COMMUNICATION TEAM WORKING
challenge & RISK
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O practice system can be 100 per cent risk-free – be it one for following-up test results or for triaging patients.
Even the most carefully designed systems can have ‘holes’ in them. Most people familiar with concepts of risk will
have come across the Swiss cheese model, first proposed by James Reason of the University of Manchester. Holes or gaps in a system can create windows of opportunity for errors to occur. In practice they are often picked up as near misses or recurring low-level failures. But when the holes align within a particular system and under particular circumstances there is the potential for catastrophic harm to occur. To promote safe practice it is important to
have mechanisms in place to control known risks and these must also extend to “softer” areas of practice such as team communication and interaction. Risks here might include difficulties around access to an appropriate clinician where multidisciplinary interactions are necessary (for example a receptionist facilitating access to the right clinician at the right time) or communication between healthcare professionals. This is particularly relevant where there is shared care and treatment by multiple clinicians over time. Actions to mitigate such risks include
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building trust, facilitating challenge and ensuring that there is a level of comfort within the team’s interactions.
TRUST AND CHALLENGE A strong factor influencing the way individu- als communicate and work together is the level of trust present. Trust impacts on the willingness of individuals to challenge each other during team interactions. Healthy conflict and interpersonal challenge amongst individuals and groups is dependent on the level of trust they share and this can have real impact on day-to-day interactions and out- comes and, significantly, can create potential for increased risk. Effective team interaction is essential in supporting risk reduction in systems of working, particularly where failures in service delivery are discussed, new processes are agreed and where the risks within clinical systems are reviewed. Problems can arise when key issues are not explored fully and honestly. The connection between trust and risk – in particular how it can lead to poor team outcomes – has been widely demonstrated in other sectors. In his 2005 work on team func- tioning, management consultant and author
Patrick Lencioni outlined five dysfunctions in teams which prevent them from achiev- ing their goals. The main goal in the case of healthcare is to deliver a service through systems and working practices that support patient safety.
WHAT MAKES A FUNCTIONAL TEAM? Absence of trust and fear of conflict are the first two of Lencioni’s dysfunctions which, if unresolved, lead to poorer team working and outcomes. Lencioni argues that the founda- tion for a functional team is the ability to “trust each other on a fundamental, emotion- al level”. Team members must be comfortable exposing their weaknesses, mistakes, fears and behaviours to each other and to get to a point at which they can be completely open with one another without filters. Lencioni believes this is essential because
teams who trust each other are much more able to engage in healthy conflict, i.e. disa- greeing with, challenging and questioning one another. These teams will achieve a better resolution to problems and more effective, safer and robust systems of working. Where healthy conflict is present, the added benefit is that individuals are often more committed to decisions and feel (and
AUTUMN 2014 ISSUE 11
Most of us don’t like conflict but can a team function effectively without it? Not likely – but you must also have trust. MDDUS risk adviser Cherryl Adams explores why
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