Chapter 6: Teamwork and Communication

Introduction

An effective healthcare team is of utmost importance to ensure safe, effective and efficient care for pediatric patients. Teamwork is particularly important when caring for children, as providers from various disciplines are performing different yet complimentary roles, all striving to provide high quality care, and at times in stressful situations. Failed communication and teamwork between providers, patients, and/or families are two of the most common attributable causes of medical errors.^1–3 Potential for error only increases when caring for children with complex medical conditions.

Providing healthcare to pediatric patients is often complicated by the inability of many children to express their symptoms and concerns, the elevated stress of caring for children, especially those who are critically ill or injured, caregiver involvement, and an increased margin for error. Rather than functioning as a skilled and integrated team, an entire group of healthcare providers may be focused on care of the patient, with each individual provider having different priorities or short-term goals which may conflict with one another. These conflicting priorities can be complicated by poor role clarity or a hierarchy that discourages open communication.

Communication errors or omissions are common and can have significant effects on patient care.⁴ Lack of accountability and follow-up can further derail team efforts and may predispose a team to an unbalanced workload. Finally, in the busy medical environment, teams must develop strategies to deal with fatigue and distractions.

Overcoming barriers to teamwork in healthcare is a group effort, and necessitates acceptance from all disciplines. While some simple interventions may provide a positive impact, producing a culture change that focuses on teams rather than individuals, takes time, effort, and frequent coaching. By following the story of one child’s illness, this chapter will discuss some strategies that have been successfully employed to address many of these challenges in hospitals and other complex work environments.

Case Scenario #1

Setting: Pediatrician’s Office

Ben is a 4-year-old boy who was climbing up onto a television cabinet to get a toy that was out of reach. Ben’s mom heard a crash, and came running into the room to find him unconscious amidst the toppled cabinet and television. When she screamed his name and scooped him up, he groggily woke up crying, and after she was able to console him, he seemed to be back to himself. However, at lunch, he did not have much of an appetite and seemed to still be a bit sleepy, so his mom decided to take him in to see his pediatrician.

Upon checking in for a sick visit, the clerk notices that Ben “doesn’t look quite right,” so she ushers him back to an open examination room. As none of the examination rooms currently being used by Ben’s pediatrician are available, the clerk puts Ben and his mother in an ...