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Effective interprofessional teamwork and communication are integral to patient safety. The Institute of Medicine highlighted the effect of poor communication on deleterious healthcare outcomes in the 1990s.[1] Detrimental outcomes caused by preventable errors are commonly the result of multiple human factors, as opposed to 1 single error by an individual. Reason et al. argue that every sequential step in medicine has the potential for failure, and medical professionals should be vigilant of this reality.[2] Commonly, such failures are the result of inadequate communication. Miscommunication is to blame for up to 30% of malpractice awarded lawsuits, where a patient is incapacitated or killed, according to the Control Risk Insurance Company.[2] The future of patient safety and avoidance of medical errors should be predicated upon systems-based error prevention instead of solely relying on a healthcare provider’s vigilance. Handoff periods are particularly vulnerable to deficiencies in verbal communication due to language impediments, misunderstandings, interruptions, and hesitation to speak up against authority.[3] Successful communication strategies are fundamental to productive team structure, collaboration, and task completion.[4] Standardized communication systems have been developed to reduce the risk of inappropriate information transfer. The aviation field has led to significant changes in team training concepts to increase patient safety, known as Crew Resource management.[5] Closed-loop communication (CLC), including a call-out, is based on standardized terminology and procedures to ensure safe communication.[6] A call-out is a primary verbalization to inform the team of a meaningful change or observation regarding patient care. CLC is a communication model from military radio transmissions based on verbal feedback to ensure proper team understanding of a meaningful message. CLC is a 3-step process, where 1) the transmitter communicates a message to the intended receiver, utilizing their name when possible, 2) the receiver accepts the message with acknowledgment of receipt via verbal confirmation, seeking clarification if required, and 3) the original transmitter verifies that the message has been received and correctly interpreted, thereby closing the loop.[7]

Despite widespread attempts to implement improved communication strategies with CLC, errors associated with ineffective communication are far too common. There has been a leap from problem recognition during operative training to solution implementation, failing to explore communication lapses among teams.[31] The differences in communication patterns between clinical subspecialists (anesthesiologists, surgeons, and nurses) suggest that a more in-depth understanding of specialty-specific practices may yield further insights into quality improvement. Salas et al proposed a model for 5 elements of effective teams, including team leadership, mutual performance monitoring, backup behavior, flexibility, and team orientation, with a groundwork of mutual trust and CLC.[36] Strong leadership involves task coordination, team development, inspiring motivation, and fostering a positive environment. Performance monitoring requires team members to have enough knowledge to identify failures or task overloads. In contrast, backup behavior requires supportive behavior from team members, including workload redistribution and altered task delegation. Flexibility or adaptability enables a team to respond acutely to changes in a dynamic clinical environment. In contrast, team orientation is the willingness to take the perspectives of others into account and the valuation of team goals over individual ones. Shared mental models lead to common situational awareness and an integrated treatment plan for the patient while considering individuals' roles and tasks. This shared mental model allows for effective team-based problem-solving and decision-making.

Salas et al proposed a model for 5 elements of effective teams, including team leadership, mutual performance monitoring, backup behavior, flexibility, and team orientation, with a groundwork of mutual trust and CLC.[36] Strong leadership involves task coordination, team development, inspiring motivation, and fostering a positive environment. Performance monitoring requires team members to have enough knowledge to identify failures or task overloads. In contrast, backup behavior requires supportive behavior from team members, including workload redistribution and altered task delegation. Flexibility or adaptability enables a team to respond acutely to changes in a dynamic clinical environment. In contrast, team orientation is the willingness to take the perspectives of others into account and the valuation of team goals over individual ones. Shared mental models lead to common situational awareness and an integrated treatment plan for the patient while considering individuals' roles and tasks. This shared mental model allows for effective team-based problem-solving and decision-making. A meta-analysis of 72 studies with 4795 teams across various industries revealed that successful information sharing predicted team performance.[32] Information sharing is most crucial during periods of handoff, including interdepartmental transfers from the emergency room to the operating room or intensive care unit, during a shift change, and across professional boundaries, including physician to nurse.[33] In a British study of handoff to the medical floor, less than half of residents felt confident in their patient handoffs.[34] In the same vein, in an observational study of operating room procedures, Lingard et al. reported over a quarter of communication events as failures, where 36% of these had adverse outcomes, including operating room delays, waste, staff disgruntlement, and procedural errors.[40] Mazzocco et al. found that teams that shared information less frequently at the start of an operative case or at postoperative handoff time had more than double the risk of surgical complications than teams that shared information more regularly.[41] Evidence suggests that specific techniques to improve information sharing can also enhance the clinical management of patients in high-acuity settings. Verbalizing observations aloud and involving team members in decision-making during a crisis aids the team in sharing a mental model.

A meta-analysis of 72 studies with 4795 teams across various industries revealed that successful information sharing predicted team performance.[32] Information sharing is most crucial during periods of handoff, including interdepartmental transfers from the emergency room to the operating room or intensive care unit, during a shift change, and across professional boundaries, including physician to nurse.[33] In a British study of handoff to the medical floor, less than half of residents felt confident in their patient handoffs.[34] In the same vein, in an observational study of operating room procedures, Lingard et al. reported over a quarter of communication events as failures, where 36% of these had adverse outcomes, including operating room delays, waste, staff disgruntlement, and procedural errors.[40] Mazzocco et al. found that teams that shared information less frequently at the start of an operative case or at postoperative handoff time had more than double the risk of surgical complications than teams that shared information more regularly.[41] Evidence suggests that specific techniques to improve information sharing can also enhance the clinical management of patients in high-acuity settings. Verbalizing observations aloud and involving team members in decision-making during a crisis aids the team in sharing a mental model. One of the limitations to enhancing CLC among professionals is that different groups have different expectations regarding the content, timing, and generalized structure of information transfer and may not grasp the roles and priorities of other groups.[35]Medical training predominantly occurs in ‘silos,’ and few providers receive teamwork training. Differing levels of education and stark separations of disciplines may impede teamwork. Hierarchical challenges also exist in medicine; while senior staff members are comfortable utilizing commands, junior staff may be more reticent to challenge decisions or offer suggestions for alternative plans regarding patient care. This hierarchical structure has been shown to have disastrous consequences in the aviation industry, where junior crew members fail to challenge the ill-advised decisions of their seniors, leading to catastrophic outcomes.[36] Every healthcare team member requires empowerment to contribute to information regarding patient safety.