Health care strategies have emerged as indispensable tools to serve the patient needs in a variety of clinical settings. They contribute to the betterment of hospital life through the dexterous job of physicians and nurses. The sanctity of such a conducive atmosphere may go undiscovered when it looses the vital components such as communication and teamwork. This issue often interferes with the patient’s life and has become a major concern in hospitals. As such there is a need to highlight the literature keeping in view practical experiences concerned with the patient safety in this context.
Firstly, communication difficulties should be given prior importance as they are believed to heighten the risk of patient deaths. It was reported that the information exchange between the medical staff members may go wrong due to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict (Sutcliffe, Lewton, & Rosenthal, 2004). These elements should be given paramount importance in promoting appropriate interventions for medical education and health care organizations aimed at improving patient safety. This was revealed when a study described a total of 70 patient mishap incidents emanating from communication and management.These factors have also contributed to the recurring patterns of communication difficulties as described by the study participants in the semistructured face-to-face interview (Sutcliffe, Lewton, & Rosenthal, 2004).
The role of communication gets more complicated when the issue is related to emergency departments where there are high chances of confusion with serious errors resulting from interaction overload (Woloshynowych et al., 2007). The factors observed here were communication levels, frequent interruptions in association with simultaneous work tasks, the channel and rationale of communication etc (Woloshynowych et al., 2007).
These have led to discrepancies in the patient’s safety and vital relationships. Hence, it was emphasized that the communication between health care staff could be enhanced by minimizing the levels of interruptions and the volume of insignificant exchange of information (Woloshynowych et al., 2007). There is a need to ensure smooth communication through appropriate nursing programs that involve interdisciplinary communication. This could be facilitated through improved teaching-learning strategies, standardized communication tool, and clinical enhancements. It was believed that these factors would influence the quality and safety in patient care (Krautscheid, 2008).
The second aspect of this article is teamwork that largely requires an integrated spirit among the health care providers. It is an important element in clinical settings as it solely depends on decisions and/ or opinions taken by all together that otherwise plays an influential role in the patient’s life. Makary et al (2006) described in a study that teamwork plays a prominent role in operating rooms where communication errors contribute to wrong site operations. This could be because of discrepancies in perceptions of teamwork. Here, physicians were reported to consider teamwork as ‘good’ in contrast to nurses who perceive them as ‘ordinary’(Makary et al., 2006).
In order to overcome this flaw, a scientifically acceptable method such as Safety Attitudes Questionnaire needs to be implemented to measure teamwork and discover the pitfalls that poorly associate various disciplines (Makary et al., 2006).This could easily strengthen the strategies aimed at improving patient safety. Further, the spirit of teamwork also influences maternity hospitals where a connection between nurses and midwives has a central role to play. This was revealed from a study that gathered data on midwifery practice and relationships in a teaching hospital through thematic analysis that involved an ethnographic framework (Kennedy & Lyndon, 2008).
It was revealed that the potential of teamwork and tensions have become severe when communication was affected, indicating the role of nurses in facilitating an evidence based practice (Kennedy & Lyndon, 2008).Hence, communication and teamwork are important components of healthcare settings. The absence of their interference in a well organized plan could lead to a total collapse of patient safety strategies.
Some of literature cited above could be further elaborated keeping in view of the practical experiences.
In my earlier job at a private nursing college and Hospital, I was assigned the duty of junior nurse soon after my graduation. I was hardly able to communicate with our superiors and this has continued for 3 –months. I used to often hear from my mates in the ward that the hierarchy shown by the authorities has prevented many of the junior nursing staff members to approach and seek information about the cases that need urgent clinical attention. This has ended up with 7 patent deaths. The responses were so inappropriate and late from the authorities that converted thes otherwise neglected case into a normal hospital deaths barely accessible to anyone to suspect. Here, the important element to highlight was that I received good cooperation from my mates that made me to understand the situation in the hospital. However, the outcome of this cooperation might have worked well and saved patient lives when there is a fair communication from the superiors. This problem could be better solved by frequent medical workshops on communication patterns and patient safety by medical professionals. This could better educate the hospital staff members at all levels and would reduce all kinds of hierarchical differences, interpersonal power and conflict. This experience could suggest that prior unbiased or unhierarchial communication should originate from the nurse staff members. This strategy could mentally prepare them to face all kinds of challenges and uncertainties.
Here, the important element to highlight was that I received good cooperation from my mates that made me to understand the situation in the hospital. However, the outcome of this cooperation might have worked better and saved patient lives when there could have been a fair communication from the superiors.
In another instance, I was assigned to provide care in an emergency department having 20 beds. Most of the patients were with severe cardiovascular and respiratory problems. They were in the age range of 65- 75. The situation goes into utter chaos when patients suffocate with frequent blood pressure fluctuations. There was such a communication defect such that nurses need to run for important life saving medications and potential ventilators. This has led to the death of 8 patients. Here, the faulty thing to note was the inefficiency shown while operating the ventilators due to poor communication between the concerned nurses familiar with the equipment and physicians. This problem was also attributed to my frequent involvement in other tasks like data entry and management. This problem could be better circumvented by assigning the job to a dedicated team of nurses and physicians. In order to effectively monitor the emergency departments, a frequent intervention programs on the potential benefits of information exchange and team spirit should be implemented every 10 days. The program should be planned such that
the nursing professionals could review the earlier patient mishaps in collaboration with medical preofesionals.This ensures them to carefully face the challenging situation in the near future.
This instance could indicate that communication and team spirit would work in an integrated manner. This strategy has also worked well in the neuropsychiatry department of the same hospital. Previously, there were incidents of mentally ill patient deaths due to lack of timely nursing intervention. This was reported to be due to a defect in the team spirit in managing the patients.
This in turn was attributed to lack of professional guidance from the concerned authorities in the hospital. However, frequent prevention strategies later by dedicated team of nurses and psychiatrists and have saved the lives of good number of patients.
This could indicate that knowledge gained from other departments could be analyzed and significantly implemented in an evidence based practice manner to strengthen the role of communication and team spirit in the management of patient safety.
- Sutcliffe, K.M., Lewton, E., Rosenthal, M.M. (2004). Communication failures: an insidious contributor to medical mishaps. Acad Med, 79,186-94.
- Woloshyn Owych, M., Davis, R., Brown, R., Vincent, C. (2007). Communication patterns in a UK emergency department. Ann Emerg Med, 50,407-13.
- Krautscheid, L.C. (2008). Improving communication among healthcare providers: preparing student nurses for practice. Int J Nurs Educ Scholarsh 5:Article40. Epub. Web.
- Makary, M.A., Sexton, J.B., Freischlag, J.A., Holzmueller, C.G., Millman, E.A., Rowen, L., Pronovost, P.J. (2006). J Am Coll Surg, 202,746-52.
- Kennedy, H.P & Lyndon, A. (2008). J Obstet Gynecol Neonatal Nurs, 37,426-35.