BP's Rehab Blog

One of the appeals of hospital work is the high degree of complex teamwork that is involved compared to other venues of care. Teamwork doesn't "just happen."

Similarly, one of the biggest challenges in healthcare is to balance highly skilled individuals' needs for autonomy while at the same time fostering teamwork and reducing barriers between people, departments and divisions. You might ask, “why is that important?” And the simple answer is that healthcare systems are not a collection of independent contractors each pursuing independent goals. The outcomes of most encounters between customers and hospitals is dependent upon the collective efforts of, and communication between, those who provide services directly or indirectly in support of patient care.

Mostly when we think of teamwork we think in terms of our worksite or department: How well do we get along, how well do we communicate, and so on? And we certainly do need that sort of teamwork in each of our work areas, but true teamwork does go well beyond department or professional boundaries.

Recently I attended the annual seminar that is sponsored by the Asante Laboratory Services. The topics were in many cases “generic” in the sense that they applied to multiple areas of the hospital. I looked at this program as a way to see some of the issues that I deal with from a slightly different perspective. [Side note: I recall a training put on several years ago by a world-famous photographer. His definition of “creativity” was to look at the subject from a different angle.]

One of the topics at the Lab seminar was process improvement. I don’t know about you, but I tend to imagine laboratories as pretty clear-cut regarding accuracy: Get the right sample, label it correctly, make sure the instrument is calibrated, don’t lose the sample, then run the sample and get the report accurately reported. However, here is one of the examples of process error that was discussed: The order was to measure a particular drug’s blood level to allow the physician to titrate dosage. Like all drugs, this one has a rate of clearance from the blood, so the timing of the draw in relation to the timing of the medication administration turns out to be critical. Thus, if the nurse administers the medication 45 minutes late in order for (as an example) a PT treatment to be on time, it can totally invalidate the lab results. The blood is drawn at the planned time, and the drug level that is measured is exactly accurate, but in terms of the goal of the test, the results are totally invalid because the blood levels do not represent the intended window in time in relation to administration.. While all the players in the blood-draw drama do exactly the right things within their scope, they had little understanding of the roles of the other team members nor the error that might be introduced into the process.

Teamwork. It’s not just about getting along. It’s about collectively making the efforts of each team member create a greater benefit for the customers.

At RVMC, those of us in the patient care departments tend to forget about who stands behind us in the other departments. I had the opportunity recently to tour some of the behind-the-scenes areas serviced by Facilities; it was quite an eye-opener for me. As the engineer said, “Everyone expects everything to work, all the time, perfectly. But they have no concept of what it takes to make that happen.” As I toured the electrical rooms, some of the data closets, the computerized elevator controls and tube systems, the boilers and so forth, it gave me a new appreciation for those folks who keep the rest of us up and running. I cannot adequately do justice trying to describe the meticulous way those systems are maintained nor the complexity of what happens behind those doors that those of us in patient care departments seldom get to go through.

So when you think of teamwork, please think beyond our little space in the universe, and consider all the people, equipment and systems that keep us functioning. And consider how your actions affect all the other complex activities and priorities in our organization. And, finally, please thank all of those people supporting us who are truly part of our team.