Friday, May 06, 2016

Teamwork Grows Up.

True teams work together and share what they know and what they learn to achieve safety.
by Lorri Zipperer, MA

"Teamwork -- Teamwork -- that’s what counts!”

I was a cheerleader in junior high school. While it was fun at the time, that was enough of that.

Uninspired to take the same path in high school, I participated in both live theater and a variety of musical group activities (pep band, marching band, jazz band, symphonic band) that provided me with the chance to work with others toward shared goals. I thought I understood what teamwork was – until I grew up.

My first introduction to teamwork as a component of safety was as a staff member at the National Patient Safety Foundation. It was then that I was presented with the idea that teamwork was much more complicated than staying in line during marching practice. Granted, to be in a marching squad you had to commit to knowing your role, pay attention to what others were doing, achieve some level of reliable proficiency, give up your personal preferences as warranted for the greater good (is standing on a wind-swept football field in January in Chicago what any teenager wants to do?) and be aware that if you failed, the group could do poorly.

But, despite some similarities, teams and their role in safety go beyond that. In the safety sense of the word, teams rely on communication, mindfulness, and culture to enable their processes to be as highly reliable as possible during times of crisis. The focus on the flattening of hierarchy to encourage and support performance that is sensitive to, while capitalizing on, the humanness of people working together contributes to the reliability of collective action that expands beyond band practice in the 1970s. Trust and understanding create an environment that facilitates individual, group, and organizational learning from failures through a team’s commitment to feedback and open discussion.

It is no news to readers of this blog that team training models have been adopted from other high-risk industries to help health care evolve in the right direction. Commercial aviation and the military are the obvious examples. Given health care’s experiences with crew resource management and the Agency for Healthcare Research and Quality’s TeamSTEPPS initiative, the idea of building teamwork skills and the expectation that clinicians develop professional competencies in this area serves the logical foundation to infusing team practice and improvement into the frontline of care delivery. People are taught to do this well because poor teamwork can be catastrophic.

Explicit attention to the team roles of health care executives came later. And patient safety leaders—as they have done in other instances—looked outside health care for successful models. The business world certainly has had C-suite members that walk-the-talk of teamness. With credibility and integrity, those who model team behaviors and enable a culture at their company that support teamness provide examples to emulate its value. They demonstrate for health care executives the importance of purposely training and engaging a wide range of staff as team members.

Business schools and executive books champion teamwork skills as a foundational competency. The language and ideas of how to recognize and practice those skills from the business literature always resonated with me, a non-clinician. From that field, one author of particular interest is Harvard Professor Amy Edmondson. Edmondson’s writings caught my eye early on in my safety career. Her discussions about how organizational, unit, and peer culture and leadership affect staff willingness to report errors was inspiring to see—at a time when the value of that approach wasn’t as universally accepted as it is now (Edmondson 1996).

I distinctly remember working hard to get copies of her early articles (read pre-World Wide Web as we know it today). I still have the hard copies of those reports. Once a librarian, always a librarian.

Professor Edmondson’s publishing output since then covers a range of topics that touch on patient safety. Her articles on organizational and individual learning from failure are core resources in my readings list (Edmondson 2008, 2011). They provide foundation to my belief that knowledge management is a key driver of that learning. Edmondson’s 2012 Teaming is an excellent resource for considering how a culture of sharing what is known amongst people working closely together on a collective goal—no matter what box on the organizational chart represents them—is imperative to both team success and continuous learning (Edmondson 2012). She emphasizes that process, commitment, and leadership—both informal and at the executive level—must be present to translate learning into sustainable change in iterative constant fashion.

The sustained commitment to a culture of teams and teaming at variety of levels across a health care system can make that happen. True teams work together and share what they know and what they learn to achieve safety. Training and facilitating all health care workers—outside of rank and role—to participate in the cross-functional activity of teaming is vital to safety achievement. It offers health care yet another opportunity for synergy that presents clinicians, the organizations they work for and the patients they care for—with a chance to really make teamwork count.

Reused with permission. 
This content was originally written for and
 published by the National Patient Safety Foundation’s P.S. Blog.

At the 2016  NPSF Patient Safety Congress, the Lucian Leape Institute will present a Keynote Session, Teaming at the Heart of SafetyThe presentation and panel discussion between Robert Wachter MD, Gary Kaplan MD and Susan Edgman-Levitan will be will be led by Prof. Amy Edmondson.


Edmondson AC. 1996. Learning from mistakes is easier said than done: group and organizational influences on the detection and correction of human error. J Appl Behav Sci. 32:5-28.

Edmondson AC. 2008. The competitive imperative of learning. Harv Bus Rev. 86:60-67, 160.

Edmondson AC. 2011. Strategies of learning from failure. Harv Bus Rev. 89(4):48-55, 137.

Edmondson AC, Schein EH. 2012. Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. San Franscisco, CA: Jossey-Bass.

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