Team Dynamics

Reviewed by Lia Lowrie, MD

Presented by Girish Deshpande, MD and Corrie Chumpitazi, MD

Girish Deshpande, MD, a pediatric intensivist, and Corrie Chumpitazi, MD, a pediatric emergency physician, presented an engaging post-prandial lecture about the importance of teamwork as it relates to healthcare, and specifically, pediatric procedural sedation.  Specific principles of the TeamSTEPPS program discussed are:

1. Definition of a team: Two or more individuals (can include the patient or family) with specialized knowledge and skills who perform specific roles and complete interdependent tasks to achieve a common goal
   1. Type: Predetermined or core team
      1. Sedation providers in a Radiology Suite
   2. Ad-hoc or contingency
      1. Code or rapid response
2. Leadership
   1. Importance of the leadership skill of listening and inviting expertise
3. Situational Monitoring and Assessment
   1. Individuals monitor situations from different perspectives and skill sets
   2. Teamwork is successful when communication of the assessments is clear
4. Mutual support
   1. Team members support each other in an anticipatory and collegial way
5. Communication
   1. The glue that holds the team together in a shared mental model

Drs. Deshpande and Chumpitazi stressed the importance of practice and training in order for team members to develop their own team work skills.  Simulation exercises are key for highly reliable and functional teamwork.

Surgery and Procedures in Low Resource Settings
Dr. Ann Marie Beddoe, MD, MPH provided a highly informative and quite sobering look at the difficulties faced in providing needed basic surgical services in low and ultra-low resource settings.  She described the extreme disparities in basic surgical and anesthetic services in some African countries.  The death rate from surgery and anesthesia has been identified by the WHO as unacceptably high in many areas.  Availability of surgical services is rarely recognized as a public health concern, there are few systems intact for surveillance of the effectiveness of surgical and anesthesia services in low resource settings, and few resources devoted to comprehensive adherence to safety guidelines.  Surgical and minor procedure challenges include wholly inadequate OR facilities, dysfunctional equipment for surgery and anesthesia, inconsistent source of pharmaceuticals, and lack of training for surgeons and anesthesiologists, nurse anesthetists and OR nursing.  Dr. Beddoe described in detail the experience of a World Bank funded health workforce team expecting to provide surgical support in a country who found such poor conditions that their expertise was best used in providing basic training in OR sanitation and equipment repair rather than in actually carrying out surgery.  She went on to discuss the pros and cons of the traditional medical mission approach, particularly in ultra-low resource settings, where the basic needs of the medical or surgical team may be completely wasted if they are not willing to provide care and expertise with an eye to allowing sustainability after they have left.