Meeting tomorrow's health care needs: teamwork trumps autonomy.

THE AMERICAN HEALTH CARE SYSTEM is rapidly undergoing a transformation that is as subtle as an earthquake. Internal forces include workforce shortages; wide variation in the quality and competence of nursing graduates; a physician education model that is decades old and still overvalues individual competence over best team care; an inpatient model of care that is inconsistent with current consumer demand for safe, high quality, cost-effective care; and a preventable medical error rate that is unacceptable to both health care providers and society at large. External forces include an aging and increasingly diverse population; a strong consumer movement; an explosion of new medical knowledge and technologies with poor guidance as to best use of these tools; demand for transparency; and health care organizations operating in an economically strained, competitive environment. These forces of change have merged quickly into what seems to be the perfect storm: an indictment that the delivery of health care services is unreliable, costly, unsafe, inefficient, and ineffective. To achieve the 21st century health care system we envision, enormous change needs to occur. Central to the innovation that is required today is an emphasis on improved teamwork and communication among health care professionals. The absence of teamwork comes from belief systems that are deeply embedded in health care culture; physician education grounded in a strong sense of autonomy (captain of the ship attitude); and a work environment that supports a hierarchy gradient so steep that it is still considered unacceptable for nurses, and other allied health professionals, to express their opinions freely to physicians. Today's workforce culture is not only averse to teamwork, but one in which teamwork is blatantly discouraged. The strongest evidence for a call to action regarding the need for a cultural shift in health care comes from an extensive body of research that identifies the factors that contribute to undesirable patient outcomes. Lack of teamwork and communication are at the top of the list. The contemporary approach to patient safety recognizes that most errors are made by the brightest and the best, and preventing medical errors often involves improving teamwork and communication among clinical teams. Effective team culture promotes openness, collaboration, communication, and learning from mistakes. A preponderance of evidence suggests that where safety is a priority, highly complex, interrelated processes and tasks are best performed by teams. …