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The Importance of a Cohesive Team in Cardiac Surgery: A group on one side

Posted by Liza Szelkowski, PA-C on Mar 7, 2018 1:05:00 PM

Whether you are on a team of 2 or a team of 20, any good cardiac surgery service starts with a good team.  In preparing for this piece, I looked up the word team in the Merriam-Webster Dictionary.  While there are several definitions listed, I found two of them particularly appropriate.  First was, “two or more draft animals harnessed to the same vehicle or implement”.  I saw this as an interesting metaphor for how I often feel at work.  Second was simply, “a group on one side”. 

Although silly, the reference to draft animals does have some relevance to this topic.  Animals pulling an implement have to work together to get the job done.  If any of them go astray, the implement will no longer continue forward progress.  In much the same way, if members of your team go astray, the patients, and the program in general, cannot continue to progress.  This is why having a team that is working consistently toward a common goal is so important.

Medical team in row looking at the camera.jpeg

Being “a group on one side” is not as simple as it sounds.  Likely, your cardiac surgery team is made up of a lot of strong personalities.  That’s what makes us good at our job.  Combining these personalities with a high stress level can be a recipe for disaster.  Patients go bad and tempers can flare. Everyone thinks he or she is right, or the only one working hard.  Surgeons and colleagues Monday morning quarter back on rounds when you feel like you’ve worked your hardest all night.  Something isn’t passed on in sign out and you take the hit for it.   All of these things add up over time, and pretty soon everyone feels like they hate everyone else on the team.  People feel like they can’t trust each other.  Unfortunately, I speak from experience.  The question is, how can we ease this?  How can we prevent it, or at least fix it when it happens?

Several small adjustments within the team can make a huge difference in creating a group that is on one side.  Having frequent meetings is essential.  This should be a time for your leader to address any practice issues, and to allow for discussion and commentary.  Our group of PAs and NPs meets twice a month.  The environment should be non-punitive so that people feel comfortable speaking up.  After these meetings, the senior staff also has a brief meeting.  Our goal is to have a united front from a leadership standpoint to try to decrease confusion, frustration, and mixed messages.  In addition to this, we have a short debrief with the nurses in our ICU at shift change twice a day.  We take 10 minutes or so to talk about what went well, and what people could do better next time.  Much of this discussion centers around communication between team members, or the lack there of.  People are encouraged to talk their problems out, rather than take the issue home and continue to harbor anger or apprehension toward the other person involved.  New this year, we are also trying to meet with our surgeons once a quarter.  We have only had one meeting so far, but it was an excellent forum to discuss practice issues.  The last adjustment I’ll mention is simple.  Get together outside of work.  Getting the chance to talk to each other in a place where the phone isn’t constantly ringing, and where people can discuss things other than work (even though the conversation always ends up back at work) will do wonders for your team. 

Some of our most difficult days will likely come from the things we experience at work.  Going it alone is difficult, if not impossible.  In my first job, I was the only PA, and it was a trying experience.  Now when the days are bad, I have my team to commiserate with.  We are all different, and we still fight a lot, but I can say for sure that I know they all have my back.  We are all on one side.  

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Topics: Cardiac Surgery