Health care teams are coping with unprecedented challenges because of the COVID-19 pandemic. Whether you are determining how to deploy scarce resources or sifting through the latest evidence-based recommendations, building a foundation of good teamwork and communication can help. The following is an excerpt from the IHI white paper, A Framework for Safe, Reliable, and Effective Care.

Effective groups develop norms of conduct that lead to shared understanding, anticipate needs and problems, and use agreed-upon methods to manage situations — including those that involve conflict. 

Hallmarks of a strong team include working together to plan, reflect back, communicate clearly, and manage risk. This applies to all types of teams, whether a surgical team in the operating room or a group of community nurses who work for the same home care agency.

• Plan: Take time — even momentarily in a safety briefing or a surgical timeout — to outline next steps, talk about potential risks, and agree on a path that best manages risk, safety, and efficiency.
• Reflect back: Use team debriefs to evaluate what went well and what didn’t go well to identify potential areas for improvement. Truly robust teams evaluate not just the clinical and operational activities, but also the cultural ones. Did the group “gel” as a team? Did everyone know the plan? Did we assure psychological safety?
• Communicate clearly: High-functioning teams use structured communication in which they consistently, succinctly, and respectfully share critical information. A prime example is SBAR (Situation, Background, Assessment, Recommendation), which team members can employ to rapidly communicate a comprehensive set of facts based on which team members can make decisions.
• Manage risk: In some critical moments, teams may use a designated word or phrase that indicates there is perceived risk, and which gives the team permission to stop what they’re doing and take stock of the situation. Perhaps the team is not following the agreed-upon plan, or the dynamics of the situation have changed. This might occur when a team member no longer understands what the group is doing relative to the plan, or the team member perceives increased risk.
  
  For example, when the general surgeon performing a difficult laparoscopic cholecystectomy has spent 30 minutes ineffectively trying to identify the common bile duct amidst the scar tissue surrounding the gall bladder, and frustration is evident, an experienced circulating nurse or anesthesiologist might suggest that another set of experienced eyes on the problem may be helpful. In most operating rooms today, this would be perceived as intrusive and an affront to the surgeon’s skill. The reality is that everyone is at risk for task fixation and can benefit from the many perspectives of a multidisciplinary team.

In a culture that espouses teamwork and communication in the pursuit of safe, reliable, and effective care, team members explicitly give permission to hold each other accountable across a flat hierarchy. During each team interaction, team members know the plan and there is a dynamic that supports psychological safety. Teams agree on norms of conduct, and remind members of these norms when necessary.

Achieving these ambitious yet necessary goals requires team members to be committed, competent, self-managing, and courageous. This enables them to plan, reflect back, communicate clearly, and manage risk.

How to assess teamwork and communication

In most cases, teams act their way into embodying the aforementioned characteristics only after regular practice. To gauge where a team is on the continuum, senior leaders should periodically enter a work setting and determine the answers to the following questions:

• How do you brief as a team? What’s the process for ensuring that everyone on the team knows the plan?
• When do you brief? How do you manage the team’s work with members coming on shift at different hours?
• How do you debrief? What activities do you do to debrief and identify what has worked and what hasn’t? When does this occur?

To learn more about other essential components of a system of safety, consult the IHI white paper, A Framework for Safe, Reliable, and Effective Care.