A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses

O’Connor, Paul; O’Dea, Angela; Lydon, Sinéad; Offiah, Gozie; Scott, Jennifer; Flannery, Antoinette; Lang, Bronagh; Hoban, Anthony; Armstrong, Catherine; Byrne, Dara

doi:10.1093/intqhc/mzw036

Cited by 41 publications

(29 citation statements)

References 29 publications

(51 reference statements)

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“…Results revealed that teamwork with other healthcare teams was rated lowest among the six socio‐cultural patient safety competencies; this result is consistent with previous findings in Canada (Ginsburg, Tregunno et al, ), Finland, the UK (Tella et al, ), Ireland (O’connor et al, ) and Korea (Hwang, ).This evidence suggests that inter‐professional collaboration is a weakness in current healthcare settings. However, careful consideration is recommended when interpreting the findings of previous literature because all respondents were nurses and other healthcare professionals and not nursing students.…”

Section: Discussionsupporting

confidence: 90%

A multi‐university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross‐sectional study

Alquwez

Cruz

Alshammari

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To assess the perceived patient safety competence during clinical training of Saudi nursing students. Background Ensuring safety in healthcare settings requires improvements in the educational and clinical practice of professionals. Experts stressed that shared patient safety culture must be of primary importance; they also emphasised the resolute need for theoretically driven research approaches for patient safety competence in healthcare organisations and educational institutions. Design Descriptive, cross‐sectional design. Methods This study was conducted in six government universities in Saudi Arabia. A sample of 829 nursing students was surveyed using the health professional education in patient safety survey. Descriptive and inferential statistics were used to analyse the data. The study adhered to the STROBE guideline for cross‐sectional studies (See Supporting Information Appendix S1). Results The percentage of agreement on the items of the health professional education in patient safety survey ranged from 61.5%–76.5%. The dimension “understanding human and environmental factors” received the highest perceived competence, whereas the dimension “working in teams” received the lowest competence. Significant differences in students’ patient safety competence from different universities were reported. Male students perceived their competence in “working in teams” higher than the female students. Students in their internship year had significantly higher levels of competence in all the six dimensions of the health professional education in patient safety survey than students in the third‐ and fourth‐year levels. Conclusions Saudi nursing students have positive perceptions towards their patient safety competencies. Significant differences were found in the patient safety competence of nursing students between universities, gender and year of study. Relevance to clinical practice The results provide valuable insights and guidance for improving the patient safety competence of nursing students. The findings can be used to guide the creation of policies and interventions that may ensure the continuous development of patient safety competence of nursing students as they navigate the clinical area.

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Section: Discussionsupporting

confidence: 90%

A multi‐university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross‐sectional study

Alquwez

Cruz

Alshammari

et al. 2019

Journal of Clinical Nursing

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“…the redesign of teams or the introduction of structured communication strategies) are sometimes shown to be highly effective when they are targeted to specific groups of clinical staff, trigger experiential learning and exploit the ‘natural networks’ of healthcare [ 24 , 30 ]. Valuable opportunities for tackling persistent challenges to healthcare safety, such as poor teamwork and communication between different disciplines [ 31 ], may be lost if healthcare contexts were to discard these interventions.…”

Section: Discussionmentioning

confidence: 99%

Learning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare

Liberati

Peerally

Dixon‐Woods

2017

International Journal for Quality in Health Care

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ObjectiveThough healthcare is often exhorted to learn from ‘high-reliability’ industries, adopting tools and techniques from those sectors may not be straightforward. We sought to examine the hierarchies of risk controls approach, used in high-risk industries to rank interventions according to supposed effectiveness in reducing risk, and widely advocated as appropriate for healthcare.DesignClassification of risk controls proposed by clinical teams following proactive detection of hazards in their clinical systems. Classification was based on a widely used hierarchy of controls developed by the US National Institute for Occupational Safety and Health (NIOSH).Setting and participantsA range of clinical settings in four English NHS hospitals.ResultsThe four clinical teams in our study planned a total of 42 risk controls aimed at addressing safety hazards. Most (n = 35) could be classed as administrative controls, thus qualifying among the weakest type of interventions according to the HoC approach. Six risk controls qualified as ‘engineering’ controls, i.e. the intermediate level of the hierarchy. Only risk control qualified as ‘substitution’, classified as the strongest type of intervention by the HoC.ConclusionsMany risk controls introduced by clinical teams may cluster towards the apparently weaker end of an established hierarchy of controls. Less clear is whether the HoC approach as currently formulated is useful for the specifics of healthcare. Valuable opportunities for safety improvement may be lost if inappropriate hierarchical models are used to guide the selection of patient safety improvement interventions. Though learning from other industries may be useful, caution is needed.

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“…A lack of communication that is often seen in the absence of a shared mental model has been identified as one of the greatest risks posed to surgical patients 20 . This raises concern as one research study indicated that while nurses widely advocated for pre-briefings sessions, such sessions only occurred in 12 per cent of observed surgical lists 8 .…”

Section: Communication Is the Foundationmentioning

confidence: 99%

“…Multiple studies address the differences in the content, structure and priorities between the way nurses and doctors communicate 7,24 . Generally nurses are taught to communicate in broader narratives whereas doctors are trained to be succinct and to move quickly to the root of the situation 20 . These fundamental differences in communication styles have been identified as impediments to cohesiveness in interdisciplinary teams and are associated causes of failures in interdisciplinary communication 24 .…”

Section: Communication: Nurses Vs Doctorsmentioning

confidence: 99%

Creating and applying shared mental models in the operating room

Wilson¹

2019

Journal of Perioperative Nursing

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A shared mental model is a concept from high reliability environments, like aviation, to help teams develop collective understanding of how they will work together to safely accomplish their goals. Areas of high-risk health care like the operating room have adapted this concept to improve interdisciplinary teamwork and thus improve patient outcomes. Non-technical skills including communication, situational awareness, task management and leadership are employed to produce a functional shared mental model. Nurses play an important role in the change process as traditional hierarchical cultures, differing communication styles between doctors and nurses and an increasingly transient workforce are all challenges to the use of shared mental models in the operating theatre.

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A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses

Abstract: Poor teamwork between junior doctors and nurses is common and places patients at considerable risk. Addressing this problem requires a well-designed complex intervention to develop the team skills of doctors and nurses and foster a clinical environment in which teamwork is supported.

Cited by 41 publications

References 29 publications

A multi‐university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross‐sectional study

A multi‐university assessment of patient safety competence during clinical training among baccalaureate nursing students: A cross‐sectional study

Learning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare

Creating and applying shared mental models in the operating room

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