A medical team can be anything from the perfect team to a group of individuals, with no connection, all going in different directions.

The perfect team trains and plays together they have rehearsed every possible event until they are a well oiled machine. They know each other’s strengths and weaknesses and how to get the best out of each other. They have defined roles which include a strong leader. They communicate well and ego is left at the door. This is a resilient and versatile team with a shared mental model that can effectively deal with any situation. In this team the chance of error due to human factors is extremely low.

The opposite is the team that is not really a team. It is two or more individuals who are doing a task together who do not communicate with each other, they have their own agendas and do not share these with the rest of the team. There are no defined roles and no clear leader. The members do not know the strengths and weaknesses of the other members and they never train together. This team is not versatile or effective and will be prone to errors due to human factors.

Medical teams should aim to be as close to the perfect team as possible. Unfortunately medical teams have the following challenges which pushes the team to the other end of the spectrum:
  1. Teams have limited or no practice together.
  2. Staff rotate often and so people will often have never met the other members of the team.
  3. There is a hierarchy in medicine which can limit effective communication.
  4. There is often knowledge gaps between team members.
  5. There is a culture of never admitting your failings.
  6. We are not taught to practice medicine as a team but as individuals and so the team is an alien concept.
  7. If we do practice it is within our profession and specialty and so doctors and nurses do not practice being a team.
  8. The team often is created in a staggered way, people arrive halfway through.
  9. We rarely brief prior to the task or debrief after the task.
  10. We rarely share our mental model
How can we get to the perfect team?
We need to create a team ethos, it needs to be important to everyone as their needs to be a critical mass of engagement. This can be done by courses and simulation. Simulations can be more effective involving all members of the team not just one specialty. 

The knowledge gaps can be address by training and an openness for everyone to teach. Social media can be helpful in teaching large groups in an interesting way. 

We need to realise there is a problem before we can work towards a solution, medics need to realise that mistakes are common and are not something to hide but an opportunity to learn, this again is a culture and ethos. 

The team approach needs to start at medical school and requires specific training, communication skills is often taught with patients but it could be taught with colleagues. 

New Zealand don’t just play test matches everyday. They train as a team and plan their actions together in the case of failure. 

We cannot naturally expect to be a team.
The lack of practice as one team, staggered arrival and changing staff means that everyone who turns up at any point needs to fit right in. This can only be achieved by having team protocols and system. It is naive to think teams just fit into place. 

Team members cannot be maverick, he works alone. 

The organisation needs to be in the habit of working as a team. The key habit in this is open lines of communication. This communication should establish the team leader and any changes if a new leader arrives. 

We should be comfortable with the concept of a “leader” We need to be reading from the same “check list” Talking through what the failure plan is authorises the team to act correctly.

The team leader is a role not an authority. The difficulty is that this naturally falls to the senior however this also naturally reduces people’s ability to be seen to challenge what is going on.

We must train cross specialty to learn team working. Anaesthetists should train with ODPs surgeons with scrub nurses.

The pre patient arrival is crucial time and should not be wasted.

The late arriver makes things difficult but if all involved already know their roles the new arriver can be quickly integrated into the team.<

There needs to be an introduction for every late arriver so they are reading from the same checklist.

A role card is a simple solution to this and gives each person an expected role and empowers them in their part. This is also true for a uniform which should blur the hierarchical barrier of communication.

 A perfect team is a goal to aim for, we know that better teams mean fewer errors and more effective and safer patient care. They also provide support and better job satisfaction. Aim for the perfect team in your hospital.

Steve Young