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:
- Bypassing professionals
- Withholding information
- Covert disregard and disrespect
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.
||Mrs X was diagnosed with PET at 34/40 in this pregnancy.
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.
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.
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
- Berger J, Rosenholtz SJ, Zelditch M Jr. Status organising process, Ann Rev Sociol 1980;6:479–508.
- Berridge EJ, Mackintosh NJ, Freeth DS. Supporting patient safety: Examining communication within delivery suite teams through contrasting approaches to research observation. Midwifery 2010;26:512–9.
- Hunt S, Symonds A. The social meaning of midwifery. Basingstoke: Macmillan Press Ltd; 1995.
- Lyndon A. Communication and teamwork in patient care: how much can we learn from aviation? J Obstet Gynecol Neonatal Nurs 2006;538-546.
- Pinki P, Sayasneh A, Lindow SW. The working relationship between midwives and junior doctors: a questionnaire survey of Yorkshire trainees. J Obstet Gynaecol 2007;27:365–7.
- Pfrimmer D. Teamwork and communication. J Contin Educ Nurs 2009;40:294–5.
- Russell KE. Mad, bad or different? Midwives and normal birth in obstetric led units. British Journal of Midwifery 2007;15:128–31.
- Sotiris C, Papaspyros KC, Rajeshwara J, Aldumi KP, O’Regan DJ. Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety. Interact Cardiovasc Thorac Surg 2009;10:43–7.