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Encourage open participation, collaboration and safety

This is one of the recommendations from the ‘departmental’ section of the RCOG/RCM undermining toolkit.

Encourage open participation, collaboration and safety

In healthy teams, participation and collaboration should be transparent and supportive, involving all parties. Teams should have zero tolerance to subversive behaviours involving passive resistance such as:

  • Deceit
  • Bypassing professionals
  • Withholding information
  • Covert disregard and disrespect
  • Tribalism

Tribalism (PowerPoint, 65 kb) can have a profound effect on patient safety, by encouraging professionals to act to protect themselves rather than collectively.

To help improve shared and common meanings, predictable structures for communication should be endorsed during both training and practice to improve collaboration. One example is SBAR, which focuses on Situation, Background Assessment and Recommendation. An example of how SBAR can be used in practice is below:

Mrs X is a 30-year-old multip. at 38 weeks of gestation under the care of JIC who is being induced for PET.

S Mrs X was diagnosed with PET at 34/40 in this pregnancy.
B

Her PCR is 300.

Her BP has required tx with 200 mg labetalol tds.

Her ALT is raised at 60 but the rest of her bloods are normal.

Ultrasound yesterday showed the fetal growth and liquor to be below the 5th centile and the Dopplers to have absent EDF.

Her first baby was delivered spontaneously at 32 weeks and was complicated by an atonic 2 l PPH.

A

Her BP is currently 140/90.

She is contracting 4:10 on 4 mu/min of syntocinon and her last VE at 12:00 found her to be 6 cm dilated.

She has a good working epidural.

The CTG is suspicious with atypical decelerations.

R

I would like the CTG reviewed on the ward round.

We are planning to perform the next VE at 16:00.

She will require repeat bloods at 14:00.

 

Team briefs that encourage everyone to introduce themselves and highlight the help they need from the team ensure everyone is more understanding of each other’s role. 

References and further reading

Elsewhere on the site

Resources and support for trainees
Further resources to support specialty trainees in O&G
Resources and support for trainers
Resources to help trainers deliver the specialty training programme in O&G