#204 Cultivating Excellence in Anesthesia Teams: Trust, Communication, and Patient Safety
May 28, 2024
Anesthesia Patient Safety Foundation
Discover the essential elements of a high-functioning anesthesia care team with our special guest Matthew Sherrer from the University of Alabama at Birmingham. In an episode that could redefine your understanding of teamwork in healthcare, we delve into the phenomenon of 'trust fractures' and their profound impact on patient safety. The authors offer rich insights from his experience, drawing striking parallels between aviation disasters like Korean Air Flight 801 and the critical importance of communication within medical teams. Prepare to be enlightened as we explore the sobering reality of communication failures in healthcare, and learn about innovative initiatives like UAB's Anesthesia Care Team Optimization Committee aimed at mending trust and bolstering team dynamics for the safety of our patients and wellbeing of healthcare professionals.
In the high-stakes world of anesthesia, the need for a culture that embodies mutual respect, curiosity, and empathy stands paramount. The University of Alabama at Birmingham's Anesthesia Care Team Optimization Committee has been at the forefront, pioneering a collaborative ethos that is transforming perioperative communication. In our conversation, we celebrate the team's triumphs—from implementing novel communication tools and educational sessions to fostering interprofessional cooperation via shared journal clubs. Witness the positive ripples of a collective intelligence model where cohesive teams not only enhance patient outcomes but also enrich healthcare professionals' lives with reduced stress and improved job satisfaction. Let this episode be your guide to cultivating excellence in patient safety and team performance in your healthcare environment.
Discover the essential elements of a high-functioning anesthesia care team with our special guest Matthew Sherrer from the University of Alabama at Birmingham. In an episode that could redefine your understanding of teamwork in healthcare, we delve into the phenomenon of 'trust fractures' and their profound impact on patient safety. The authors offer rich insights from his experience, drawing striking parallels between aviation disasters like Korean Air Flight 801 and the critical importance of communication within medical teams. Prepare to be enlightened as we explore the sobering reality of communication failures in healthcare, and learn about innovative initiatives like UAB's Anesthesia Care Team Optimization Committee aimed at mending trust and bolstering team dynamics for the safety of our patients and wellbeing of healthcare professionals.
In the high-stakes world of anesthesia, the need for a culture that embodies mutual respect, curiosity, and empathy stands paramount. The University of Alabama at Birmingham's Anesthesia Care Team Optimization Committee has been at the forefront, pioneering a collaborative ethos that is transforming perioperative communication. In our conversation, we celebrate the team's triumphs—from implementing novel communication tools and educational sessions to fostering interprofessional cooperation via shared journal clubs. Witness the positive ripples of a collective intelligence model where cohesive teams not only enhance patient outcomes but also enrich healthcare professionals' lives with reduced stress and improved job satisfaction. Let this episode be your guide to cultivating excellence in patient safety and team performance in your healthcare environment.
You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.
Speaker 2:
Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. It is almost time for the June 2024 APSF Newsletter, but don't worry, there is still time to cover more articles from the February 2024 APSF Newsletter and you do not want to miss this discussion on collectively intelligent teams. Before we dive into the episode today, we'd like to recognize Brazinius Cobby, a major corporate supporter of APSF. Brazinius Cobby has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, brazinius Cobby. We wouldn't be able to do all that we do without you.
Speaker 2:
Our featured article today is from the February 2024 APSF newsletter. It is Collectively Intelligent Anesthesia Care Teams by Matthew Scherer, melissa Ramsey and Kesha Thurston. To follow along with us, head over to APSForg and click on the newsletter heading. The first one down is the current issue. Then scroll down until you get to our featured article today. I will include a link in the show notes as well. Before we get into the article, we are going to hear from one of the authors, matthew Scherer. You may have heard him on our podcast a couple of weeks ago when we did the APSF Fresh Flow podcast takeover. I will let him introduce himself now and tell us why he wrote this article.
Speaker 3:
Hi, my name is Matt Scherer and I'm an anesthesiologist at UAB, the University of Alabama at Birmingham. This article is five years in the making. It's about that long ago that our care teams experienced what we still to this day refer to as our trust fracture, where we saw professional politics spill over into our workspace and really divide our team. While some of the underlying tensions have been percolating under the surface for many years, they finally boiled over, drastically and negatively impacting the relationship between our anesthesiologists and our anesthetists. The relationship was suddenly so ice cold that it was pretty plain to see that it was a threat not only to our frontline clinicians but to our patients, and our institution, to its credit, responded quickly with support and resources. We retained the services of a skilled facilitator or mediator who expertly guided us through a path to recovery, which we now call ACT-TALK or the Anesthesia Care Team Optimization Committee. This article represents knowledge gained along the way on our journey.
Speaker 2:
What a great way to kick off the show today with that important background information. Way to kick off the show today with that important background information. We are excited to learn more about optimization of anesthesia care teams, with ideas that you may be able to implement at your institution. Let's get into the article now. The authors open with the tragic story from August 6, 1997, and the Korean Air Flight 801 crash. At first, guam Fire Department dispatchers received calls about a fire on the hillside. Despite the rescue effort, 228 passengers and crew lost their lives. Since then, this flight and crash have been studied, which revealed contributing factors including fatigue, inadequate crew training and failing monitors and warning systems.
Speaker 2:
The communication of the flight crew is particularly difficult to understand. According to news reporter Bernadette Stern, at a public hearing after the crash, the co-pilot attempted to alert the pilot that he was flying too low. In response, the pilot was getting upset because he didn't believe that the co-pilot should question his authority, and then the plane crashed. Further investigation showed that the co-pilot recognized the dire situation and verbalized this with repeated comments about the rainy weather and the plane's warning systems. He did not speak up definitively, though, and give the command let's make a missed approach until it was too late, six seconds before impact and six seconds before his death. By that time it was too late, with the captain reacting too slowly to pull the plane up to safety. We will never know why the co-pilot did not speak up sooner, but it is likely due to a long-standing culture of deference to authority and elders. Investigators believe that if the co-pilot had taken control of the plane when he did finally speak up, there would have been enough time to clear the hillside and save lives. In addition, if the pilot and co-pilot have worked together as a collectively intelligent team, the crash may have been completely avoided. Have you ever had the experience of working on a team and failing to speak up or speaking up too late? What was the outcome? Let's keep going with the article to learn more about collectively intelligent teams and how these are created and maintained.
Speaker 2:
This kind of teamwork is vital to keep patients safe during anesthesia care. Intelligent teamwork is necessary for patient safety and can be beneficial for healthcare professionals as well. Communication is an area where we can make some improvements. Did you know that, according to the Joint Commission, 80% of serious medical errors are due to failures in communication? Failures in communication. In addition, teamwork, communication and human factors are the top three causes of sentinel events. A 2016 study by Macri and Daniel reported that medical error is the third leading cause of death in the United States, with cancer and heart disease taking the top two spots. Since that time, medical errors have not been eliminated, which means that there is still work to do.
Speaker 2:
The benefits of improved teamwork and communication include improved patient outcomes and improved mental health for healthcare professionals. We have known this to be true for a long time. There is a 1993 study by Hayworth and colleagues predictors of work satisfaction among senior house officers during accident and emergency medicine training that looked at work-related stress and other work environment characteristics on stress levels and work satisfaction. The results showed that senior medical officers who felt that they were in a cohesive team at work had lower stress levels and were more satisfied with their jobs than those with less cohesive teams. Another study revealed that the most effective intervention to improve workplace morale and productivity, as well as mental and physical health of employees, is team building. There is an opportunity for intentionally educating and training on teamwork in the perioperative environment to improve anesthesia patient safety, as well as the mental and physical health of anesthesia professionals. The authors highlight the significant challenges that anesthesia professionals face at this time of ongoing provider shortages, an increased workload for anesthesia professionals, with role ambiguity, stereotyping and microaggressions constantly threatening patient safety and wellness. It may be hard to focus on learning about teamwork and building stronger teams when you have not had a lunch break and are working longer hours, but this is really important, since effective clinical care teams bring together more knowledge for problem solving and safely, effectively and efficiently completing tasks than individuals alone. There is a call to action for anesthesia professionals to speak up and bring this relevant information to the table, because this is a very real threat to patient safety and our well-being.
Speaker 2:
Next up, let's talk about human performance in small groups. In the United States, many anesthetics are delivered in some form of an anesthesia care team model. There are other examples of small groups that work together to provide anesthesia care, such as with anesthesia trainees or with anesthetists and anesthetic technicians in some parts of the world. What does the literature tell us about team performance in small groups? Let's find out. We'll start with collective intelligence in the landmark 2010 study by Anita Woolley on collective intelligence in small group performance. The study evaluated groups of two to five members and applied the methods used in foundational psychological studies on general intelligence, to groups rather than individuals. The collective intelligence of the group was determined by the group rather than the individuals in it. So it is not just that smart teams are made up of smart people or average teams are made up of average people. Instead, woolley and her colleagues determined three primary factors that contributed to collective intelligence Number one, the average social sensitivity of team members. Number two, the number of females in the group, which was likely directly correlated with social sensitivity. And number three, a negative correlation with variance in speaking turns. Effective teams are made up of socially sensitive team members who equally distribute participation in conversation and value the input from all team members, rather than rely on a hierarchical communication structure. That sounds like a team that we would all like to be a part of.
Speaker 2:
Another important concept is teaming, which was coined by Amy Edmondson. This refers to teamwork in dynamic environments, when you must work with a changing mix of collaborators on a range of projects in fast-paced environments where the time between problem identification and solution application is rapidly shrinking. Many anesthesia professionals may recognize teaming as what they do every day Work with different team members while providing a variety of anesthetic techniques to an increasingly complex and aging patient population. Teaming requires working quickly to identify what collaborators know and can bring to the table in order to complete tasks with no known solution. A teaming culture must include curiosity, so that we can figure out what each team member contributes, and empathy, which allows us to see another's perspective, to allow for effective collaboration under time pressure. Once again, we see that sharing the conversation, valuing everyone's input and being socially sensitive are keys to effective small group performance.
Speaker 2:
It's time for another concept mutual learning model. This was highlighted by Roger Schwartz as a critical component for helping teams develop trust to be able to work through difficult challenges. Mutual learning requires compassion and curiosity. Be more familiar with the unilateral control model, where one person dominates the conversation as a superior, with the assumption that only that one person understands the problem and everyone else does not. The mutual learning model celebrates that differences are opportunities for learning. Everyone on the team may see things that others do not. Everyone on the team may see things that others do not, through the processes of sharing all relevant information, asking genuine questions, stating interests rather than positions, and working together to develop the next steps. This is how trust increases, conflict and defensiveness decreases and solutions are found quickly with satisfied team members.
Speaker 2:
Let's talk about what the Anesthesia Care Team Optimization Committee at the University of Alabama-Birmingham has done to build anesthesia care teams that incorporate collective intelligence, teaming and the mutual learning model. From the very beginning, this was a top priority for the department and the original committee members included the department chair, executive vice chair, division directors, hospital nursing leaders, crna managers and C-suite executives. Other committee members included frontline anesthesiologists and nurse anesthetists who exemplified the characteristics of civility, inquiry, openness and ability to visualize a world where both groups succeeded. The first step was being guided by a consulting psychologist facilitator and using the mutual learning model for the foundation. The UAB Medicine Certified Registered Nurse Anesthetist and the UAB Anesthesiologists worked together to overcome tensions in the operating room and improve the performance of team members, with everyone committed to delivering world-class anesthesia care. The common ground goal was safe and excellent anesthesia care, with all stakeholders acknowledging that workplace tension had a negative impact on patient care, wellness and job satisfaction. The committee also recognized that each team member offered a unique perspective and skill set for the team to create synergy in patient care.
Speaker 2:
The work of the committee started by airing grievances and identifying common goals. The next step was to create a shared vision and mission statement. From this foundation, the team was able to establish clinical teamwork, education and scholarship task forces with 7 to 10 frontline anesthesiologists and CRNAs. The task forces continue to work hard with the following accomplishments New perioperative communication tools, publications on overcoming anesthesia, interprofessional conflicts, lunch and learn education sessions on clinical topics, shared journal clubs and social events. The committee leaders' work continues as well with the following responsibilities Presentations at continuous quality improvement meetings with updates on initiatives invited outside.
Speaker 2:
Expert presentations on teamwork leadership, conflict management, well-being in burnout and organizational behavior. It appears that this hard work is paying off, with the culture in the operating room shifting to be warmer, with more rewarding interactions. Survey comments speak to this with the following remarks Peace in coming to work, mutual appreciation, stronger Improvement in collaboration. The UAB Anesthesia Care Team Optimization Committee has succeeded in creating a safe space for team members to speak up about opportunities, challenges and successes. The committee leaders continue to solicit feedback from team members to determine areas of success and growth opportunities. The work of the committee has not gone unnoticed in the organization, with requests for consultation from perioperative nursing leadership as well as obstetric, perinatal and emergency medicine colleagues who are confronted with teamwork challenges. The next big projects for the committee are the following IRB-approved studies related to CRNA and anesthesiologist perceptions of the anesthesia care team. Optimization committee experiences. Creation of a formalized curriculum focused on high-performing collaborative teamwork. Expansion of the committee principles to other UAB-associated community hospitals. And further interprofessional engagement with other colleagues, specialties and departments within the institution.
Speaker 2:
We made it to the end of the article. The authors leave us with the reminder that advances in evidence, knowledge, technology and techniques have led to improved anesthesia patient safety. There continue to be threats to safe anesthesia care from external circumstances such as poor teamwork and communication that put pressure on anesthesia professionals and compromise their skill and knowledge. Going forward, anesthesia departments, perioperative teams and healthcare institutions need to prioritize civility in the workplace and collectively intelligent teamwork to benefit patients and healthcare professionals. Before we wrap up for today, we are going to hear from Scherer again. I also asked him what he hopes to see going forward. Let's take a listen to what he had to say.
Speaker 3:
Going forward. We hope to see continued intentionality in relationship building. Our teams have come such a long way from five years ago, but we are really just getting started. We now need to scale our efforts to all of our people in all of our clinical locations. We also expect to scale outside of the walls of the perioperative space and into other areas of the hospital. The ACT-OC journey and process is not something that's specific to anesthesia and we believe that it has real relevance across the institution and beyond. Finally, we hope to bring our frontline teams together for intentional teamwork and leadership training boot camps in partnership with the UAB Leadership Development Office, so that those teams can create what my friends and co-authors, Keisha Thurston and Melissa Ramsey, referred to in the article as an environment where all of our team members can voice opportunities, challenges and successes in a safe place.
Speaker 2:
Thank you so much to Cher for contributing to the show today. We will look forward to hearing about the continued work at your institution with intentional teamwork and leadership training boot camps, and we hope that other anesthesia departments and perioperative teams and healthcare institutions continue to work on creating a safe place for all team members. Do you work on a collectively intelligent team? Let us know by tagging us at APSForg on X using the hashtag hashtag APSFpodcast. We would love to hear from you. If you have any questions or comments from today's show, please email us at podcast at apsforg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apsforg for detailed information and check out the show notes for links to all the topics we discussed today.
Speaker 2:
Have you seen the original APSF Prevention and Management of Operating Room Fires video, which was released in February 2010? Well, the APSF has an exciting announcement we have an all-new video and resource page dedicated to Surgical Fires, a Preventable Problem. The new video is an exciting tool for helping to keep patients safe. It is called Preventing Surgical Fires. It is about five minutes long and filled with information to help prevent this serious event. Plus, it will be available in multiple languages. Other resources include commentaries for the anesthesia professional and the ENT surgeon to put the recommendations in the video into the context of current practice, as well as printable posters and visual aids. You can use the video and supplemental information to lead a fire safety session at your institution. We hope that you will check it out and share it with your colleagues. I will include a link to the page in the show notes as well. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.