Teams, team training, and the role of simulation

Abstract

Many areas of acute care medicine have a low error tolerance and demand high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depends on appreciating, measuring and improving system factors, in particular, effective team skills. In recent years, the relationship between surgical team behaviour and patient outcome has been studied by a number of researchers. Teamwork concerns the communication and coordination processes that are required to bring together the individual knowledge, skills and attitudes in the service of a common and valued team goal. Individual surgical team members are highly specialized and have their own functional taskwork (e.g., anaesthesia, nursing, surgery and perfusion), yet come together as a team towards the common goal of treating the patient. Interventions focusing on teamwork have shown a relationship with improved teamwork and safety climate. The ‘working together’ of a clinical microsystem is accomplished by a complex suite of ‘nontechnical skills’. Teams that score low on independently observed non-technical skills make more technical errors and in cases where teams infrequently display team behaviours, patients are more likely to experience death or major complications. There is a significant correlation between subjective assessment of teamwork by team members themselves and postoperative morbidity. Good teamwork (in terms of both quality and quantity) is associated with shorter duration of operations, fewer adverse events and lower postoperative morbidity. Finally, this chapter addresses the importance of nurturing and sustaining team leaders. Able leaders anticipate events, prepare for them, and nurtured and grow by the effective team support and improved outcomes.