assessment - Professional Issues, (Melbourne: La Trobe University).