“Coming together is a beginning. Keeping together is progress. Working together is success.” –Henry Ford,
“Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved.” —Mattie Stepanek
“Teamwork makes the dream work” –John Maxwell
We’ve all heard of the importance of teamwork in any and all environments – whether it is at home, or school/college or business organization. Teamwork is key!
When a person has a cardiac arrest, they need CPR (Cardiopulmonary Resuscitation) and the American Heart Association has guidelines for providing effective CPR – whether it is Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS). One of those guidelines is effective team dynamics – and they emphasize on effective communication. So when there is a code because a person is in need of resuscitation, they recommend that the following things be in place for the code to be most successful. And I believe that we can learn from them and apply these same principles in our organizations and other places of business. So we will go through these one at a time and I would like you to think about instances where you may have seen these play out (in your workplace or other), and how you can apply these to your place of work or school or home environment.
Close Loop Communication
When working together as a team to serve your customers (be they orphans & donors, or customers at a department store), it is equally as important to know how to communicate, as it is to know what to do. In order to be successful and have good results, the team must communicate effectively. In BLS CPR or ACLS, the team leader (TL) gives an order to a team member such as:
TL: “Lindsay I need you to attach the patient to monitor and get us a heart rhythm.”
And Lindsay responds,
“Okay, I am going to attach the patient to the monitor and get us a heart rhythm.”
Lindsay: “I have attached the patient to the monitor and she is in ventricular fibrillation.”
Lindsay responded by restating the message to confirm that she heard and understood it and will be doing what is asked. Once she completed the task, she stated to the group that the task was complete. She closed the loop; so what happens is that the team leader and the rest of the team (including the recorder) know that Lindsay did what he said, and he knows what heart rhythm the patient is in. This is the same at hospitals; when a doctor or another practitioner (nurse practitioner or physician assistant) gives orders to a nurse over the phone, the nurse is responsible for writing it down as it is received and then he or she needs to read it back to the doctor to ensure that the orders were correctly received. This is a requirement to prevent errors. When the nurse enters the order into the computer, she needs to select the option “Telephone Order Read Back” to indicate what method the order was received and to show that she read it back.
It is important that the person assigning a task or communicating (in the case of CPR, the team leader giving an order) do so in a clear and concise manner. The message should be distinct and calm, not rushed. E.g. “Marc, I need you to administer 1mg of Epinephrine by IV push now.” He can’t just say, “Marc give Epinephrine 1mg” without saying how it should be administered. So how can we as team leaders or members communicate more clearly with the rest of our team?
Clear Roles and Responsibilities
In a code, the AHA teaches that the team leader should define and delegate tasks appropriate to each team member’s level of competence and confidence. This is vital to having the task done safely and correctively. At a hospital where I worked, at the beginning of each shift, the charge nurse would assign roles for the code team in case of a code; a person to do CPR, a person to be the runner, a person to grab the crash cart & running the cart, etc. And they knew to assign those roles based on competencies e.g. a runner should be someone who works on that floor and knows where to find supplies quickly and has access to all the rooms where the supplies are found. In a code situation, it is appropriate for the team leader to ask an RN to administer an IV medication as needed, and to assign the Certified Nursing Assistant (CNA) to do chest compressions. The CNA is trained and competent to do chest compressions and give breaths, but they are not trained to give IV medications or to interpret a heart rhythm. Now in an organization, this is also applicable. However, there are many times where the leader or supervisor may and should assign tasks or projects to a team member who does not have experience in an area but then provides them with the resources and training necessary to complete the task or project. For example, you may want your secretary to create a PowerPoint presentation for you, however, he or she may not be very familiar with PowerPoint. So you could provide him or her with tutorials on how to create PowerPoint or Keynote presentations, and then tell her to complete the task.
Know Your Limitations and ask for Assistance Early
In a code situation for example, if you were asked to start an IV and you try once or even twice and unsuccessful in establishing the IV access, it is important and vital to the patient’s recovery that you stop and ask for help, instead of delaying out of embarrassment or stubbornness. The AHA recommends this as an important part of teamwork in CPR. Team members including the team leader should ask for assistance or advice early before the situation gets out of hand. This will apply in any team environment. It is vital to know one’s limitations and then ask for assistance when needed.
The AHA teaches that – “team leaders should ask for ideas for a differential diagnosis…” as well as frequently seek observations from team members for possible oversight. As part of the ACLS process, the team must try to come what with a differential diagnosis; it is the process of differentiating between two or more conditions that share similar signs or symptoms. Getting contributions from everyone in the team gives you the best chance of coming up with what the real problem is, so you can treat the cause of the problem and so help the patient. Same thing applies for any other team; the Proverbs say, “Where there is no guidance the people fall, but in the abundance of counselors there is victory” and also “Without consultation, plans are frustrated, but with many counselors they succeed.” We can all learn from someone else’s knowledge and experiences.
In healthcare, errors can be deadly. Therefore, it is important, especially in a code situation, that if you see someone about to make an error or if you notice that the team leader gave an incorrect order or gave and order at the wrong time, then you say something. However, the delivery of this message is equally as important. The AHA says we must be tactful and professional at all times, especially when correcting a colleague you think is about to make a mistake. Again, you can take this and apply it in all settings; we must be professional and gracious when providing constructive feedback.
Summarizing & Re-evaluation
At the end of the code (or soon after), when all the information is still fresh in mind, the AHA recommends that we step back and evaluate the process so the team members can learn. Similarly, at the end of every project, it is vital to look back and see what you did well and what you didn’t do well and can improve on.