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Analysis

14 Care Team Factors Linked to Safety for Older Hospital Patients

By Christopher Cheney  
   September 10, 2019

Care team factors associated with patient safety include teamwork, a multidisciplinary approach, knowing each other, and openness to questions from staff members.

There are more than a dozen care team factors associated with patient safety on hospital wards for older patients, recent research shows.

The number of Americans over age 65 is expected to double to nearly 100 million by 2060. With multiple chronic conditions and high costs of care at the end of life, older adults have relatively higher healthcare costs compared to younger Americans. In 2010, citizens over age 65 were 13% of the population but accounted for 34% of healthcare spending.

The recent research published in BMJ Quality & Safety features data collected from 70 staff members working on eight hospital wards for older patients, including 23 nurses and 10 doctors. The researchers found there were 14 care team factors that contributed to patient safety on the wards:

  • Knowing each other
     
  • Trust
     
  • Multidisciplinary approach
     
  • Integrating allied health professionals throughout ward activities
     
  • Teamwork
     
  • Openness to questions from staff members
     
  • Setting expectations
     
  • Pleasure in coming to work
     
  • Learning from incidents
     
  • Acquiring additional staff
     
  • Stable and static teams
     
  • Focus on discharge
     
  • Support from healthcare organization leadership
     
  • Keeping patients and families informed

The BMJ Quality & Safety researchers highlighted five of the care team factors:

1. Knowing each other: Familiarity with coworkers helped staff to support each other in providing safe patient care.

"Friendly, personal connections between staff members were perceived to facilitate communication, influence their ability to contribute different perspectives, encourage them to work beyond silos and to be more broadly involved in patient care. The importance of knowing each other was apparent across professional grades and roles regardless of whether staff were permanent or temporary team members," the researchers wrote.

2. Multidisciplinary approach: Establishing a multidisciplinary care team encourages staff to get involved in all aspects of patient care and blurs the lines between care team roles.

"Everyone's contributions were encouraged and valued; staff felt listened to, were actively involved in ward activities and were kept informed of the bigger picture rather than just being told essential information. This created a shared awareness about a patient's care plan and the risks they faced, and it engendered a sense of responsibility towards patients and the team. Positively deviant wards particularly emphasized the importance of involving non-professional staff such as healthcare assistants and domestics in ward activities," the researchers wrote.

3. Integrating ward-based allied health professionals: Most of the wards in the study had allied health professionals such as physiotherapists and occupational therapists assigned to work in single wards. Integration of these staff members into the wider team was associated with higher degrees of patient safety.

For example, two wards created dedicated workspaces to allow therapists to complete all of their tasks such as documentation on the ward, which promoted communication between the allied health professionals and the rest of the staff. Another ward crafted its pharmacist's work schedule to allow participation in daily safety meetings.

4. Teamwork: Working together as a team promoted collaboration between staff from different professional groups and experience levels.

"Staff worked beyond silos contributing to multiple aspects of patient care and they trusted one another's judgments. Although this was considered to make their teams more effective, staff often struggled to describe how, referring to a 'feeling they got' and a lack of distinction between 'them and us,'" the researchers wrote.

5. Openness to questions from staff members: Establishing an open environment for asking questions promotes an emotional lift from being able to approach other staff members without concern.

"This ensured that problems were raised with the wider team and it enabled information to be checked immediately and/or passed on to others without delay. Again, this was apparent across staff grades and professional groups and was particularly evident for new team members such as rotating doctors or student nurses," the researchers wrote.

Traits of successful care teams
 

Effective care teams that work with older patients achieve a comfort level in working with each other and have shared objectives, the researchers wrote. "Together, some of the findings suggest that staff within positively deviant teams experience high levels of psychological safety (which facilitates interpersonal risk taking) and possess shared mental models (a common understanding of shared goals, roles and how to achieve these)."

The study calls into question patient safety initiatives that focus only on discrete aspects of safety such as ward-level efforts to address specific errors and harm, the researchers wrote. "That focus should also be dedicated to improving the cultural contexts that underpin a range of safety outcomes. Although this proposition is unsurprising, the balance is yet to be struck—healthcare organizations do not typically facilitate relationships, integration and multidisciplinary working as a means to promote safety."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

With multiple chronic conditions and high costs of care at the end of life, older adults have relatively higher healthcare costs compared to younger Americans.

Effective care teams that work with older patients achieve a comfort level in working with each other and have shared objectives.

To boost safety, healthcare organizations should foster relationships, integration of care teams, and a multidisciplinary approach to care.


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