Editorial

Teamwork

Healthcare team collaboration has been key to numerous developments in medicine. Otolaryngologists have advanced their subspecialties through assembling teams, without which some of our most notable successes might not have been possible. For example, extensive, complex skull base surgery requires close collaboration among otologists, head and neck surgeons, neurosurgeons, anesthesiologists, intensivists, oncologists, radiation oncologists, nurses, psychological professionals, social workers, nutritionists, and others. The state-of-the-art in professional voice care and the evolution of the subspecialty of laryngology were dependent upon voice teams, including laryngologists, speech-language pathologists, singing voice specialists, voice scientists, acting voice specialists, nurses, anesthesiologists, pulmonologists, neurologists, gastroenterologists, and others.

For some professionals, interdisciplinary collaboration and teamwork come naturally. For others, the concept sounds good, but execution can be challenging. This may be true particularly for traditional surgeons who are accustomed to working alone, “running the show,” and having total control. Recognizing the importance of teamwork and the intricacies of establishing and maintaining a successful team, the American College of Surgeons (ACS) convened an ad hoc committee and developed a “Statement on high-performance teams” that was approved by the Board of Regents of the ACS in October 2009. The brief statement is insightful, and otolaryngologists would benefit from considering its precepts. Although the statement was directed primarily at surgical teams, it is equally applicable to team collaborations in other venues.

The ACS statement has crystallized critical attributes of high-performing teams [Editor's note: Excerpts are reprinted below with the permission of the Bulletin of the American College of Surgeons 2010;95(2):23–4]. These include:

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  A commitment by all team members to teamwork for the best interest of the patient

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  Respectful behaviors, where contributions of all disciplines and providers are valued

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  Recognition and constructive resolution of conflict

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  Coordination among all team members that includes accountability for mutual performance awareness and backup behaviors

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  Leadership characterized by:

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  Timely, accurate, and structured communication with verification of understanding

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  Effective care coordination, including structured hand-offs through all phases of care

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  Ability to remain flexible and adaptable to changing situations

These “critical attributes” are well conceived, but they are not as simple as they may seem. Leadership styles of high-power surgical professionals are not always optimally sensitive to the needs of other team members, particularly nonsurgeon (or nonphysician) colleagues. In addition, leadership of a team also requires the ability to follow, and to listen with a truly open mind to input from other members of the team. One of the great benefits of teamwork is the collaboration of people who have expertise in different (but overlapping) areas. A good leader has to have as much intuitive respect for the knowledge and importance of each member of the team as for his/her own contribution and knowledge. Also, it is easy to talk about communication, and few would argue against its importance; but it requires time that many of us do not have. In order for a team to function as it should, every member of the team (including the otolaryngologic surgeon) has to make it a priority to take the time to interact effectively and communicate with other team members.

The ACS statement also addresses obligations of healthcare organizations and lists “four critical components for success”:

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  Ensuring that all staff learn and use team-based knowledge, skills, and attitudes (the institution must provide appropriate education and training)

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  Providing opportunities to practice team-based skills in a supportive environment that includes feedback and fosters experiential learning

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  Building teamwork techniques, prompts, and structure into the institutional workflow, such that teamwork becomes the routine and team behaviors are the norm

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  Institutional leadership and governance must support sustained team-based practice through the following:

The ACS's Ad Hoc Committee on the Development of High Performance Teamwork in Surgery Through Education should be commended. Its statement, the essence of which is included in this editorial (with minor modifications and omissions), crystallizes the elements needed for successful collaboration. The guidelines embrace intellectual open-mindedness, appropriate behavior, and efficient communication. Teams that incorporate these principles successfully not only provide state-of-the-art patient care, but they also advance our knowledge through interdisciplinary intellectual creativity.

When teamwork functions at its best, the whole truly is greater than the sum of the parts. All otolaryngologists should benefit from consideration of these principles, whether they are collaborating in a skull base team, head and neck team, or voice team, or if they are simply trying to optimize a team to make an office run well. The teamwork concepts are universal, but that does not mean they happen without thought, work, ongoing assessment, and constant change.