Medicine has depended on the extraordinary ability, training, energy, and commitment of its individual practitioners. It continues to do so today. Yet medical practice is becoming increasingly complex in its clinical information, devices, and procedures; and the acuity of patients is increasing since we now treat more difficult cases. Efficiency of care is critical, especially for those organizations that struggle with overcrowding or fixed budgets. At the same time, institutional and accreditation pressures are calling for evidence-based medicine, significantly improved communication, shorter duty cycles, and reliability improvements of multiple orders of magnitude.

As the legacy of heroism faces rising complexity, ‘sicker’ patients, efficiency demands, and institutional change, healthcare organizations are realizing they can no longer safely rely on brilliant and tireless individual performances. Diving catches, once a source of pride, are now seen to reveal safety risks and opportunities for improvement.

Medicine is now a team sport. Teams diagnose, test, and treat the patient. Members of the team do their part - play their role - with strong expectations about what others are doing or will do. Being able to act out of expectations for the actions of others is vital because, as in sports, teams in medicine change their membership many times during the course of caring for the patient. The team evolves over shifts, and changes almost completely following transfer to another unit. Specialists enter for brief consults. Some units and teams are involved for specialized tests, for recovery after surgery or other procedures, and for rapid response. Sometimes the team is best thought of as including the family, primary care physician, and advisors of varying types. Through these changes, the members of the team admit, communicate, round, problem-solve, plan, choose, treat, monitor, cover for one another, and discharge the patient.

The function of communication is to ensure that the team is coordinated now, knows the plan, and is prepared for possible complications. The effectiveness of the team depends on the quality of communication, especially during rounds and handovers. Failures of communication have been shown to be the leading critical factor in sentinel events and other highly negative outcomes. Great risks can follow from the loss of a key clinical datum or treatment task. Its not enough that its "in the EMR."

In real time, communication brings expectations about one another’s understandings and tasks in line. Here are illustrations of how the clinical situation creates the context, not just for treatment actions, but also for coordination needs.

Effectiveness also depends on the quality of the roles and role relationships - whether they cover the tasks that may arise, and how well they fit together. Conflict, inefficiency, and error in the organization almost always rest on role incompatibilities - roles need to be analyzed and harmonized.

Synergia has developed uniquely powerful methods and tools to produce maps of roles and role relationships. We create these maps to enable clients to establish the causes of conflict and resolve it, improve efficiency, develop change plans, and design practices for new facilities. We also train in methods for superior communication - including training in the distinction between passing clinical data and plans, versus aligning expectations about the team’s state and future. We develop coordination technology and practice solutions for clients. [Contact Synergia for more information on proprietary technology solutions for your organization.]