Teamwork and team training in the ICU: Where do the similarities with aviation end?

Tom W Reader, Brian H Cuthbertson
2011 Critical Care  
Teamwork in the intensive care unit (ICU) refers to the leadership, decision-making, communication, and co ordination behaviors used by multidisciplinary team members to provide patient care [1]. Patient safety research has demonstrated the importance of eff ective teamwork for ensuring positive patient outcomes in the ICU. Poor communication during rounds and handovers (or handoff s) is frequently cited as a cause of medical error [2][3] [4] , and units with high levels of nurse-doctor
more » ... ation have improved patient mortality rates and reduced average patient length of stay [5] . In attempting to understand and improve teamwork in the ICU, researchers cite teamwork models and training techniques used to manage and improve teamwork skills in aviation [1, 6] . Like work environments in aviation, the ICU is a complex, high-risk, and stressful setting, and it can potentially gain from adopting and integrating the principles and techniques used to train team skills in aviation [4] . We consider the case for this and refl ect upon the similarities and diff erences that exist between aviation and intensive care. The aviation teamwork model Th e aviation model of teamwork draws heavily from social and cognitive psychology and is based on an under standing that team behavior can both cause and protect against error. It considers the team-related 'active failures' (for example, failures to communicate the proximity of nearby aircraft) and 'latent failures' (for example, lack of team training, poor ergonomic design, and organizational culture) that infl uence behavior and error in the cockpit [7] . Psychology concepts relating to communi cation, shared decision-making, leadership, team cohesion, team mental models (shared knowledge structures for teamwork and taskwork), and team climate are applied to understand performance and error. Th rough the use of systemized models, these various concepts are bound together to explain how 'team processes' (for example, leadership and communi cation) predict 'team outputs' (for example, error and team eff ectiveness). Furthermore, shared knowledge struc tures and 'team inputs' (for example, group hier archies and culture) are shown to infl uence teamwork behaviors, and safety culture is particularly signifi cant [8] . To understand the specifi c team behaviors important for safety in aviation, human factor specialists have performed cognitive task analyses, error analyses, attitudinal surveys, observational studies, and ergonomic assessments. Th ese data have structured the content of team training packages [9] and have contributed to the identifi cation of teamwork knowledge, skills, and attitudes that underpin eff ective team performance (Table 1) . Training and assessment in aviation focus on improving communication skills, briefi ng behaviors, selfcritique, leadership skills, workload management, vigilance and stress management, knowledge of team member skills/roles, and attitudes toward teamwork. Teamwork Abstract The aviation industry has made signifi cant progress in identifying the skills and behaviors that result in eff ective teamwork. Its conceptualization of teamwork, development of training programs, and design of assessment tools are highly relevant to the intensive care unit (ICU). Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work eff ectively under highly complex, stressful, and uncertain conditions. However, there are substantial diff erences in the nature of work and structure of teams in the ICU in comparison with those in aviation. While intensive care medicine may wish to use the advances made by the aviation industry for conceptualizing team skills and implementing team training programs, interventions must be tailored to the highly specifi c demands of the ICU.
doi:10.1186/cc10353 pmid:22136283 pmcid:PMC3388698 fatcat:fv6drlnjwvh2na6keiqdahkqim