- Evaluate the differences between a group and a team.• Value four key concepts of teams.• Describe the process of debriefing team functioning.• Apply the guidelines for acknowledgment to a situation in your clinical setting.• Compare a setting that uses agreements with your current clinical setting.• Develop an example of a team that functions synergistically, including the results such a team would produce.• Discuss the importance of a team to patient safety and quality.
Diane Gallagher, RN, MS Director, Women’s and Children’s Services, Rush-Presbyterian–St. Luke’s Medical Center, Chicago, Illinois
An extensive “team” of people works together to care for a neonate in a neonatal intensive care unit (NICU). The team includes registered nurses, physicians, respiratory therapists, physical therapists, social workers, neonatal nurse practitioners, and ancillary staff. Occasionally, specialists are consulted for specific cardiac, neurologic, or gastrointestinal problems. These are intermittent “team” members who play a crucial role in the baby’s care.
Recently a new group of specialists joined our team. They were identified as a top-notch group who would, by virtue of their expertise and reputation, increase the census and revenues for the hospital. Our team was excited to have this opportunity to grow in an area in which we had infrequent experience. However, integration of these new team members did not go smoothly. Clinical disagreements, communication breakdowns, and interpersonal conflicts occurred. The experience evolved into mutual distrust and control issues.
As disagreements, insults, and complaints escalated on both sides, the situation came to a defining moment when the director of the specialty group said, “I’m never bringing any of our patients here. I’m sending them to the PICU [pediatric intensive care unit].” The response from the NICU team was, “Fine with us; we don’t need you, your patients, or the hassle.” It seemed reasonable to not work together because, in fact, functionally we were already not working together. This response was in direct conflict with our belief that we could provide a valuable service and make a difference for both the patients and their families. This posed a dilemma for the staff, but everyone felt the situation was hopeless.