Interprofessionality: A Pathway to a More Sustainable National Healthcare System

Introduction

The healthcare system is like an orchestra. The orchestra combines instruments from different families which are unified by a set tempo that shapes the sound of the ensemble. These instruments must be in sync to produce the harmonious and satisfying sound that offers the patron an opportunity to experience the power and passion of classical music.

Preventable medical errors (PME) is the third leading cause of death in the United States (US) (Makary & Daniel, 2016; Robertson & Long, 2018) with an incidence range of 210,000 to 400,000 deaths per year (Andel, Davidow, Hollander, & Moreno, 2012; James, 2013; Makary & Daniel, 2016). The cost of PME is estimated at $19.5 billion to $958 billion per year (Patient Safety Movement, n.d). Despite advances in patient safety, PME persists across the nation.

An unmarked extremity, a soft sponge, medication dose, poor communication are possible precursors of PME that lead to patient injuries or death. Preventable medical errors that are frequently reported include: wrong-patient or wrong-site surgery; botched transplants, and death from myocardial infarction or septic shock following a discharge from the emergency department (Wachter & Gupta, 2019). According to a multicenter study led by researchers from Boston Children’s Hospital (Starmer et al., 2014), poor communication and hand-off errors are the most reported PME in hospitals across the US. Starmer et al., (2014) reported a relationship between communication, hand-offs, and PME. Hence PME decreased by 30 percent if improvements were made in verbal and written communication between healthcare providers during patient hand-offs. Similarly, PME decreased in the operating room through the use of ‘time-outs’ - when a procedure can be interrupted to confirm patient identification and surgical site selection (Altpeter et al., 2007).

Preventing PME has become the responsibility of the entire healthcare team. According to the Institute of Medicine (Wakefield, 2000), most PME in the healthcare system are caused by poor team collaboration and care coordination, particularly when patient care was provided by independent providers (Wakefield, 2000). Hence, effective collaborative interprofessional teamwork may serve to avoid and mitigate medical errors (Thomas, Sherwood, & Helmreich, 2003).

The healthcare industry looked toward aviation to determine how teamwork was instilled in the crew members to similarly inform healthcare teams. Following the tragic collision of two 747s on a foggy morning in Tenerife and other similar accidents, aviation began a series of training programs, generally called “crew resource management” or “cockpit resource management” programs, designed to train diverse crews in communication and teamwork (Wachter & Gupta, 2019). Some of the training programs utilized the Situation, Background, Assessment, and Recommendations (SBAR) technique - commonly used in healthcare - for communication strategies and briefing/debriefing techniques (Wachter & Gupta, 2019). The aviation industry acknowledged that these communication and teamwork-based programs were in large part responsible for improving the culture of aviation and the remarkable safety record of commercial airlines over the years (Wachter & Gupta, 2019). The dynamics of the airplane cockpit are similar to those of the operating room. Therefore, operating room services were selected to pilot-test the aviation model of safety training in healthcare (Rivers, Swain, & Nixon, 2003).