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TRANSCRIPT
Teamwork: Why there’s actually no “I” in ICU
Peter Brindley MD FRCPC FRCP-Edin Full-time Clinical Doc, and proud of it
Other Stuff:
Professor, Critical Care Medicine, UofA Adjunct Professor, Dossetor Health Ethics Centre
Vice-chair, Canadian Resuscitation Institute
Division of Critical Care Medicine
Declare your biases
Dr Giles Brindley. Physiologist…
NOT related!
Brindley dropped his pants before the audience …a very respectable erection
Prof Alvaro Morales Queen’s University Kingston, Ontario
“it’s amazing how much you can achieve when nobody cares who gets the credit”
Which team do you want?
With thanks to Dr D Paton Gay 0.08-0.38
Pit Stop: 1950 vs 2013
Which team do you want?
With thanks to Dr D Paton Gay 1.46 - End
Pit Stop: 1950 vs 2013
Medicine: the most humane of the sciences;
the most scientific of the humanities
E Pellegrino
The cold-hard truth (baker CMAJ 2004)
0200400600800
100012001400160018002000
Medical Auto Workplace Air
Deaths
A Ziv With permission
Bridging the “care gap”
Brindley P.G Can J Surg 2011
Some of this is obvious
“Engineering” Medicine
Knowledge exceeds any individual • Craftsmen Guilds Process engineers
Focus on Human factors, Team training • Engineering pressure tests a system- so should we
Brindley P.G Crit Care 2010 Brindley P.G ISICEM Yearbook 2010
W Dunn Chest/ D Angus/N Gibney communication
Personality Team
Culture
Less “me” more “we”
Culture Reinforcement
Can’t rely (only) on most fallible part
People Handshakes 1 0 2 1 3 3 4 6 5 10 6 15 7 21 8 28 9 36 10 45 11 55 12 66
Carl Friedrich Gauss (1777-1855)
“Science of managing complexity”
180 steps/pt/day 13,000 different diseases/syndromes “Too much plane for one man to fly”
A Gawande, P Pronovost, many others
“Science of team performance”
# Steps Probability entire process correct
1 0.95 25 0.28 50 0.08 100 0.06
LL Leape 1994; IHI. Preventing errors: the role of complexity. Pronovost PJ
“A team of experts is not an expert team”
• Obedience
• Milgram & electric shock
• Conformity • Asch
• Play a role • Zimbardo & Stanford Prison
• Performance in different-sized teams
• Dunbar
Human Factors, Crisis Management, Team Work
Brindley. J Crit Care 2010
“Completely preventable ”
“Didn’t take the time to become a team”
US Airways1549: “Miracle on the Hudson”
A Gawande 2009
“Sully Sullenberg”
“Captain America” “Hudson River Hero” “Le Nouveau Heros de l’Amerique”
The Pilot Not Flying fewer planes crash when copilot flies
A Gawande 2009
PATIENT
Surgeons Physicians
Respiratory Therapist
Family Spiritual services
Pharmacy
“Medical Ergonomics”
“Ectopia”: land of danger
De Vita et al. & Trauma.org S
L
A
S
S
Attudinia: equally dangerous! • Task v. Power
• Cognitive Dissonance
• Too early vs too late – The 7 yr hangover
Elaine Bromiley: just a routine operation www.youtube.com/watch?v=JzlvgtPIof4
System A vs System B: Focus vs Vigilance
Agnotology: Proctor & Schiebinger Brindley Crit Care 2010 P Croskerry; AIME text
Fixation Errors in medicine
P Brindley, S Taylor Resuscitation 2008
Blindfolded Simulation
“The blind learner: a unique addition to CRM Brindley, Hudson, Lord, J Crit Care 2008”.
5 dimensions of culture Geert Hofstede
Power distance index (PDI) Inequality/ How the less powerful accept their status
Individualism “Me” vrs “We”; loyalty; everyman for himself
Masculinity Assertive; money-focus; self-centre
Uncertainty Avoidance Comfort with uncertainty; rules versus style
Long term orientation Persistence; sense of shame; sense of face
• “Culture eats data for breakfast”
– Peter Drucker
Drucker 1909 – 2005
Many thanks Questions/comments?