UBC Theses and Dissertations
Uncovering teamwork in a pediatric emergency department Manio, Trisha Joyce
Effective teamwork underpins multidisciplinary healthcare practices providing safe, quality care to children and their families. Emergency departments (EDs) are multifaceted, acute health care environments, imbued with uncertainties and prone to potential adverse events. There exists a paucity of research however about the impact of, the barriers and facilitators for, as well as, the overarching features of effective teamwork in a pediatric emergency setting. The current study addressed the knowledge gap by providing foundational insights to build future work to enhance, support and sustain this multidisciplinary collaboration and teamwork. Offered here are insights to the teamwork practices of a diverse group of 15 health care professionals (HCPs) who worked in a pediatric Emergency department (ED). Comprising individual interviews, the timing of the data collection coincided with the department relocating to new larger premises. The current study findings revealed that collaboration, communication and skilled leadership were highly rated facilitators of effective teamwork. Within the context of established and ad-hoc teams (teams that assembled quickly without pre-planning to provide intensive acute emergency care), respect, role awareness and trust were disclosed as contributing factors to effective teamwork. Barriers to achieving effective teamwork were also discussed, and most ran counter to the aforementioned facilitators. For example, ineffectual leadership negatively affected teamwork to the extent that staff retention issues were linked to feeling undervalued and subordinate to some report line leaders. This was particularly evident during trauma situations when ad-hoc teams formed and leadership wavered. Additionally, within the context of jockeying for position and jurisdictions (turf wars and tensions), the findings revealed challenges related to the ownership of care, further fracturing teamwork and signaling a need for culture shifts. The study concludes with clinical implications and recommendations for enhancing effective teamwork in pediatric EDs, and by extension the provision of safe care. A key recommendation discussed relates to the development, implementation and formal evaluation of a team training program to advance staff competencies in fostering change and collaboration. Furthermore, the incorporation of multidisciplinary simulation strategies, focused on non-technical skills (i.e., communication), along with a staff driven ED workplace respect policy, could also strengthen effective teamwork practices.
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