Working Effectively as Part of a Team

Author(s):  
David Metcalfe ◽  
Harveer Dev

Teamworking is an inevitable part of working within a complex multidisciplinary environment. Thankfully, most interactions with other members of the healthcare team will be positive and constructive. Unfortunately, such happy circumstances do not make for particularly interesting SJT scenarios. The following section is therefore full of colleagues that are angry, rude, dishonest, unprofessional, and even intoxicated. In Raising and Acting on Concerns About Patient Safety (2012), the General Medical Council (GMC) states that ‘all doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organizations in which they work’. The GMC proposes taking the following steps in sequence when you develop serious concerns about a colleague: ● Raise the concern with ‘your manager or an appropriate officer of the organisation . . . such as the consultant in charge of the team, the clinical or medical director’. Alternatively, a foundation doctor may raise their concern with an appropriate person responsible for training such as their Foundation Programme Director. ● Raise the concern with a regulator (such as the GMC), professional body (such as the British Medical Association), or charity (such as Public Concern at Work). This step should be taken if you have exhausted options for raising the concern internally and there is an ‘immediate serious risk to patients, and a regulator or other external body has responsibility to act or intervene’. ● Raise the concern publicly. This step should be taken when you have exhausted options for raising the concern internally and have ‘good reason to believe that patients are still at risk of harm’. Your usual duty is to avoid breaching patient confidentiality. This is a highly unusual and significant step to take and is unlikely to be appropriate without first having taken advice from an appropriate organization such as the GMC, BMA, or Public Concern at Work. The questions within this section highlight your ability and willingness to work with team members. You will need to work collaboratively and respectfully within a multi- disciplinary team, as well as provide advice and support to colleagues.

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S87
Author(s):  
Mamta Kumari ◽  
Arun Kumar Gupta ◽  
Peter Clarke

AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.


2015 ◽  
pp. 921-931
Author(s):  
Jill E. Stefaniak

Administrative leadership of Wayburn Health System decided to move forward with a training program to address communication between healthcare professionals within their emergency center. After a few sentinel events where errors had occurred that compromised patient safety due to miscommunication amongst healthcare team members, hospital administration decided that communication processes needed to be standardized within the emergency center during trauma resuscitations. Four hundred employees from various departments and disciplines would require training. An instructional designer was brought onto the project to ensure that training was customized to fit the specific needs of the trauma resuscitation team.


2012 ◽  
Vol 94 (2) ◽  
pp. 90-93 ◽  
Author(s):  
G Kirby ◽  
K Kapoor ◽  
P Das-Purkayastha ◽  
M Harries

INTRODUCTION The General Medical Council states ‘a surgeon must not work when their health state is adversely influenced by fatigue, disease, drugs or alcohol’. However, there are no defined criteria for acceptable blood alcohol levels when operating. The aim of this study was to measure the effect of varying amounts of alcohol on surgical dexterity, cognitive abilities and the social interactions required to ensure patient safety during a routine ear, nose and throat (ENT) operation. METHODS ENT surgeons were asked to perform a microlaryngoscopy with excision of a predetermined glottic lesion on a validated laryngeal model. The procedure was repeated four times over a period of four hours with varying doses of alcohol (no alcohol control, one glass, three glasses and six glasses of wine). The parameters recorded included theatre etiquette, surgical time, operative skills and patient safety. Scores were adjudicated by two independent observers. RESULTS The more glasses of wine consumed, the more detrimental the effect was on the surgical performance of all participants. There was a global reduction in ability of 7.25% after three glasses and 19.25% after six glasses of alcohol. No domain showed an improvement following sequential increase in blood alcohol concentration. CONCLUSIONS This study suggests that there are no deleterious effects on surgical performance following the consumption of one glass of wine 45 minutes prior to microlaryngoscopy among ENT surgeons of varying experience. However, there is clear evidence that with three or more glasses of wine there is an adverse effect on performance, with decreased surgical dexterity, cognition functions and professionalism.


2019 ◽  
Vol 8 (1) ◽  
pp. e000548 ◽  
Author(s):  
Adam Backhouse ◽  
Myra Malik

BackgroundPatient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors’ education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area.MethodWe used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room—a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding ‘clinician error’. This is followed up with an after action review where students reflect on their experience and identify learning points.OutcomeStudents praised the session’s interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work.ConclusionOur findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.


2019 ◽  
Vol 13 (1) ◽  
pp. 94-105 ◽  
Author(s):  
Mirette Dubé ◽  
Jonas Shultz ◽  
Sue Barnes ◽  
Bobbi Pascal ◽  
Alyshah Kaba

Purpose: The aim of this article is to outline overall goals, recommendations, and provide practical How-To strategies for developing and facilitating patient safety and system integration (PSSI) simulations for healthcare team members and organizations. Background: Simulation is increasingly being used as a quality improvement tool to better understand the tasks, environments, and processes that support the delivery of healthcare services. These PSSI simulations paired with system-focused debriefing can occur prior to implementing a new process or workflow to proactively identify system issues. They occur as part of a continuous cycle of quality improvement and have unique considerations for planning, implementation, and delivery of healthcare. Method: The Delphi technique was used to develop the recommendations and How-To strategies to guide those interested in conducting a PSSI simulations. The Delphi technique is a structured communication technique and systematic process of gathering information from a group of identified experts through a series of questionnaires to gain consensus regarding judgments on complex processes, where precise information is not available in the literature. The Delphi technique permitted an iterative and multistaged approach to transform expert opinions into group consensus. Results: The goals, recommendations, and How-To strategies include a focus on project management, stakeholder engagement, sponsorship, scenario design, prebriefing and debriefing, and evaluation metrics. The intent is to proactively identify system issues and disseminate actionable findings. Conclusions: This article highlights salient features to consider when using simulation as a strategy and tool for patient safety and quality improvement.


2021 ◽  
pp. 203-213
Author(s):  
Lucian L. Leape

AbstractIn 1997, Britons were shocked by a report from the General Medical Council (GMC) of a series of deaths from bungled surgery at the Bristol Royal Infirmary. In response to parents’ complaints, the GMC had launched an investigation into the high mortality of cardiac surgery of children at the Infirmary. It found that of 53 children who were operated on, 29 had died and 4 suffered severe brain damage. Three surgeons were found guilty of serious professional misconduct, and two were stricken from the medical register [1].


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S177-S178
Author(s):  
Hannah Campling ◽  
Dominic Aubrey-Jones

Aims1. To standardise the doctor handovers for on-call duties2. To ensure there is documented evidence of handover taking place at the end of each shiftBackgroundSince the introduction of the European working time directive the amount of hours that doctors are allowed to work has been reduced, resulting in increased handovers between teams. The National Patient Safety Committee and General Medical Council have recognised that this means we need to ensure handovers are as safe and robust as possible to ensure that patient safety is not compromised. A recent serious investigation report carried out at Chase Farm Hospital, London identified a lack of formalised handover between doctors as a contributing factor leading to patient harm. One of the recommendations of the report was for a Quality Improvement Project to be carried out in order to formalise handover.The handover procedure at Chase Farm Hospital for core trainee doctors 'on-call' prior to this QIP was not standardised and consisted of an informal, verbal handover. Frustrations had been raised by doctors and other staff members that this current method of handover was unreliable and unsafe.MethodWe sent out a questionnaire about handover to all doctors on the on-call rota to help establish what intervention would be appropriate.We then performed a retrospective collection of documented handovers within a two month time period.Our intervention was to introduce an email handover procedure.Following a two month trial of this intervention, we resent the questionnaire and performed a second retrospective collection of handover documentation.ResultPrior to this QIP we found that 0% of on call handovers were being formally documented. After the introduction of our handover email 88% of handovers were being formally documented using the handover email.Satisfaction with the handover procedure went from 0% being very satisfied and only 33% being satisfied to 50% being satisfied and 50% being very satisfied.ConclusionA standardised and documented handover procedure is crucial for patient safety and to allow doctors to communicate jobs effectively with each other.A secure email for handover is a successful way of formalising the handover process.Limitations include:Access to the handover email for new staff or locum staff.Ensuring that doctors who aren't on the on-call rota know how to use it to handover their ward jobs.


Author(s):  
Jill E. Stefaniak

Administrative leadership of Wayburn Health System decided to move forward with a training program to address communication between healthcare professionals within their emergency center. After a few sentinel events where errors had occurred that compromised patient safety due to miscommunication amongst healthcare team members, hospital administration decided that communication processes needed to be standardized within the emergency center during trauma resuscitations. Four hundred employees from various departments and disciplines would require training. An instructional designer was brought onto the project to ensure that training was customized to fit the specific needs of the trauma resuscitation team.


2018 ◽  
Vol 23 (2) ◽  
pp. 66-70
Author(s):  
Damian Lake

It is estimated that over 40 million people have had laser vision correction worldwide since 1991. Laser-assisted subepithelial keratomileusis is commonplace in the UK in high street chains and from more bespoke suppliers. The standards around this treatment have always been regulated by the General Medical Council (GMC), but litigation cases have been common. The recent GMC guidance for cosmetic procedures and subsequent guidelines by the Royal College of Ophthalmologists cover advertising, facility regulations, equipment, consent and surgeon training which should improve industry practices and deliver improved patient safety standards.


2007 ◽  
Vol 100 (10) ◽  
pp. 440-441 ◽  
Author(s):  
Iain Chalmers

‘You must work with colleagues and patients to maintain and improve the quality of your work and promote patient safety. In particular you must … help to resolve uncertainties about the effects of treatments.’ General Medical Council 1


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