1. Thompson, Elizabeth M. RN, CNOR, MSN

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Effective teamwork contributes to workplace efficiency, effectiveness, staff retention, and patient safety. While this is true in any healthcare setting, teamwork takes on a different dimension in the OR. Every discipline depends on each other to promote the best patient outcomes. This interdependency can sometimes cause role confusion in the OR. For example, whose role is it to ensure proper patient positioning? Anesthesia personnel's? The OR nurse's? The surgical assistant's?

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While the ultimate responsibility may belong to one discipline, the reality is that all disciplines need to work collaboratively to ensure patient safety. This focus is constantly reinforced in healthcare using the example of the airline industry's initiative to em-power team members to "speak up" if someone observes an unusual or untoward event. The goal is to bring the problem to the team's attention before it results in a poor outcome.


A system-wide challenge

While this initiative has been in place for several years, team members are often reluctant to speak up. It might be the perception of a hierarchal power within the OR that doesn't welcome questions. Some may be worried about stepping on another discipline's toes, fear negative consequences, not want to appear ignorant, or any number of other reasons. The issue becomes a "system" problem and the focus is taken from the individual to a larger model.


Institutions have the responsibility to determine the best way to encourage staff to speak up. Every team's collaboration in the OR is unique. Some teams work well together, others don't. Diverse factors can effect team dynamics such as the introduction of new or different team members, the skill level of the team members, or the communication and trust between team members.


The organizational climate needs to support the goal of open communication. This goal can then be transferred to the individual OR and the team. Unfortunately, the overall culture within an organization can be supportive of a collaborative framework, but the individual subcultures are resistant to change.


Same goals, different perspectives

Why are individual teams often resistant to change despite a common goal to deliver outstanding patient care? The answer is as complex as the question and there are no easy answers. The intent for a collaborative practice within the OR may be sound and pure, but actualizing this framework against other individual goals compromises the purity. I have no doubt the team's goal and each individual team member's goal is to provide the best patient care. But other individual factors such as perceptions of efficiency and turf issues can undermine the overall goals of promoting the best patient outcomes and collaborative teamwork.


Encouraging input

Ultimately, an effective, cooperative team is built on open communication and trust. Each individual team member should feel safe to speak up because the organization supports this initiative. For example, a supportive organization could reward candor by offering incentives designed to encourage opposing viewpoints. Though most of us would normally prefer to suppress our individual views, better outcomes and better patient care are seldom achieved by remaining silent.


Elizabeth M. Thompson, RN, CNOR, MSN


Editor-in-Chief, Nursing Education Specialist, Mayo Clinic, Rochester, Minn.