Dr. Ronald Burkman says that teamwork is certainly not a new concept in the delivery of health care.
Indeed, health professionals have traditionally worked as members of teams, said Burkman, chairman of the Department of Obstetrics and Gynecology at Baystate Medical Center (BMC), and especially in his field of care.
But there are ways to enable teams to operate more efficiently and further reduce errors, said Berkman, who used the phrase “teamwork technology” to describe this phenomenon. This concept is at the heart of a training program called MedTeams, which evolved from two decades of aviation safety training in the United States, and is now being explored for use in the broad health care industry.
There are many similarities between aviation and health care, said Burkman, noting that both are high-performance, high-stress environments where even the slightest error can have serious consequences.
“Everyone is concerned about errors in medicine,” he said. “One of the approaches is to adapt what has been utilized in both military and civilian aviation, and that is to incorporate the use of teams in ways that are above and beyond what is traditional.
“In this approach, each member of the team carries a lot more weight, and can step in and suggest things to someone who might be more senior,” he continued. “This has been proven successful in aviation, and many think it will have similar results in health care.”
While an emergency department would be a logical environment to test the MedTeams approach, and it has been utilized there, he said, many believed that a labor/delivery room setting would also be appropriate. Thus, BMC participated with 15 other hospitals nationwide in a clinical trial entitled “Evaluation of a Teamwork Intervention in Labor and Delivery Units,” which was funded by the Department of Defense and the Harvard Risk Management Foundation.
The objectives of the study were to determine whether the MedTeams intervention improves patient safety by reducing the occurrence of adverse outcomes while enhancing patient and provider satisfaction.
Of the 15 hospitals, seven were in the intervention arm, which received MedTeams training, and eight, including Baystate, were in the control group. Data on deliveries at all hospitals were collected for a 12-month period beginning in December 2002, said Burkman, adding that results should be available by the end of the year.
And while he wouldn’t speculate on the outcome of the study, Burkman said that it only makes sense that improved teamwork technology will reduce the number of errors in a setting like a delivery room.
“I think that regardless of what the study shows, this is the way to do things,” he said, adding that MedTeams should be particularly effective in smaller facilities where turnover is greater and team members change more frequently. He drew an analogy to sports.
“It’s similar to when new players join the Red Sox,” he explained. “They’re playing as a team, but it takes time for that team to function well together, even though everyone knows what they’re doing. The same is true in medicine — you can’t step right in and say, ‘I’m ready to go;’ you have to work at it a little bit.
“The ability to cross over and use a team to help manage someone else’s patient enables you to break through the silos,” he continued, adding that the MedTeams approach permits to nurses and other team members to communicate with doctors and prevent errors.
The principles of MedTeams teamwork are particularly relevant to those segments of health care where integrated actions by two or more caregivers are required, quickly and in the proper sequence to maintain patient safety, said Nancy Rines RN, manger of LDRP (labor, delivery, recovery and postpartum) and Wesson 2 in the Wesson Women and Infants’ Unit at Baystate Medical Center.
“It’s all about patient safety and wanting to further improve the quality care we deliver to our patients,” she said.
The introduction of MedTeams principles in the delivery of patient care on labor and delivery units couldn’t come at a better time, noted Burkman. “A recent report by the American Medical Association noted Massachusetts is the 20th state in the country to enter a full-blown medical liability crisis, and tort reform has been slow,” he said.
“There has also been a major focus on preventing medical errors by the Institute of Medicine, whose recent recommendation was to refocus health care so that delivery is performed by teams, with an emphasis on patient safety, patient satisfaction, and efficiency in delivery of care,” he added.
During the 12 months of the study, data was collected on deliveries including inductions of labor, cesarean deliveries, anesthesia methods, and infant outcomes, Rines said, adding that following the study, the eight control hospitals were offered classes in the MedTeams process in hopes they would implement the program at their hospitals. Seven Baystate caregivers attended the two-day class recently at Beth Israel Hospital in Boston Those attending included Elsie Matos, RN, Kathy Freme, RN and Beth Zabielski, RN (all from Westfield) and Eileen Giardina, RN (from Florence), as well as Burkman, Rines, and Molly Gray RN, director of Baystate Medical Center Children’s Hospital and Women’s Services.
The L&D Team Coordination Course was crafted by physicians, nurses, and behavioral scientists. Its goals are to teach health care providers how to form effective teams and to teach team members effective teamwork skills. Organizers hope the course will change the way those attending it organize, coordinate and communicate. It is also expected that the course will expand their skills and improve their job performance through teamwork, and it is also an opportunity for professional and personal growth.
“Even before attending the class we felt that we were already working well as a team on our birthing unit, and we discovered at the sessions that the processes we practice are very close to those of MedTeams,” said Rines. “While the class was an affirmation of our teamwork, we also recognize the fact there is always room for improvement, especially in the area of communication.
“An essential part of this process is allowing each team member to have a say in the patient’s actual care,” she continued. “When I observed a meeting at Beth Israel, I noticed that everyone working on the unit was in attendance – from the secretaries to the anesthesiologists,” she added.
Rines noted other health care environments most likely to benefit from the MedTeams concept are those where effective real-time, face-to-face communication, and coordination is essential to safe patient care, such as intensive care units and operating rooms. The group that attended the conference will be looking at ways to implement this approach at Baystate.
“Although all the research data is not yet clear, it is obvious that a team approach such as MedTeams can only enhance the safety of patient care and that is our focus,” she said.