Developing Team Climate for Patient Safety

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Developing Team Climate for Patient Safety

• Georgina Fletcher
• Safer Practice Dept., NPSA

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Why team working?
research showed clearly that more than 70 of
airline accidents involved some degree of human
error. More surprising was that most of these
errors stemmed from failures in communication,
teamwork and decision making rather than from
technical short comings. The airline industry
was shocked to realise that well-trained and
technically proficient crews could crash
airworthy craft because of failures of human
interaction and communication - areas in which
neither training nor formal evaluation was
required R.L. Helmreich, May 1997,
Scientific American
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Team working in the NHS -

• Team-based working is necessary to achieve goals
  of NHS
• operating theatre teams, obstetric teams,
  resuscitation teams, ward teams
• GP teams
• community mental health teams
• management and administration teams
• Teams may be
• within or between departments and organisations
• uni- or multi-disciplinary
• fixed or ad hoc

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How does effective team workingimprove patient
safety?

• Poor team working can lead to patient safety
  incidents
• Good team working helps teams avoid risks and
  manage adverse events if they occur

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What is a team?

• A team is a group of individuals who work
  together to produce products or deliver services
  for which they are mutually accountable. Team
  members share goals and are mutually held
  accountable for meeting them, they are
  interdependent in their accomplishment, and they
  affect the results through their interactions
  with one another. Because the team is held
  collectively accountable, the work of integrating
  with one another is included among the
  responsibilities of each member.
• Mohrman et al (1995) Designing Team-Based
  Organisations

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Effective team work

• Clear, shared objectives
• with feedback on performance
• Participation
• team member interaction, communication of
  information, influence over decision-making
• Focus on quality
• critical evaluation of performance, constructive
  controversy
• Support for innovation
• social support
• practical support - time, resources, effort,
  cooperation
• Reflexivity
• learning from successes, error, failures, changes

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The Benefits of Team Based Working

• Research findings presented are from the Health
  Care Team Effectiveness Project conducted by
  Professor Michael West and Dr Carol Borrill at
  Aston Business School and work from Aston
  Organisation Development

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Team working and patient mortality
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Team working and staff stress
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Team working and patient experience
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Other research

• Adverse incident reporting is higher in effective
  team, particularly in teams with high level of
  participative safety ands a focus on quality of
  service (Edmondson, 96)
• Organisational learning takes place primarily in
  a team environment and is most effective in team
  environment that is learning goal rather than
  judgement oriended (van Dyck, 2000)

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NHS Staff Survey 2003 2004

• Working in a team predicted higher levels of
  staff injuries and stress
• Working in a well structured team predicted
  lower levels of injuries and illness amongst
  staff and lower levels of errors and near misses
  witnessed by staff in the previous month

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Improving team working in the NHS

• Range of initiatives to support team working
• Team Resource Management
• simulation-based training
• support for poorly performing teams
• But not always accessible or affordable
• Different programme also appropriate for
  different aspects

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Team Climate Assessment Measure Project

• NPSA develops tool to support NHS in improving
  patient safety
• Identified need to develop a tool specifically
  focussed at the team level
• Project set up with Aston Business School/Aston
  Organisation Development to adapt research tools
  into practical product called Team Climate
  Assessment Measure (TCAM)

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Aims of the TCAM Project

• To develop a measure that will predict team
  climate for effective patient safety and adverse
  incident management
• To assess the impact of a team development
  programme on the relevant dimensions of team
  climate

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The Team Climate Assessment Measure
The TCAM measures dimensions of a work group
climate that are associated with effective team
working in general and the specific area of
adverse incident management

• Team stability
• Effective leadership
• Regular contact
• Team efficacy
• Task reflexivity

• Participative trust and safety
• Mutual trust
• Inter-professional credibility
• Individual development
• Team learning behaviour
• Inter-professional learning

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TCAM Team Development Programme

• Modular and self-directed, facilitated by a
  member of the team
• Comprises a collection of exercises, notes and
  case studies for the dimensions of team working
  associated with patient safety
• Is designed to be run over period of about 3
  months

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The Pilot Teams

• 60 80 Teams
• Variety of settings
• Acute Trusts
• PCTs
• Mental Health Trusts
• Ambulance Trusts
• Patient / client contact teams
• Control Group and Team Development Group Teams

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Key Activities

• Administration of the TCAM Questionnaires
• Feedback of TCAM Report to Teams
• 50 of teams will undertake the TCAM Team
  Development Programme
• Administration of the TCAM Questionnaires
• Feedback of TCAM Reports to Teams
• Team Co-ordinator completion of Team Logs

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Development Topics

• Elements of effective Team Working
• Effective Team Meetings
• Clarifying Team Roles
• Effective Communication
• Effective Decision Making
• Team Learning from incident Management

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TCAM pilot study

• Currently piloting TCAM with staff from across
  NHS
• validate questionnaire, provide norm data,
  evaluate effectiveness of guides
• Recruiting up to 80 teams from 4 types of trust
• acute, primary care, mental health, ambulance
• Following study will develop material into
  package to be released to wider NHS