Thank you for watching this video on becoming an expert team. We're going to talk about what that means in transitioning from being an individual expert to being part of an expert team. We're going to talk about what it takes to do that, why that's important and why it's a little bit harder than it may sound initially. We're going to start with a bit of a case example of a non-expert team. You can read the full details on the link below but this starts out with a 20 month year old boy admitted to an ICU following a surgical procedure for a heart condition. The boy does pretty well throughout the day. Around 7:00 pm, he develops respiratory distress with acidosis and fever. At that time the resident notifies the on call ICU attending who comes in to help manage care. Around midnight, the surgeon phones is informed of the status and orders an echocardiogram. From that order, cardiology fellow comes in to perform the echo and communicates the results to the surgeon but not the ICU attending. The results of the tests are low cardiac outputs, so really kind of two dangerous things going on at this time. The patient stabilizes but doesn't improve dramatically throughout the night. The ICU attending goes home receives updates from the resident throughout the night, but the patient status again is not improving dramatically. This entire time the resident is assuming that the ICU in the surgical attendings are talking to one another and does not explicitly share the echo findings. Tragically at 7:00 am, the next morning, the child suffers a cardiac arrest and the entire team attempts to resuscitate him but they are not successful. Now, outside of the absolutely tragic outcome to this event, the circumstances here are usually very familiar to many clinicians. We have a lack of clear leadership structure. We have a lack of communication flow getting to the right people at the right time. Basically we have a group of people who are jointly responsible of taking care of this patient, but are not necessarily organized in a way to be collaborative or to be effective as a team. And that's really what we mean by moving from an individual expert, which we have many in this scenario, to an expert team. And we'll dig a little bit deeper into that. We'll start by thinking about how does an individual become an expert to begin with and what his expertise really mean? There's big literature on this, it's very fascinating and what it says is that, expertise defined as being reliably superior achieving superior outcomes in a reliable fashion, that's a function of my performance processes, the experts performance process and the demands of the task, right? So I'm expert at some things, some set of tasks or demands whether it's medicine or chess or tennis, whatever it is, my expertise has bounds and it's around a set of tasks. And those tasks can be different in terms of their complexity, their variety or how often they change or not change, how stable they are. In the performance processes, have to fit these tasks, whatever they are and that includes our knowledge base, what we know how we organize our knowledge the skills we have, whether that's a surgical procedure or something else and our perceptual abilities, ability to recognize situations and cues and interpret them effectively. And these things have to align in an effective manner and that's really what drives superior performance outcomes. That is where healthcare education has focused for a very long time. And reasonably so there's a lot to learn to be an expert clinician. But that's not all of the picture, right? So as we saw on our case study, a lot of the tasks I cannot achieve by myself. The tasks are linked together. I cannot reach my goal without someone else's input. And this is what we call task interdependence. So many of the things we have to do to care for patients require us to coordinate our activities. And that can be sequential, some things I have to perform on the patient and then you do something or pooled, we're all doing a little bit of something that is patient care at the same time or reciprocal, we have to go back and forth or in the case of the scenario we saw which is really kind of massively interdependent. There's a lot going on and we all needed to coordinate and be there together at the same time. So that's the first piece of the puzzle. Being an expert team means recognizing that our tasks are not just manageable by individuals, all of them. Some of them yes, all of them no. And that takes another skill set. It's not just what I need to know to manage my tasks as an expert but what are the skills I need to manage the team as a whole. So I don't need to know what I need to be able do and what I would need to be able to feel, my attitudes, my preferences, what do I value? And that's a critical piece of that. And on top of all these task constraints at the team level, we also have interpersonal relationships we have to manage. Yes we're performing tasks together but we're also working together and how we treat each other as human beings matters quite a bit. And this can relate to how well we know each other. Do we have an opportunity to know each other or do our teams just change so frequently? We have to kind of make some snap judgments about you as a person, what your communication style and preferences are, all these types of things. And of course our personality preferences matter quite a bit too for our social interactions. And then there's a skill set to managing these interpersonal competencies as well. It's how we deal with conflict, how we're able to build trust in an appropriate way and how we're able to inspire, engage people intellectually and motivate people in this transformative way when we're working on an especially project and safety and quality improvement teams. So we have this set of skills we need to manage our interdependent tasks and we have the set of skills we need to manage our interpersonal relationships. And that can be a lot harder than it sounds actually compared to what you need to know to be an expert clinician. This may seem much easier but it does take some key things and there are some reasons why for the task inter-dependence as we saw in our initial case study, we kind of mis-recognize those. So people in that scenario did not necessarily understand how their work fit together and that caused them then to mismanage that work. They weren't communicating information to people that needed it, when they needed it. And for the interpersonal relationships, we can kind of mismanage those as well, right? So we may not have the skills or we may not have the time to invest in enacting those skills and frequently what we see as we kind of mis-categorize other people's behavior. If people are in a system that's not organized well, they may feel like they're fighting the system to protect the patient. And that can be about the task, again we're not recognizing well but it can feel to people in that system, like they're being attacked as an individual, that their competency is being questioned or that they're being treated in a nonprofessional manner. So there's a lots of things to address but these are the key things we're going to focus on really throughout this series of understanding how we can do a better job managing our task, inter-dependencies and also how we can do better job managing our interpersonal relationships. So there's a very large science behind all of these things we talked about, decades of research on teams in many different areas looking at what makes them effective, what makes them expert. And like safety and quality in general, there's a three part model that's handy and understanding much as this literature. There are some set of inputs, these are stable things about the team and the organization that are going to influence how people work together. How people work together we call mediators and these tend to be things like action processes which are how we perform tasks together, transition processes which are how we prepare for and reflect on the work that we're doing and interpersonal processes, again how we manage the relationships that we have. All of these things will interact to influence the outcomes. And that's where we'll be digging deeper in the series of videos. We're going to talk much more about the existing science behind teams and how teams relate specifically to safety and quality and health care, what we can do to improve teamwork in healthcare for safety and quality. In our next video, we'll be digging deeper into the science of teams, what we know about effective teams and healthcare. What we know about how to improve the performance of teams and ultimately safety in quality health care.
