Medical Teamwork Reviewed

The aim of this critical review is to contrast prevailing approaches to teamwork in healthcare with current concepts in safety science. After identifying relevant articles through multiple formal search methods, we found that, although current teamwork literature acknowledges a lack of comprehensive investigations linking team training in healthcare and patient outcomes, the predominant strategy to achieve safety remains a traditional, reactive approach that regulates behaviour and constrains performance variability. post

It appears that in the current state of entangled quality and safety agendas, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept.

Table 1 -- Integrated teamwork skill dimensions Adaptability -- Process by which a team is able to use information gathered from the task environment to adjust strategies through the use of compensatory behaviour and reallocation of intra-team resources Shared situational awareness -- Process by which team members develop compatible models of the team’s internal and external environment; includes skill in arriving at a common understanding of the situation and applying appropriate task strategies Performance monitoring and feedback -- Ability of team members to give, seek and receive task clarifying feedback; includes the ability to accurately monitor the performance of team mates, provide constructive feedback regarding errors and offer advice for improving performance Leadership/team management -- Ability to direct and co-ordinate the activities of other team members, assess team performance, assign tasks, motivate team members, plan and organize and establish a positive atmosphere Interpersonal relations -- Ability to optimize the quality of team members’ interactions through resolution of dissent, utilization of co-operative behaviours, or use of motivational reinforcing statements Co-ordination -- Process by which team resources, activities and responses are organized to ensure that tasks are integrated, synchronized and completed within established temporal constraints Communication -- Process by which information is clearly and accurately exchanged between two or more team members in the prescribed manner and with proper terminology; the ability to clarify or acknowledge the receipt of information Decision making -- Ability to gather and integrate information, use sound judgement, identify alternatives, select the best solution, and evaluate the consequences (in team context, emphasizes skill in pooling information and resources in support of a response choice)

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Software teams require the same dimensions. Note to self to try mapping these dimensions to Graceful Extensibility