Sucato Daniel J
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Pediatr Orthop. 2020 Jul;40 Suppl 1:S25-S29. doi: 10.1097/BPO.0000000000001526.
The ability for teams to work together in a coordinated manner may be where the greatest improvements in health care occur in the next generation. To perform at the highest level there are several key principles that all teams must have no matter what playing field they are on, including health care.
Several resources were used to identify the challenges we face in health care with respect to the delivery of quality care, improving outcomes and decreasing complications. A search of the lay press and scientific literature was evaluated to identify those key elements that lead to improvements in team performance. In addition, personal observations were accumulated with time and examples of strategies used at home institutions were identified.
The teams in our pediatric orthopaedic practices are many and include those in the clinic, the operating room, research, and our administrative office. The Institute of Medicine, in their influential article in 1999, defined the alarming rates of complications/harm occurring in the US health care system. In response, the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DOD) collaborated to create the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in 2006. This was implemented in military facilities and later civilian hospital settings with varied success in civilian hospital settings.
They defined key principles based around team structure, communication, leadership, situation monitoring, and mutual support. Other important foundational attributes of a successful team include identifying the vision of the team, hiring top-talent in the form of hard and soft skills, having open communication, being goal-focused, practicing accountability, and having an organized team. We can look to excellent examples in medicine, business, and sports to see where and how high-functioning teams have existed and to learn from them to implement similar successful teams.
Team performance is a function of talented members who share a common vision, who have the opportunity to voice their thoughts/opinions, and have the ability to be accountable to each other. Surgeons need to lead by example, and provide each member of the team an opportunity to contribute in a meaningful way which ultimately will improve the lives of the patients we are honored to care for.
团队以协调一致的方式开展工作的能力，可能是下一代医疗保健领域实现最大改进之处。为了达到最高水平的表现，所有团队无论处于何种领域，包括医疗保健领域，都必须遵循几个关键原则。
我们利用多种资源来确定在提供优质护理、改善治疗效果和减少并发症方面，医疗保健领域所面临的挑战。对大众媒体和科学文献进行检索评估，以确定那些能提升团队绩效的关键要素。此外，随着时间的推移积累了个人观察结果，并找出了所在机构所采用策略的实例。
我们小儿骨科业务中的团队众多，包括诊所、手术室、研究部门以及行政办公室的团队。医学研究所（Institute of Medicine）在其1999年具有影响力的文章中，指出了美国医疗保健系统中令人震惊的并发症/伤害发生率。作为回应，医疗保健研究与质量局（Agency for Healthcare Research and Quality，AHRQ）和国防部（Department of Defense，DOD）于2006年合作创建了“提升绩效与患者安全的团队策略和工具”（Team Strategies and Tools to Enhance Performance and Patient Safety，TeamSTEPPS）。该策略在军事设施中实施，后来也应用于民用医院环境，但在民用医院环境中的成效各异。
他们围绕团队结构、沟通、领导、情况监测和相互支持确定了关键原则。一个成功团队的其他重要基础属性包括明确团队愿景、以具备硬技能和软技能的形式招聘顶尖人才、保持开放沟通、以目标为导向、践行问责制以及组建一个有组织的团队。我们可以借鉴医学、商业和体育领域的优秀范例，去了解高效能团队存在的地点和方式，并向他们学习以组建类似的成功团队。
团队绩效取决于有才华的成员，他们拥有共同愿景，有机会表达自己的想法/观点，并且能够相互负责。外科医生需要以身作则，并为团队的每个成员提供以有意义的方式做出贡献的机会，这最终将改善我们有幸照料的患者的生活。
