BLOCK 5 ASSIGNMENT
tribes and patient safety by Weller:
deliver the modern healthcare not individuals and requires multi-disciplinary
support. These teams are composed of multiple skilled specialties and
professions, and the final goal is to deliver the best healthcare to the
patient. Each specialty has own background and culture.
of effective teams:
Salas proposed a model for five key characters for efficient
Team leadership, is responsible for coordinating and planning tasks, in addition
to this, team development, stimulation
and creating a good environment
are additional resposibilies.
monitoring which identifies lapses or overwhelmed members with tasks and supervise other members of the team
to create a healthy environment.
Backup behavior, to provide needed support to members of the team and redistribute
the workload between members which needs a better understanding of the tasks of the team members.
Adaptability, team should be flexible to accept changes in
the environment and be able to make the necessary changes in the management
plan with a better response.
Team orientation, which is about the willingness of the whole team members to
identify and accept the general goals of the group, and to consider this to
have more importance than the individual
These characters are
coordinated by the following factors which include: mutual trust mechanisms,
closed-loop communication and shared mental models.
To achieve these five characters
of efficient teams, the team members must have respect and trust to
each other , so giving and receiving feedback will be smooth about their
performance, also the members must have good communication skills
so the information will be conveyed accurately, and must have a shared
Shared mental models will
help in a better situation understanding,
management plan, and the assignments of
the multiple team members.
of information among
the team members will improve the effectiveness of the group performance and will
reach the goals of the team.
sharing: a challenge for healthcare teams
improvement needs improvement in sharing information.
failure is critical and will affect the communication among the team members
which will be reflected on patient safety.
There are multiple
factors which have roles in information sharing, and they are educational
factors, psychological factors and organizational factors.
It is important to teach
the students how to communicate with different health professionals properly
Education for health
professionals remains largely discipline-specific with minimal interaction
between healthcare disciplines.
It is crucial also, to
understand the roles of other specialties and responsibilities to make a better
Some professions are
attractive to some people. Among the team, some tension could exist when
different specialty groups have different pathways to do things.
allegiances can lead to tensions when different professional groups have
different expectations about how things should be done.
may act as a barrier which affect a good communication.
Less senior staffs may
hide their concerns or suggestion, in contrast to senior staffs who are using
Different locations of
the patients inside the hospital may affect the team who provide healthcare in
terms of ward rounds or treatment plans.
This factor may act as a
barrier for communication and sharing information.
For example, a nurse who
is taking the best care for the patient, may not be available when there is a
decision about the patient.
Nut Island Effect by Levy:
This team was composed of 80 or so men and women who worked
in Nut Island sewage treatment plant in Quincy, Massachusetts, from the late
1960s until it was decommissioned in 1997. Majority of them came from
military services who are hard workers and committed. The military background
had affected the group dynamics in form of work ethics, respect and to depend
on each other to survive. They had a poor and deficient linkage with the higher
authorities in Boston City. Levy described the 5 steps for failure
1. The main focus of the higher
authorities was on the clear problems which lead to a higher degree of autonomy
to the staff. With time, members of the team started to have special identity.
2. Feedback or concerns of the team members
were ignored by the higher management which caused the team to feel betrayed if
the was a trouble.
3. The team mentality became
us-against-the-world. And to work out of the supervision of the higher
management, the team had to deal with problems. Problems never exposed to
outside and help was not asked. Higher management considered the silence as a
sign of wellness.
4. Team was not exposed properly to another
practice from outside which reflects a failure of higher authorities. The team
set its own procedures and rules.
5. Higher authorities and the team distorted
a picture that is hard to modify or change. Ignoring each other until the major
During my residency
training program, as an orthopedic resident, I was in one of the rotations in a
non-consultant based hospital. The junior staffs are almost totally separated
from the senior staffs which is reflected on management of patients. It was
difficult to communicate and get helped from a senior staff due to lack of clear
communication pathways and responsibilities. Also, there was no formal job description or privilege for the resident.
The junior residents
developed the sense of self management without the immediate supervision from
the higher experts or consultants.
The whole rotation was
stressful in terms of patient management and follow ups. Also, it was stressful
from educational point of view. I heard about some cases which were mismanaged
due to lack of supervision or senior involvement, especially in the theater or
critical areas. And when disaster happens, the junior level will receive the
blame or warning.
I would consider that
experience as a nut island effect.
Teach effective communication strategies
To improve the outcome,
the communication methods have to be taught and implemented.
Train teams together
Outcome will be improved
when the team working together is trained together.
Train teams using simulation
Simulation is a safe
teaching method and different skills can be taught to the team which will increase
the awareness and understanding level.
Define inclusive teams
Unification of the team
goal will help in gathering different professions.
Create democratic teams
To encourage team
communications, it is advisable to make a flat hierarchies.
Support teamwork with protocols and procedures
Policies and procedures
facilitate the team work and sharing of information among the group.
Develop an organizational culture supporting healthcare teams
Develop the culture for
collaboration and team work, and should be led by seniors and department heads.
The key differences between the two papers by Levy and Weller can be summarized
The Nut Island by Levy
The tribes, team in healthcare system
workers who have a military background.
professionals with who work in a comfortable
environment. They are with different backgrounds, and multiple
are considered as one team in one organization.
teams in one organization.
as a family unit with a shared work
ethics and background
as different tribes with different values, and background.
separated from the team..
with different teams within the health organization system.
vs against the world mentality
Levy, PF (2001) The Nut Island Effect: When good teams go wrong. Harv Bus Rev, March 2001, 51-59
J , Boyd M, Cumin D (2014) Teams, tribes and patient safety: overcoming barriers
to effective teamwork in healthcare. Postgrad Med Journal. 2014 Mar;90(1061):149-54. doi: