Resources Module 4: Being an Effective Team Player
On November 29, 2009 at 3 am in the morning, 3-year-old Imanae spilt hot water on her wrist while playing with her friends who were celebrating the Muslim festival of Eid together. Her parents took her to the most prestigious and expensive Hospital in Lahore. Although it was a very small burn, they chose to go to the hospital as their baby was crying and they wanted her pain to go away as soon as possible. At the hospital they were met by the emergency ward staff nurse, who applied an ointment to her hand. When Imanae continued to cry because of the pain, the nurse called the doctor on duty. The parents noticed, when he walked into the room, that he had obviously been asleep and had just been woken up. The doctor instructed the nurse to give Imanae an injection, which was later (on investigation) was found out to be "Dormicum"(Midazolam). Imanae however continued to cry. Ten minutes later the doctor instructed the nurse to repeat the injection dose.Then fifteen minutes later, the sleepy doctor went to the pharmacy and bought another injection. He asked Imanae’s father to go and pay at the pharmacy for the injection. The doctor then instructed the nurse to inject Imanae with this 3rd injection which was "Pavulon"(pancuronium bromide) that he had earlier brought from the hospital's pharmacy himself. This was the moment when the little angel went completely silent and started losing consciousness. Just before she totally passed out, she started calling out her father’s name and saying that everything was getting blurred and she couldn't see clearly. The ECG showed a flat trace and CPR achieved nothing. The girl was dead.
The Pakistan Medical and Dental Council (PMDC), after a long investigation, has held the Hospital responsible for the death of 3-year-old Imanae Malik and imposed a fine and cancelled the professional registration of the doctor in question (Dawn, 2015).
Being an effective team player
Among other problems, the above patient story involves a highly dysfunctional team; the doctor recklessly acting alone and other team members, the pharmacist and the nurse, failing to speak up, or to alert him and stop complying with his orders of giving Pavulon injection. Pavulon (pancuronium bromide) injection is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. It should never have been used to treat pain from a minor burn as was done in Imanae’s case.
Effective teamwork in healthcare delivery can have an immediate and positive impact on patient safety. Team is defined as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common and valued goal / objective / mission, who have been assigned specific roles or functions to perform and who have a limited lifespan of membership.
Different types of healthcare teams include core teams, coordinating teams, contingency teams, ancillary services and support services and administration. Teams can improve care at the level of the organization, the team as a whole, the individual team member and the patient.
An effective team is one where the team members, including the patient, communicate with one another, as well as combining their observations, expertise and decision making responsibilities to optimize care. There is some evidence that multidisciplinary teams improve the quality of services and lower costs.
Challenges or barriers to effective teamwork include: changing roles, changing settings, healthcare hierarchies, individualistic nature of healthcare, instability of teams, failing teamwork, disagreement and conflict.
Resolving conflict and disagreement is crucial to effective teamwork which can be achieved by “Two challenge rule”, CUS (Concerned, Uncomfortable, Safety issue) or DESC (Describe, Express, Suggest, Consequences).
Read more using World Health Organization’s handout “Being an effective team player” (WHO,2012)
Optional readings include:
TeamSTEPPS which is an acronym for Team Strategies and Tools to Enhance Performance and Patient Safety
Teamwork: Collaboration and enhanced communication by HRH Global Resource Center (HRH, 2016)
Dawn (2015) PMDC holds hospital responsible for Imanae’s death [Online][Accessed on 28 April 2021] [Available at http://www.dawn.com/news/1180488]
World Health Organization (WHO) (2012). Being an effective team player [Online][Accessed on 28 April 2021][Available at https://www.who.int/patientsafety/education/curriculum/course4_handout.pdf]