Action 5.5 states

The health service organisation has processes to:

  1. Support multidisciplinary collaboration and teamwork
  2. Define the roles and responsibilities of each clinician working in a team

Intent

Clinicians are supported to work in collaborative multidisciplinary teams, and they understand their own roles and responsibilities, and those of other team members.

Reflective questions

How do multidisciplinary collaboration and teamwork operate in the health service organisation?

How are the roles and responsibilities of each clinician working in a team defined? How is this communicated to team members and the patient?

Key task

Develop structured processes to support multidisciplinary teamwork and collaboration.

Strategies for improvement

Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Given the complexity of health care, teams and clinicians may change regularly or over time, depending on the needs of the patient.6,7 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Some Australian programs targeting improvements in multidisciplinary teamwork include:

  • In Safe Hands (NSW Clinical Excellence Commission)
  • TeamSTEPPS® – Team Strategies and Tools to Enhance Performance and Patient Safety (SA Health).

Although interventions to improve multidisciplinary teamwork and collaboration vary, there are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11-13 

Work with local clinical teams to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Day Procedure Services

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced risk of complications of medical care and reduced risk of surgical complications or death.9,10 To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

Examples of tools and processes that can help to structure and facilitate effective teamwork are:

  • Structured opportunities for multidisciplinary team communication
  • The surgical safety checklist
  • Evidence-based scoring systems, such as the Aldrete or PADDS score
  • Structured communication tools such as ISBAR (see Action 6.7).

In a day procedure service, the multidisciplinary team may include the referring clinician, anaesthetist and nurse involved in delivering care for the patient.

Consider providing formal training in teamwork and communication.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Examples of evidence

Select only examples currently in use:

  • Policy documents or by-laws that outline structured communication processes that are used to ensure that members of the workforce understand their delegated roles and responsibilities when working as a multidisciplinary team
  • Audits on clinical handover
  • Employment documents that describe the roles, responsibilities and accountabilities of the workforce
  • Organisational chart and delegations policy that show clinical governance reporting lines and relationships.

MPS & Small Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. MPSs and small hospitals will need to develop structured processes to support multidisciplinary teamwork and collaboration. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Teams and clinicians in MPSs and small hospitals are likely to change regularly as agency or locum clinicians come and go. This poses a challenge to effective teamwork. There are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11-13

Examples of tools and processes that can help to structure and encourage effective teamwork include:

Work with clinicians to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Given the complexity of health care, teams and clinicians may change regularly or over time, depending on the needs of the patient.6,7 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Some Australian programs targeting improvements in multidisciplinary teamwork include:

  • In Safe Hands (NSW Clinical Excellence Commission)
  • TeamSTEPPS® – Team Strategies and Tools to Enhance Performance and Patient Safety (SA Health).

Although interventions to improve multidisciplinary teamwork and collaboration vary, there are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11-13 

Work with local clinical teams to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Day Procedure Services

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced risk of complications of medical care and reduced risk of surgical complications or death.9,10 To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

Examples of tools and processes that can help to structure and facilitate effective teamwork are:

  • Structured opportunities for multidisciplinary team communication
  • The surgical safety checklist
  • Evidence-based scoring systems, such as the Aldrete or PADDS score
  • Structured communication tools such as ISBAR (see Action 6.7).

In a day procedure service, the multidisciplinary team may include the referring clinician, anaesthetist and nurse involved in delivering care for the patient.

Consider providing formal training in teamwork and communication.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

Examples of evidence

Select only examples currently in use:

  • Policy documents or by-laws that outline structured communication processes that are used to ensure that members of the workforce understand their delegated roles and responsibilities when working as a multidisciplinary team
  • Audits on clinical handover
  • Employment documents that describe the roles, responsibilities and accountabilities of the workforce
  • Organisational chart and delegations policy that show clinical governance reporting lines and relationships.

MPS & Small Hospitals

To deliver comprehensive care that is safe and continuous, effective communication and teamwork are critical. MPSs and small hospitals will need to develop structured processes to support multidisciplinary teamwork and collaboration. Implement this action with consideration of the requirements of the Communicating for Safety Standard.

A substantial proportion of potentially preventable adverse events are underpinned by failures in communication and teamwork.1-5 Improvements in multidisciplinary collaboration and teamwork have been associated with outcomes such as reduced length of stay8, reduced risk of complications of medical care9 and reduced risk of surgical complications or death.10

Teams and clinicians in MPSs and small hospitals are likely to change regularly as agency or locum clinicians come and go. This poses a challenge to effective teamwork. There are consistent indications that structured tools and processes are necessary to achieve effective and lasting change.11-13

Examples of tools and processes that can help to structure and encourage effective teamwork include:

Work with clinicians to review current work processes, design or adapt relevant tools, and build the use of structured processes and tools into the workflow.

Consider providing formal teamwork and communication training.14,15 Skills in communication, collaboration and team behaviours can be developed through simulation, workshops or lectures. Strategies to improve clinical communication are discussed in more detail in the Communicating for Safety Standard.

References

  1. Alvarez G, Coeira E. Interdisciplinary communication: an uncharted source of medical error? J Crit Care 2006;21(3):236–42.
  2. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13(Suppl 1):i85–90.
  3. Kohn L, Corrigan J, Donaldson MS, editors. To err is human: building a safer health care system. Washington (DC): National Academy Press; 1999.
  4. Baker DP, Gustafson S, Beaublen J, Salas E, Barach P. Medical teamwork and patient safety: the evidence-based relation. Rockville (MD): Agency for Healthcare Research and Quality; 2005. (AHRQ Publication No. 05-0053.)
  5. Shen H, Chiu H, Lee P, Hu Y, Chang W. Hospital environment, nurse-physician relationships and quality of care: questionnaire survey. J Adv Nurs 2011;67(2):349–58.
  6. Shojania KG, Thomas E. Trends in adverse events over time: why are we not improving? BMJ Qual Saf 2013;22(4):273–7.
  7. Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core principles and values of effective team-based health care. Discussion paper. Washington (DC): Institute of Medicine; 2012.
  8. Wachter RM. Understanding patient safety. 2nd ed. New York (NY): McGraw-Hill; 2008.
  9. Tschannen D, Kalisch B. The impact of nurse/physician collaboration on patient length of stay. J Nurs Manag 2009;17(7):796–803.
  10. Pannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of interdisciplinary team care interventions on general medical wards: a systematic review. JAMA Intern Med 2015;175(8):1288–98.
  11. Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, et al. Care pathways lead to better teamwork: results of a systematic review. Soc Sci Med 2012;75(2):264–8.
  12. Mazzocco K, Petitti D, Fong K, Bonacum D, Brookey J, Graham S, et al. Surgical team behaviors and patient outcomes. Am J Surg 2009;197:678–85.
  13. Gillespie BM, Withers TK, Lavin J, Gardiner T, Marshall AP. Factors that drive team participation in surgical safety checks: a prospective study. Patient Saf Surg 2016;10:3.
  14. Zwarenstein M, Rice K, Gotlib-Conn L, Kenaszchuk C, Reeves S. Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards. BMC Health Serv Res 2013;13:494.
  15. Buljac-Samardzic M, Dekker-van Doorn C, van Wijngaarden J, van Wijk K. Interventions to improve team effectiveness: a systematic review. Health Policy 2010;94(3):183–95.