Work as a team

Medicine is a team sport, and effective teamwork is an essential element of delivering safe patient care. Junior doctors are central to most teams within the hospital and your ability to work within a team is a core outcome of your prevocational training. This blog will explore your role within different teams and provide some practical tips so that your peers and supervisors describe you as a ‘team player’.

The importance of teamwork in health is reflected in the shift from the traditional focus on an individual doctor as solely responsible for a patient’s care, to a model that relies on the collaboration between many doctors, nurses and other allied health professionals. The incorporation of multiple perspectives in health care offers the benefit of diverse knowledge and experience. In practice, however, shared responsibility without high-quality teamwork can be fraught with danger. For example, handover has been identified as a potential area of risk with near misses and adverse events common. The lack of purposeful team care can also lead to unnecessary waste and cost.

Different types of teams in medicine

You are probably a member of more health care teams than you imagine. Your teams may be ward-based, specialty-based or inter-professional. Some teams are constant and others have a constantly changing membership, such as cardiac arrest teams.

Patients and their carers should also be considered active members of the healthcare team as part of a patient-centred care approach. Engaging the patient as a team member can improve the safety and quality of their care, as well as enhance shared-decision making and the informed consent process. After all, they are the only team members present at all times during their care.

Strategies for working successfully in a team

Have a think about some simple strategies to improve your teamwork abilities as a junior doctor. The following are some suggestions that may be more applicable for an intern working in a team for a clinical term, rather than a temporary team.

1. Ensure that the common purpose of all the members of the team is to provide patient-centred care. It may seem an obvious statement but it can be forgotten in a busy team with conflicting demands.
2. Workload is rarely evenly distributed within teams or on an after-hours shift. Monitor the workload and performance of your colleagues. If a colleague is struggling, step in and offer to do some of the simple tasks that may be on their list such as cannulas, bloods or fluid orders. This will help create a culture of collegiality amongst your peers that will make your year much more enjoyable.
3. Good communication skills are at the core of effective teamwork. I don’t think that you can be a team player without excellent communication skills. Listening skills are essential for an intern, as you will often be delegated to complete tasks on behalf of the team. All members of the team should feel safe in asking questions including junior medical staff. The concept of graded assertiveness and ‘speaking up’ is receiving increasing interest in medical education especially within the area of simulation.
4. Ideally, your team should work like a well-practiced pit crew with each member understanding each other’s roles. But this rarely happens in health. The move to multi-disciplinary teams combined with our failure to learn or to train together is a barrier to understanding each team member’s strengths. Get to know your nursing and allied health team: ask them questions, understand their roles and how they can contribute within the team. This will help ensure that we utilise all our team members’ strength and skills.
5. A simple strategy that will help you be viewed as a team player is to learn and remember the names of as many of the staff members as you can. Communicating with the ward clerk, porter, radiographer, departmental secretary and nurses by their first names will help you develop a collegial and respectful relationship. Unfortunately, if you are like me you have the ability to remember loads of useless medical facts but are hopeless at remembering the name of colleagues that you have worked with for years. But take the time to learn names. You will be surprised with the impact that that this small effort has on your work.
6. We often forget the team members that look after our patients in the community. Early involvement of GPs, community nurses and nursing home staff will improve the patient care in hospital and on discharge.

Trust

How do you know that you are seen as a valuable member of the team? Trust. When you feel trusted you also feel valued for your contribution. But trust takes time and is less likely to occur in a temporary team. This concept of trust supports the proposal for longer junior doctor terms and highlights a potential advantage in ward-based terms were junior doctors can develop stronger relationships with allied health and nursing staff.

But I have noted that there is considerable resistance to the move from the traditional team-based structure during the day with overtime shifts, at other times to a rotating shift based roster attached to a ward, from junior doctors. This may reflect the belief from junior doctors that the drivers of this move are more financial to reduce overtime payments than ideological or to ensure their safe working hours.

Medical tribalism

What don’t junior doctors like about ward-based rosters? Is it the lack of the apprenticeship model with consultants less available to supervise after hours, fewer opportunities for formal teaching or the type of work they will be doing? Or is it about the junior doctor not feeling part of team? One that is valued for their contribution and trusted by senior colleagues, not as a name on a roster that is replaceable but as an individual with an unique sets skills and knowledge that they bring to the team. Do we also need to feel that bond that exists within teams, the feeling that you are a part of a tribe? Medical tribalism was discussed in a lecture by Dr Victoria Brazil and explored in more detail by Dr Andrew Coggins in The Tribal Nature of Medicine.

Medicine is moving towards providing high-quality health care 24/7. Junior doctors will be the first group to be rostered with that in mind and ward-based care is the likely model. Paying junior doctors an appropriate wage for after-hours and weekend work is essential as highlighted by the current junior doctor dispute in the UK. But I think the requirement to develop teams that deliver quality patient-centred care independent of the time or day of the week is an unrecognised challenge that needs to be addressed moving forward.