Pediatric emergency medicine trisk 0107 0107
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Closed-Loop Communication
Closed-loop communication verifies the exchange of information between
the sender and the receiver. An example of this is the use of I-PASS at
hand-overs where the receiver is asked to repeat back the information that
they heard from the sender and ask for clarification.
Mutual Trust
Each team member has separate and important knowledge, technical skills,
and perspective—information must flow easily between team members.
The traditional hierarchical culture of medicine is a significant barrier to
this. Surveys administered to physicians and nurses demonstrate different
perspective on teamwork. Difficulty speaking up, lack of input into decision
making, collaboration with physicians, and conflict resolution are issues
often reported by nurses. These attitudes reflect poor teamwork which is
associated with job satisfaction, fatigue and burn-out, errors and potentially
poor patient outcomes. High-status team members must use inclusive
behaviors—actively soliciting information from team members to assure
that the team is getting the best information.
The importance of psychological safety cannot be underestimated.
Simply put, psychological safety describes an environment where people
can speak up freely, share their ideas and their concerns and create a free
exchange of knowledge. Mutual trust and respect are required; members
then actually feel responsible to express their concerns; they are not fearful
and do not see it as a risk-taking behavior. There is a well-documented
tendency for people in the work place to choose silence over candor.
Evidence has documented that units characterized by high-quality
relationships and supportive leadership and expectations for excellence
actually report higher error rates. High-functioning teams do not make more
errors, they just report them in order to learn from them to avoid them in the
future. Psychological safety is a characteristic of the workplace;
organizational culture provides the operating conditions that define norms
of interaction and thus has an opportunity and a responsibility to promote
effective teamwork.
