Health Care Assemble!

As our discussions on Day 3 made very clear, health care professionals are not a united team. During a SBAR/I PASS the BATON communication exercise, it was blatantly obvious that by the end of our first year of medical school we have already been assimilated into our siloed profession–as medical students, we have absolutely no idea what nurses do or what their spheres of influence are in patient care.

As a fan of superhero movies, our deep confusion about how doctors and nurses work together to safely take care of patients reminded me of the movie, The Avengers. In the first half of the movie, a rag tag team of super heroes is brought together with the mission to save the world from alien domination. Each hero has his or her own superhuman talents (intelligence, strength, lightning generating hammer, etc.), not to mention movie franchise. However, the villain’s first attack quickly demonstrates that even superheroes are not effective alone and are at risk of causing unintentional harm. Thankfully by the second half of the movie, the superheroes unite as a team, defeat the villain and save Manhattan from complete destruction.

The transformation in the second half of the movie was remarkable. Captain America rose to the challenge of leading the team. Each of the members communicated effectively removing any ambiguity about each member’s role. Most importantly, the superheroes played to each other’s strengths and supported each other. If my memory serves me correctly, I don’t believe any human lives were lost despite impressive damage to much of Midtown. Is similar effective teamwork possible in health care? I think so. But, we need to invest in building teams while we are still in school.

As the IHI Open School Chapter at the University of Michigan has demonstrated, interdisciplinary teamwork can result in exciting solutions to deliver high quality care for our patients. In the inaugural Medical Device Design Competition, 23 graduate students from medicine, engineering, business, and public health split into five teams, used principles of human factors and developed at least three innovative ideas each that could dramatically improve the home hemodialysis experience in just two hours of collaborative work. This project based event and others, including month long patient safety projects with Internal Medicine residents, root cause analysis projects with the nursing school, a nursing distractions simulation, and LEAN tools workshops have not only helped us build our experience in quality improvement, but also have united health professions students of all disciplines to work together under the banner of improving patient care. It’s that kind of practice understanding each other’s strengths while we are still in-training that can facilitate better communication and teamwork when we finally assume full responsibility for patients.

We had a few opportunities to challenge our communication and teamwork skills throughout the week. One of the most stressful exercises was a team challenge to balance a wooden plank on top of a cinder block. Our task was to keep the plank balanced as six team members stepped onto the wooden plank one by one, and then stepped off the plank one by one. Sounds easy, right? Well, sitting under each end of the wooden plank was a “patient” (an egg). Could we load 6 team members onto the plank one member at a time and step off the plank without “harming” our patients? The exercise not only demonstrated the importance of clear and precise communication, but also the need for situational awareness and agility to readjust plans as a team. The physical maneuvers we employed to stay balanced on the plank could lead to some interesting health care teamwork metaphors. For example:

  1. My team decided that staying as close as possible to each other and to the center of the plank allowed us to get a better sense of each team member’s role in keeping the plank balanced.
  2. At some points during the exercise, we were all tightly hugging each other to maintain stability, representing a fully supported united front.
  3. Each new member stepped onto the plank at the center for orientation like a slow acculturation period.
  4. We deliberately inched out towards the sides of the plank creating new room for each new team member by shuffling one foot at a time and then shifting our weight to join the farthest foot–a series of small tests of change?

I was the first team member to step onto the plank and the analogy of the egg as our patient was very real. My heart was racing throughout the entire exercise. My greatest concern was that my actions would throw off my team and we would collectively hurt the patient. But, what comforted me was faith in my team and that I had the power to stop the line to express my concerns and get immediate feedback. After nine minutes of tachycardia, my team triumphantly stepped off the plank without harming either “patient.” Just more proof on the power of effective teamwork.

After the big win of saving the world from alien domination, The Avengers become a solidified team. They unite at the rallying cry of “Avengers Assemble!” What we need is a similar rallying cry in healthcare and let’s start now!