Week 6 Group/Team Collaboration & Laboratory Errors

Group or team

• made up of individuals from the same or different organizations/departments within the same organization

• Majority of groups have 4 -12 individuals

  • a group with more than 12 individuals is possible

    • but is usually a committee

      • determine safety and quality of patient care

    • with each having their own agendas

• Members are connected through a common purpose

  • are working towards

    • a common goal

    • improvement

    • major change or project planning

• Members are interdependent

  • so behaviors, communication and skills

  • have significant impact on the members

Healthcare Teams

• is a small group, mandated with a specific task

  • committed to achieving the same clearly defined goal as stated by the patient

• has clearly defined roles

• is committed to achieving the same goal

• patients circle of care

  • physican and allied health workers

• Each member has a unique role and function

  • each member brings expertise and knowledge about the patient

in units

• interdisciplinary teams are made up of

  • physician

  • nurse

  • physiotherapist

  • social worker

• the specific goals are planning the

  • treatment

  • discharge/transfer of the patient from the Hospital

Team Work

• Individuals working together for a common

  purpose by collaborating with others

• All individuals contribute knowledge and expertise

Characteristics of Effective Teams

1. Work together with specific objectives in mind

2. Members place the best interests of the team above

individual interests

3. Each team member has an important role and contributes

uniquely to the work

4. Use agreed-upon decision-making and communication

processes

5. Use problem-solving skills and trust each other

Tuckman’s (four) Stages for Group Development

1. Forming

2. Storming

3. Norming

4. Performing

Forming (Stages of Team Development)

• Hesitant participation

  • need ice breakers as all strangers

    • need introductions

    • formal/informal leader to guide group through this step

• Roles and responsibilities are unclear

• Exchange of functional information

• high dependence on leader for direction+

Practical Approaches

• Get acquainted and orient members to the tasks

• Clarify roles & goals

• Establish group norms and agreements

• Identify information resources

Storming (stages of Team Development)

• Resistance to the task as members realize it is more difficult than imagined

• Conflict among the members

  • because not everything is going smooth

• Polarization of issues and lack of unity

• Leader may be challenged by team members

Practical Approaches

• Use active listening

• Be flexible and open-minded

• Clarify issues

• Apply different approaches to conflict

Norming (Stages of Team Development)

• Development of cohesive team

• Engage in fun activities

• Co-operation & commitment is high

  • making progress improves cooperation

• Acceptance of others & respect for individual differences

Practical Approaches

• Give and receive constructive feedback

• Focus on the problem and not on the person

• Seek opinions and perspectives from the team

Performing (Stages of Group/Team Development)

• Shared vision & values

• Strong interdependence of task & relationships

• Team has a high degree of autonomy

  • everyone understands role

  • shared decison making, no formal leader

Practical Approaches

• Use participative decision-making

• Sense of achievement

• Apply problem-solving approaches

Healthcare Problem Solving Group Stages – Four Stages

1. Opening Stage

2. Feedforward Stage

3. Feedback Stage

4. Closing Stage

Opening Stage: (first stage of Healthcare Problem Solving Group Stages)

Members in the group introduce themselves, their positions and roles

Feedforward Stage (second stage stage of Healthcare Problem Solving Group Stages)

• The group identifies the mandate in terms of what

  needs to be done

• who will do what and the date the deliverables must be

  submitted.

• In hospitals.

  • Groups have an agenda which identifies the problems/issues that need resolution

  • any sharing of information and the tasks to be achieved

Feedback Stage (Third stage of Healthcare Problem Solving Group Stages)

• The group reflects on what has been done and what else needs to be accomplished.

  • The group evaluates if the problem is solved

  • do we need more information

  • are we on track

  • do we need to re-group or change course

Closing Stage (fourth stage of Healthcare Problem Solving Group Stages)

• The members reflect on the group’s accomplishments.

• The focus of the group changes from tasks to interpersonal relationships

  • as the group terminates

Brainstorming

• technique used in group for analyzing a problem by generating many ideas

• is common process used in groups for problem solving as

  • it lessens group inhibitions

  • encourages participation by all the members

• Each member contributes many ideas

  • no evaluation or criticism of the idea is permitted

examples

• Each idea is written on a sticker “post-it” note

  • the members then group the ideas

    • in order of their

      • importance based on their individual perspective

      • resources required

• The ideas are evaluated

• the idea with the most “post-it” notes is considered as the priority.

Process Improvement

• Define the problem and the root causes of the situation below

  • something a healthcare administration group would try to address

  • possible solution

    • add wait time to ticket to allow patient to comeback a later time 

• Patient arrives at Blood Collection Lab - 08:00

• Patient asked to take a number - 08:05

• Patient ‘s number is called by Receptionist - 08:30

• Receptionist checks patient’s requisition and demographics and then asks the patient to take a seat - 08:40

• Patient waits until called by Phlebotomist - 09:10

• Phlebotomist calls patient and the blood is taken - 09:15

• Complaint by Patient about waiting for over one hour
  

Decision by Authority (a type of decision making)

the group members provide recommendations with advantages and disadvantages.

The final decision is made by Management,

• is considered an efficient process for decision making.

  • Management has a “big” picture view

  • understands the impact the decision may have on the organization.

• ensure information flows to management

• The disadvantage

  • is that the members may feel that they have very little influence

    • understandable feeling

Majority Rules (a type of decision making)

• Where the group’s majority makes the decision and voting is the method used to decide on issues.

• It is not an unanimous decision but a decision that the group can live with.

• Disadvantage 

  • The minority members of the group may feel

    disenfranchised

not ideal for important/big decisions 

Consensus (a type of decision making)

• Each member has a say and the opinions are carefully considered.

  • not efficient, but more group satisfaction 

• The best ideas/opinions are synthesized and presented as a solution(s) that the  group agrees to, and recommends be implemented.

• Disadvantage 

  • Consensus is time consuming

    • hard to do

    • timely meetings

  • however it facilitates participation and collaboration.

Focus Groups - in Healthcare

• common means to elicit opinions on service delivery

  • but more importantly are used for

    • clinical trials and clinical studies

• consists of people who use the service or the drug or have undergone a particular procedure.

• Group is lead by a facilitator, who explains the process, the goals and time limit for each speaker on each question.

• There is usually a scribe and the dialogue is taped

• intent of focus groups is to

  • analyze the information generated by the groups,

  • implement changes to the service delivery model

  • modify the drug composition

Patient Partner Program (at the school level)

• are community members including

  • patients

  • family members of patients

  • caregivers of patients

• who with the hospital staff to enhance the care experience from the perspective of the patient, family and caregiver

• Patients share their unique experiences and perspectives

  while in hospital or about the service they receive in

  hospital clinics.

• How Will it Help Improve Patient Care?

  • By considering the patient care experience from

    many different perspectives

    • hospitals adapts current and future practices to be more inclusive

    • create the best health experience for all

      patients and their families

• In practice

  • In 2023-2024 the MLAB program plans to include patient

    • who have had experience with phlebotomists

    • or the lab as partners with lived experience to support students in their

      learning.

  • The plan includes having patient partners participate as guest lecturers in course MLAB 102

    • with students having an opportunity to ask questions and write a reflection

      about their experience

  • will be recorded

Group Culture – Group Norms

• These are rules and standards that identify appropriate behaviors among the group members

  • are explicit

  • Attending meetings

  • being on time

  • flexibility to learn

  • take on additional tasks

  • delivering what is required etc

• In groups,

  • if you accept the norms

  • you are more likely to consider the group membership as important.

• It is the group norms that

  • hold the members together

  • where every one knows

    • how to behave

    • to depend on each other

• If you violate the norms, you are asked to leave the group

Groupthink

•  A phenomenon in groups and is marked by the consensus of opinion without critical reasoning or evaluation of consequences or alternatives.

• evolves around a common desire to not upset

  • the leader

  • the balance of a group of people by creating conflict

• Creativity and individuality are considered potentially harmful traits that should be avoided

• causes employees and their bosses to overlook potential problems in the pursuit of consensus thinking.

  • Because the individual’s critical thinking is viewed negatively

  • employees may self-censor themselves and not bring up alternatives

    • at the risk of upsetting the status quo.

• Strategies:

  • 1) Ability to air objectives and to accept constructive criticism

  • 2) Consider unpopular alternatives

  • 3) After reaching a preliminary consensus on a decision

    • any alternatives should be reconsidered

Dysfunctional Groups

• Conflict that obstructs the achievements or the goals of the group

• Being Aggressive:

  • Criticizing and blaming others

  • showing hostility against the group or individuals

• Blocking:

  • Unreasonably resistant

  • slowing the progress of the group

  • going off tangent and arguing too much

• Recognition-seeking:

  • trying to call attention to self

  • boasting and reporting on personal achievements

• Dominating:

  • Asserting authority by manipulating the group

  • interrupting others

• Horsing Around:

  • Clowning

  • joking and disrupting the work of the group

• It is Conflict

  • weakens the organization

  • valuable employees leave the organization

  • the distrust causes a negative impact on productivity

American System - Medical Errors & Financial Cost

• Over 33.6 million admissions to U.S. hospitals in 1997

  • 44,000 to 98,000 Americans die in hospitals each year as a result of medical errors

  • Attributable to the 8th-leading cause of death

  • Exceed the deaths attributable to

    • motor vehicle accidents (43,458)

    • breast cancer (42,297)

    • or AIDS (16,516)

• Impact of medical errors is lost income, lost household production, personal disability, health care costs

  • $37.6 billion to $50 billion are accountable for adverse events

  • slightly higher than the direct and indirect costs of caring for people with HIV and AIDS.

A 2004 Canadian study estimated that in 2000 of the 2.5 million admissions to hospitals in Canada, about 185,000 patients were associated with an adverse event of which 70,000 were potentially preventable.

Error

• the failure of a planned action or procedure to be completed as intended (i.e., error of execution)

• Examples

  • the use of wrong

    • patient information

    • specimen

    • procedure

    • treatment

    • medical equipment

    • medication

Adverse event

• injury caused by medical action or procedure or information resulting in a wrong diagnosis or treatment or injury/harm or even death to the patient

• is not related to underlying health condition of the patient.

• are preventable

SOME COMMON LAB ERRORS

Lab incident reports must be completed

Highlighted the most common

• patient ID error

• lost sample

• sample delayed in transit

• contaminated samples

• wrong test performed

• test performed inconsistent with the written procedure

• proficiency testing error

• no action on out of range controls

• false negative result

• late reports

• missing reports

• Complaints

• laboratory accident “near miss”

Errors in Testing Process – Pre-Analytical

• occurs before testing of sample occurs

  • test selection

  • Test collection

  • sample transport

  • errors in processing

Examples include:

• Wrong sample collected

• Sample mislabeled or unlabeled

• Sample stored inappropriately before testing

• Sample transported inappropriately

• Reagents or test kits quality damaged by improper storage

• Needle stick Injury

Post-Analytical Errors

• Occurs when results are available till in physicians hands

• does not include misinterpretation by doctors 

  • unless if was done by lab tech

• errors after sample testomg

  • report creation

  • report transport

System related errors

• A quarter of incidents were related to data output problems, such

  • as retrieving the wrong patient record

    • because the system does not ask the user to validate the patient identity before proceeding.

• This kind of problem has led to incorrect

  • lab requests

  • medication orders

  • unnecessary chest x-ray.

One system failed to issue an alert when a pregnancy test was ordered for a male patient or entering the health number (OHIP) of the patient

Health care providers errors

twenty-four percent of incidents were linked to data-input mistakes.

• For example, the lab recorded blood glucose results for the wrong patient due to inputting the incorrect patient identification number to access the record.

• This kind of mistake led to wrong diagnose and treatment.

Patient Safety and Risk Management Program

• Continuously improve patient safety

  • minimize and/or prevent the occurrence of errors

• Minimize adverse effects of

  • errors

  • events

  • system breakdowns when they do occur.

• Enhance the safety of

  • patients

  • visitors

  • employees

  • minimize the financial loss to the hospital

    • through

    • risk detection, evaluation and prevention

• Protect human and intangible resources

Principles Regarding Chain of Custody

• States that chain of custody is a set of procedures to ensure physical evidence is not subject to tampering, misconduct or anything that raises questions about whether the evidence is what the government or court says it is

• Occurs when patient/s are considered criminal responsible for a crime

  • or for investigations, or coroner reports

• The number of persons handling evidence from the time it is secured should be limited

• Individuals who handle the evidence should affix their names and signature on the seals to the package containing the evidence and the chain of custody sign in and out form/log

• Statutes and ordinances very often dictate the methods and procedures for handling, storage and disposal of property

proper documenting and copies have to be made, but also ensure patient information is protected

Chain of Custody Process

• The movement and location of physical evidence from the time it is obtained until the time it is presented in court