Feature Article

The Human Factor: The Critical Importance of

Effective Teamwork and Communication in
Providing Quality and Safe Care
Seep Sonali, BDS, MHA and Harmanpreet Kaur, BAMS
with the patient through the combination of knowledge,
To achieve the desired results, teamwork requires
expertise, and decision-making to maximize treatment.
cooperation, coordination, and communication among
Establishing a therapeutic relationship, contacts between
team members. This article outlines and presents various
doctors and patients are pivotal. That is why the quality
ways of reducing communication errors and failures, the
of communication in the medical field has been seeking at-
importance of teamwork, and communication among
tention in recent decades. The interaction between patient
direct patient care personnel. The study was descriptive
and physician must be centered on a common understand-
and exploratory in nature with a sample size of 200. The
ing and complex relationship between patient families.
efficient use of teamwork and communication had
One goal of communication is to use skillful negotiation
enhanced the level of quality of care for patients. Results
to overcome differences in viewpoints arising from differ-
of this article confirmed that the level of patient care
ent professional cultures or other influences (eg, personal-
improved by teamwork and communication.
ity differences). The ability to adapt the language to the
Consequently, conflicts occurred exclusively during the
target audience was also an important communication
handover between nursing staff, and after their switch,
skill listed. The capacity to connect through cultures was
the nursing staffs were usually in zeal to leave.
demonstrated both in terms of patient awareness and in
terms of working with members of the interprofessional
team. Coordination errors are also caused by discrepan-
Most of the transitions to teamwork were attributed to the cies in coordination between healthcare providers and pa-
Hawthorne studies, a series of research carried out in the tients, especially physicians.
1920s and 1930s that emphasized the positive aspects of
teamwork in an organizational environment. When orga-
nizations realized the importance of teamwork and the
Measure of Effective Teamwork
positive effects it had on their businesses, whole fields of Improving teamwork2 can have benefits beyond improv-
work changed from the traditional assembly line to the ing patient outcomes and safety that include benefits for
contemporary organizational high-performance model.1 the individual practitioners in the team, the team as a
Good teamwork requires not only the knowledge whole, and the organization in which the team resides
and use of particular resources and tools of the team, (Figures 1 and 2).
but also effective administration and an acute insight
into the safety culture, the atmosphere in which the team Strategies of Effective Communication
works. Effective team has an efficient way to communicate
Efficient teamwork and communication3 both are built
Corresponding author: Dr Seep Sonali, BDS, MHA, is an Assistant Pro-
into the following basic components:
fessor at MYAS-GNDU, Department of Sports Sciences and Medicine, 1. SBAR (Situation-Background-Assessment-
Guru Nanak Dev University, Amritsar. She has done Bachelor degree in Recommendation)
Dental surgery from University of Jammu, India and Masters in Hospital
Administration as a Gold medalist from Guru Nanak Dev University,
2. debriefing
Amritsar-143001, Punjab, India. She is a visiting quality consultant asso- 3. SOAP (Subjective-Objective-Assessment-Plan)
ciated with Management Mantra, Amritsar, Punjab, India and can be
reached at [email protected].
Dr Harmanpreet Kaur, BAMS, has a master's degree in hospital admin- SBAR
istration and is with the Department of Sports Sciences and Medicine Common techniques and conducts such as SBAR, debriefing,
at the Guru Nanak Dev University in Amritsar, India. She finished a
bachelor's degree in ayurvedic medicine and surgery and can be and so on, will enhance security. Creating the scenario
reached at [email protected]. briefing model will greatly enhance protection. Such
The authors declare no conflicts of interest. methods will help overcome the mutual gaps between
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. patients, doctors, and others arising from the current
DOI: 10.1097/JCE.0000000000000404 processes of education (Figures 3 and 4).

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 Feature Article

FIGURE 1. Measures of effective teamwork.

SBAR is a technique that requires immediate attention ago. Today, it is commonly used to provide updates on
and action to communicate critical information about a the status of patients as a mechanism for collaboration be-
patient's concerns. In an exchange of information among tween interdisciplinary healthcare providers (Figure 5).
medical professionals, the technical process is designed SOAP reports are usually used as a guide for communicat-
to ensure accurate information and level of expertise. ing information to the patient's EMR for doctors:
The SBAR was first military-built and implemented at
1. Subjective (S): What the client tells you
Kaiser Permanente in Colorado for healthcare. SBAR tool
2. Objective (O): What the counselor personally
can be used for admitted patients and ambulatory patients, a
observes/witnesses
communication tool between physicians, laboratory techni-
3. Assessment (A): Summarizes the counselor's clini-
cians, nurses, and so on. This can be used through patients
cal thinking
every time they are allowed to seek medical advice:
4. Plan (P): Describes the parameters of treatment
1. Situation: This part of SBAR determines what is (action plan and prognosis)
happening.
2. Background: This part of SBAR determines what
is the background. Debriefing
3. Assessment: What do I think the problem is? Debriefing is the mechanism of spending a few minutes or
4. Recommendation: What do I recommend? at the end of a day, assessing what the team has done well,
which issues have been, and what they will do differently
next time. Debriefing is an important tool for successful
SOAP collaboration and a constant learning and development
The SOAP4,5 note is a tool for recording information in a environment. In aviation and in military settings, de-
patient's chart and other forms, such as the admission briefings are equally important. They allow us to assess
record, which healthcare providers use. The SOAP note how well the process went, but it is important to learn
was taken from the problem-oriented medical record, how the next encounter will change. The implementation
which Lawrence Weed, MD, created almost 50 years of structured debriefing systems was restricted for

FIGURE 2. Strategies of effective communication.

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 Feature Article

FIGURE 3. Benefits of SBAR.

healthcare purposes. Structured debriefing was widely 2. permanent employees with experience of more
adopted after tests, but debriefings are often casual and un- than 6 months
structured inpatient care and occur between some staff 3. age older than 18 years
members instead of the entire team. This kind of debriefing
is not always useful for the enhancement of team perfor- Exclusion criteria were as follows:
mance because the procedure is carried out in an ad hoc 1. employees who have less than 6 months' working
fashion and does not include the entire team at the experience
same time. 2. part-time employees, interns, and trainees

Methodology Procedure
Research approach to be adopted in this study included
The study was descriptive and exploratory in nature: de-
collection of information/opinions from permanent em-
scriptive in the reporting of the phenomena and exploratory
ployees working in surveyed hospital in Amritsar through
in the determination of the interorganizational commu-
a well-structured questionnaire. Questionnaires were duly
nication teamwork in providing quality and safe care.
filled without prompting, and their informed consent was
Sample size of 200 healthcare employees included both
taken on questionnaires provided to them individually.
clinical and nonclinical who are working in surveyed
hospital, Amritsar.
Results and Discussion
Inclusion criteria were as follows:
The goal of the research was to examine the effectiveness
1. employees working in surveyed hospital in Amritsar, of coordination and the relationship between the health-
India care professionals engaged in direct patient care and to

FIGURE 4. SBAR form for nurse handover.

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 Feature Article

FIGURE 5. SOAP note.

propose different means of reducing errors and delays in such as the quality of care that was compromised. It was
communication, and the results show that the medical noted that patient's treatment and orders given by the con-
and nonclinical staffs of the hospital knew how to make sultants were administered rigorously. But some percent-
use of teamwork and coordination while providing quality ages of respondents disagreed with this as treatment
patient care. It was noted that disparities in therapeutic en- orders were sometimes not revised timely. The nursing
vironments had not been adequately addressed, healthcare staffs were generally in hurry to leave after their shift was
guidelines had not always been embraced by the supervi- over, and maximum conflicts occur during this time period.
sors, and relationship breakdowns lead to inadequate pa- They got frustrated with excessive documentation, which
tient care. There were also issues with the care of nurses, had affected the patient care (Figure 6).

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 Feature Article

FIGURE 6. Graph 1 shows data of disagreements resolved properly and graph 2 depicts the impaired performance during excessive workload.
Source Fortis escorts Hospital.

Having analyzed the data, the following are few sugges- and contribute to more efficient and effective communication.
tions that can enable hospital staff to incinerate their team- While inefficient coordination and collaboration between
work and communication if taken into consideration, which members of the healthcare team lead to patient injury and
in turn provides adequate, secure, and high-quality care: adverse events, strategies and mechanisms of delivery are
1. High-level officials and managers should encour- critical to avoiding unfavorable patient outcome. The suc-
age team members to openly speak and share their cessful use of teamwork and coordination has increased
views, make suggestions, and make their views care satisfaction. Results from this article concluded that
known across all facets of patient care. The appre- coordination and collaboration have strengthened patient
ciation of that and respect for their contributions care. Improving coordination and cooperation not only
should enhance their faith and morality, chang- decreases preventable adverse effects, but also increases
ing the workplace climate from terror because the efficiency and confidence of the staff, patients,
workers cannot speak out. and doctors.
2. Conflicts should be settled to please all. External
conflicts between workers should be settled collec-
tively in order not to affect the organizational References
structure. Delete expectations and goals from
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atmosphere.
2. World Health Organization. Being an effective team member. 2012.
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dled, and duties should be properly adjusted on handout.pdf. Accessed February 14, 2020.
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ficiency, and the quality of care rendered by staff barriers to effective teamwork in healthcare. Postgrad Med J. 2014;
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Accessed February 15, 2020.
Conclusion
5. 35+ SOAP Note Examples (Blank Formats & Writing Tips). Templates for
The research indicates that techniques can be successfully Microsoft® Word. https://www.wordtemplatesonline.net/soap-noteexamples.
implemented to improve coordination and collaboration Accessed February 16, 2020.

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