Team Training Leads to Better Outcomes and Staff Morale

By Jennifer Larson, contributor

January 10, 2012 - Can a program that builds teamwork among a surgical team make a difference for patients and staff? A new study in Archives of Surgery suggests that it can.

A team of researchers analyzed data from the Veterans Health Administration (VHA) Surgical Quality Improvement Program to compare surgical outcomes in hospitals prior to and after enrolling in a special teamwork and communication program. They found that hospitals logged a drop in surgery-related complications after training surgical staff members in the VHA’s Medical Team Training (MTT) program.

The research team looked at data from nearly 120,000 surgeries that were performed at hospitals over a three-year period, from 2006-2008. Thirty-seven of the 42 facilities with the teamwork program, or 88 percent, improved their complication rates. Of the 32 hospitals that had not implemented the program, only 22 (69 percent) improved their complication rates.

The Medical Team Training program was originally launched as a VHA pilot program in 2003, and was rolled out on a larger scale in 2005. Although it was originally mandatory for critical care units, that is not the case today. But the program has become an integral part of the VHA culture--and even new units and facilities regularly request training sessions prior to launching.

Team Training
Doug Paull, M.D., co-authored a VHA study that found surgical team training can enhance patient outcomes and staff morale.

“Medical Team Training [MTT] is just part of what we do and who we are,” said surgeon Doug Paull, M.D., a researcher at the VHA’s National Center for Patient Safety in Ann Arbor, Mich., and co-author of the new study.

The MTT program focuses on creating a multidisciplinary team that works well together and communicates across professional boundaries with the goal of providing safer patient care. As part of the training, participants learn structured communication strategies such as the SBAR technique, or Situation-Background-Assessment-Recommendation, which is used during handoffs. After training, they devise and launch an ongoing project to implement those new strategies.

This type of team-building training is becoming more common in many healthcare organizations, in part because of changes in Medicare rules that affect (or eliminate) reimbursement for certain complications, as well as the greater emphasis on eliminating “never” events. Additionally, Paull noted, a program like MTT is not expensive and does not require outlays of money for new technology, yet it can produce significant results and reduce surgical mortality rates. And it can improve morale--a less tangible but very important result.

“Morale matters, and morale is much better after Medical Team Training, whether you look at decreased turnover which has been measured and published, or other outcomes,” Paull said.

Co-author Lisa Mazzia, M.D., noted that even seemingly small aspects seem to have a significant impact on team morale. For example, the MTT program brings all team members together to participate in training sessions at the same time. The team members get the chance to learn each other’s names and roles at a time when they are not under any pressure. They also get the chance to acknowledge and discuss the obstacles they face and how they can work together.

“That’s been a real revelation to a lot of people,” said Mazzia, co-director of the MMT program since 2007.

Surgeon Martin Makary, M.D., MPH, a faculty member at the Johns Hopkins School of Medicine and School of Public Health, said that introductions are the first item on a surgical safety checklist that he developed for the World Health Organization. People start to feel more comfortable with each other after introductions, he noted, which can lead to them feeling more comfortable speaking up when they see something that might cause an error or contribute to an adverse event.

A number of other studies in recent years have proposed that a greater emphasis on team building can have positive benefits for both staff and patients.

For example, a 2006 study that was published in the Journal of the American College of Surgeons noted that discrepancies exist among the perception of teamwork in the surgical setting. According to “Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder,” the aviation industry had demonstrated that the appropriate attitude toward teamwork can result in error reduction, and a similar attitude in healthcare can also result in better patient outcomes and reduce nurse turnover.

But there have often been barriers to achieving that teamwork. According to the 2006 study and others, physicians are less likely to report problems with teamwork in their ORs, while nurses are more likely to report dissatisfaction with the teamwork (or lack thereof). Makary noted that surgery has traditionally been very hierarchical, which can be very intimidating to nurses and other team members.

“Slowly, the culture is changing,” said Makary, who also co-authored the 2006 study.  “It’s [been] a very rigid culture, but it is slowly changing.”

Linda Groah, MSN, RN, CNOR, executive director and CEO of the Association of periOperative Registered Nurses, agreed that the operating room’s hierarchical set-up was problematic in the past. Nurses and physicians didn’t train together and so often they didn’t learn to communicate effectively with each other. It seemed inevitable that the surgeon was going to “come out on top” when they were put together in a clinical setting--and that nurses might not feel they could speak out.  She said she’s pleased to hear about the increased awareness of the need for more interdisciplinary collaboration and communication.

“Teamwork in the operating room is absolutely essential,” said Groah. “The number one reason is that the patient is very vulnerable…They can’t speak for themselves, so the team has to be focused and patient-centric so there aren’t any issues that come out that are lapses in judgment or disrespect.”

“That’s what we really want to strive for: that culture of safety, where everyone is aware that something might go wrong and they’re on guard against that,” she concluded.