My career in healthcare started as a neonatal nurse back in the late 90s. At that time, most Neonatal Intensive Care Units (NICUs), were designed in an open “bullpen” style. These multi-patient wards had few, if any walls, though curtains could be pulled between the individual bedsides for privacy (but not quiet) when needed.
While that arrangement certainly was not ideal for a variety of reasons, the one big benefit to clinicians was the general ease of communication. If I needed assistance, all I had to do was call over my shoulder. If someone needed me, I was just a shout and a few steps away. We almost always knew where the physicians and the rest of our care team members were—we could see them across the room—so for the most part, we avoided the communication breakdowns that are so prevalent today. And perhaps most importantly, we never felt alone.
When the transition to single-room NICUs began, the experience was jarring. The nearly-instant flow of communication that we were used to, and that we relied on, was eliminated. Of course, the benefits for the babies we loved and cared for, and for their families, were significant. However, we had to completely reimagine our approach to teamwork and restructure our communication patterns to account for the loss of direct, rapid contact whenever we needed it, for issues both minor and critical.
Modern healthcare is delivered by teams rather than individuals, and requires collaboration among professionals from multiple disciplines. Communication methods that may have been effective 10, 20 years ago in less complex and less distributed environments like that bullpen-style NICU are no longer sufficient. Failures in communication lead directly to “compromised patient care; staff distress, tension, and inefficiency; make substantial contribution to medical error; and are a contributory factor in 61 percent of sentinel events.”
We must do better because our patients depend on our ability to collaborate. Using the “Big Five” model of teamwork(definitions from Salas, et al included below each item in italics), let’s explore how a clinical communication platformsupports real-time collaboration among modern care teams:
The Big Five Teamwork Model in Healthcare
1. Team leadership
The ability to direct and coordinate the activities of other team members, assign tasks, and plan and organize.
Clinical communication starts at the top: It’s the responsibility of hospital and health system leadership at the institution level and clinical leaders at the team level to foster a culture of communication among care teams. As we detailed last year in “Preventing Patient Harm Through Better Communications,” this means taking an enterprise approach to the technology that supports excellent communication. That requires avoiding the approach of piecing together a communication strategy with point solutions, and instead, investing in a clinical communication platform that supports real-time collaboration among all members of the care team.
2. Team orientation
The propensity to take others’ behavior into account during group interaction, and the belief in the team over individual.
This teamwork behavior is supported by taking multiple inputs into account, increased task involvement, and information sharing. One of the most common clinical workflows is seeking information from outside sources. For example, a consult request: In the past, this may have involved manually looking up the specialist you wish to connect with, asking the operator to connect you, and playing phone tag when the specialist didn’t answer the first time. With the right clinical communication technology, a physician enters the order consult via CPOE. The consult request is automatically sent to the correct consultant, along with an accept or decline button. Upon acceptance, they can connect to each other via voice call or text, and the acknowledgement and full audit trail is sent to the EHR. Providing the best patient care isn’t individual, “cowboy” effort. It requires “pit crews” that rely on one another to share knowledge.
3. Backup behavior
The ability to anticipate the needs of other team members, and the ability to shift workload during periods of high intensity.
When clinician burnout is at an all-time high, it’s critical to ease their extraneous cognitive load burden and give them a safety net whenever possible. A clinical communication platform can provide this peace of mind in the form of automated escalations. For example, a nurse is busy changing a wound dressing of a patient when she receives a nurse call request from another patient who is not doing well. She might feel some mental anguish over whether she should complete the task at hand, or pause and check on the other patient quickly—what if they’ve fallen, or are in pain? A clinical communication platform alleviates that friction by shifting the workload via an automated escalation. If that nurse doesn’t respond to the nurse call in x minutes, then the alert is automatically delivered to the charge nurse or another designated caregiver. Similarly, the platform can also automatically direct patient needs that do not require the attention of a nurse or a physician to another role: a loose lead or low battery alert may go to a biomed technician, and a request for a glass of water to a patient care assistant. This can minimize interruptions and additional workload, helping nurses focus on what they do best and practice at the top of their licenses.
4. Mutual performance monitoring
The ability to develop common understandings of the team environment, and accurately monitor teammate performance.
How do you measure communication in the healthcare setting? First and foremost, you ensure that everyone not only knows how to communicate with the hospital-issued or personal devices (BYOD), but also knows what’s expected of them for communication. It’s important to determine whether a read receipt suffices as acknowledgement, or do you require a reply or some other action? Next, document if communication is happening effectively and any issues that may occur from ineffective or broken communication pathways. A clinical communication platform can provide a full audit trail for any communication on the platform. For a particular scenario, you can look back at that conversation and determine where the breakdown occurred. At a hospital or system level, you can track how many devices are used, messages are sent, message delivery time, etc.—metrics that can both uncover issues (for example, undeliverable messages may indicate Wi-Fi infrastructure problems) and celebrate successes (for example, the organization sent x million messages last year, which contributed to better coordinated care).
The ability to adjust strategies based on information gathered from the environment—altering a course of action in response to changing conditions.
As healthcare evolves to real-time health systems, real-time information is key. Care team members must be equipped with the intelligence that allows them to take action. A clinical communication platform provides the full context they need to understand the conditions in their environment and adapt their plan accordingly. Full context includes information that is static, like patient name and DOB, but also information that could change by the second, like their current vital signs, including live-streaming waveforms. With clinical alarm surveillance, comprehensive, continuous patient data enables advanced smart alarms and a more holistic view of the patient status. No matter where they are at that moment, care team members can be alerted on their mobile device of a patient who needs assistance, and have access to the information they need to make a clinical decision right at their fingertips.
The Mechanisms You Need to Support the Big Five
The “Big Five” are supported by the underpinning mechanisms of shared mental models, mutual trust, and closed-loop communication.
1. Shared mental models
An organizing knowledge structure of the relationships among the task the team is engaged in.
This mechanism is so vital, yet often overlooked: What is your single source of truth for communication within the hospital? A successful shared mental model depends upon a shared knowledge base. A clinical communication platform has a web-based enterprise directory at its core, so all care team members are accessing, updating, and using relying on the same information source. This directory contains the most current contact details, preferences, and scheduling information. You can look up the on-call hospitalist, even if you don’t know her name, and the moment you update your own schedule and preferences, everyone who’s looking to get in touch with you knows when you’re available and how best to reach you. With a shared understanding of the relationships among the care team and beyond, you have the structure in place necessary to facilitate all communication.
2. Mutual trust
The shared belief that team members will perform their roles and protect the interests of their teammates.
We previously talked about the importance of a culture of communication in terms of leadership, but it’s also important for the care team itself to have mutual trust. This comes in the form of information sharing, as well as thewillingness to admit mistakes and accept feedback. Even if you had the most perfect communication platform imaginable, it’s still possible for human errors to occur. The only way we all get better is to admit when that happens and work together to prevent future errors. When you evaluate your clinical workflows and communication methods on a regular basis as a team, you can hold up a magnifying glass and see what’s not working, or not working as well as it should, and how to adjust accordingly together.
3. Closed-loop communication
The exchange of information between a sender and receiver, irrespective of the medium.
Finally, what holds it all together: closed-loop communication. A clinical communication platform should support information exchange among all members of the care team (physicians, nurses, therapists, technicians, and assistants, but also environmental services, transport, contact center, and other roles that touch patients), the systems they rely upon (EHR, ADT, nurse call, patient monitoring, etc.), and all of the devices supported by the organization (smartphones, tablets, pagers, Wi-Fi phones, voice badges, etc.). All of these inputs and outputs must be fully supported on a single clinical communication platform for successful real-time care collaboration.
Fun fact: The Spok name was inspired by the spoke of a wheel. When you consider every member of the care team as a spoke in the wheel of patient care at your hospital, together, they complete the closed-loop and move patient care forward.
Go Forward Together
The closed-loop structure in our former open-plan NICU design might have been broken apart when we transitioned to the single-room design, but by following the tenets of the Big Five and bolstering them with the support required to make them work, we were able to develop a new model that leveraged our common trust, expertise, and technology resources to create an even better, more effective loop in a more therapeutic environment for our babies and their families.