Medicine could once be practised in isolation – indeed, young doctors often found themselves working alone – a situation evocatively described by Bulgakov in his ‘Country Doctor’s Notebook.’ Nowadays, it is almost impossible to work in isolation, and team working is the norm. Atul Gawande wrote about the different approaches of Cowboys and Pit Crews in the New Yorker a few years ago, and these are a couple of the texts I regularly refer medical students to as we walk along to consult radiology colleagues, or when I ask physiotherapists for their input into a case.
So, we all tend to work in teams. Some, especially those which form in emergencies – like the crash team, for example, tend to function very well. Some, particularly those which are distributed across organisational boundaries, and throughout the health economy tend to function less well (in the main.)
In an excellent article (online ahead of print) the importance of effective teamwork for the protection of patients is reviewed, and strategies for improving teamworking are drawn out of the literature. I have been thinking about teamworking – especially across the traditional divides of the healthcare economy a lot recently, and this piece really brought home a couple of things I had been thinking about.
The paper covers a lot of ground, and mentions several features of effective teams. Possessing a shared mental model is one of these. In teams where I have experienced very good team-working, I can see now that this has been at play. The acute take team sometimes displays this, the arrest team almost always does. The unifying, common theme, and common training at play when the medical take team tackle a long shift, or the diverse members of an arrest team all work to the same ‘rules’ and ingrained protocols gives an almost physical feeling of common purpose when one is in the thick of it.
In contrast – I have also experienced a very tangible feeling of frustration, disbelief and pure exasperation when I have had conversations with members of the wider healthcare team, when it is clear that those I am working with are coming at a problem from a very different perspective, with entirely different priorities and beliefs about what the outcome should be.
As we see the medical profession move towards an era of ever closer working across the healthcare economy, and as patients start to play an ever more prominent part in the decision making about their disease management, we as healthcare professionals will need to be open to others mental models. One way to increase such awareness is through training together with members of other disciplines.
To realise this ambition, we need to change undergraduate and postgraduate training:
We still train the doctors of tomorrow to work in the hospitals of yesterday.
If teams working across the traditional boundaries of acute / specialist / general / primary / secondary are to be effective – we need to take this evidence to heart and start developing programmes where professionals work together to build respect, understanding and empathy for each other. The resulting communities of practice will enhance not only the lives of those working in the teams, but will very likely enhance the safety of those they serve.