Effective teamwork is a fundamental cornerstone of medical care, and it is critical to patient safety. Competent teams enhance patient care, whilst dysfunctional teams threaten patients and disrupt healthcare delivery as a whole.

The most salient feature of all good teams is excellent leadership. Good leaders possess certain competencies which Warren Bennis, in his insightful book, On Becoming a Leader, listed as vision, integrity, passion, curiosity, daring, empathy, and the ability to learn from adversity and mistakes. Bennis also describes effective leaders as possessing emotional intelligence, and the capacities of self-knowledge and self-invention.

Situation awareness is another crucial component of effective teamwork, and the book Safety at the Sharp End: A Guide to Non-Technical Skills defines this as the mental process of building and maintaining awareness of workplace situations or events. The book describes the three processes of situation awareness as gathering information, interpreting information, and anticipating future states. Exploring the most important advantages of situation awareness in her book Error Reduction in Health Care: A Systems Approach to Improving Patient Safety, Patrice Spath explained that it enables individuals to intermittently check their errors and self-correct themselves, and to cross-monitor for the errors of team members and intervene to rectify these as well.

Situation awareness is however prone to become disrupted by certain behaviours which team members must monitor at all times. These disruptive factors, according to the authors of Safety at the Sharp End: A Guide to Non-Technical Skills, include the following:

• • Tunnel visioning
  • Zoning out
  • Mind wandering
  • Daydreaming
  • Distraction
  • Interruption
  • Cognitive overload

To avoid losing situation awareness, what is also referred to as ‘being out of the zone‘, the authors suggested that team members should:

• • Avoid time-pressure to complete tasks
  • Avoid performing non-essential tasks when distracted
  • Back up a few steps whenever a task sequence is interrupted

Charles Vincent, in his classical book Patient Safety, reviewed several other behaviours that are crucial for teams in preventing, detecting, and managing errors. Some the the features he explored are:

• • Effective task prioritisation
  • Constant cross-monitoring
  • Having shared mental models
  • Practicing effective handovers
  • Using checklists
  • Using daily goal sheets
  • Giving and receiving feedback
  • Regular training and simulation
  • Effective communication

Because of its importance to teamwork, we will review the communication competencies of effective teamwork in more detail in the next post.