Overcoming Professional Silos and Threats to Psychological Safety: A Conceptual Framework for Successful Team-Based Morbidity and Mortality Conferences

IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2025-02-27 DOI:10.1016/j.jcjq.2025.02.005

Brian A. Campos MD (is Safe Surgery/Safe Systems Fellow, Ariadne Labs, T.H. Chan School of Public Health, Boston, and General Surgery Resident PGY3, Department of Surgery, Beth Israel Deaconess Medical Center, Boston.), Mary E. Brindle MD, MPH (is Principal Research Scientist, Ariadne Labs, and Professor, Department of Surgery, Cumming School of Medicine, University of Calgary.), Emily Cummins PhD (is Senior Qualitative Specialist, Ariadne Labs.), Alexander Hannenberg MD (is Core Faculty Member, Safe Surgery/Safe Systems Program, Ariadne Labs, and Adjunct Clinical Professor, Department of Anesthesiology, Tufts University School of Medicine.), Danielle Salley MS, BSN, RN (is Manager, Department of Quality and Clinical Projects, Children's Memorial Hermann Hospital, Houston.), Yves Sonnay MSPH (is Assistant Director of Project Management, Safe Surgery/Safe Systems Program, Ariadne Labs.), Aubrey Samost-Williams MD, MS (is Associate Faculty Member, Ariadne Labs, and Assistant Professor, Department of Anesthesia, Critical Care and Pain Medicine, University of Texas Health Science Center, Houston. Please address correspondence to Brian A. Campos)

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引用次数: 0

Abstract

Background

Adverse events in health care are frequently discussed in morbidity and mortality conferences. However, while health care has evolved to be delivered by interprofessional teams, morbidity and mortality conferences have been slow to include all team members. One particularly potent barrier to conducting an interprofessional team–based morbidity and mortality conference is a lack of psychological safety among team members. Clinicians from various professions bring differences in perspectives, culture, perceived hierarchy, and assumptions about other professions. These perspectives may bring value to the interprofessional team–based morbidity and mortality conferences, but they may also degrade psychological safety.

Methods

This report explores the link between professional silos and psychological safety among the health care team in the context of an interprofessional team–based morbidity and mortality conference using the perioperative space as an example. The authors draw on the concept of team fault lines—a potential division along a team members' characteristics that can divide a group or team into subgroups. The roots of perioperative professional silos, which define these fault lines, are then traced to the historical context of the health care professions, the individual development of professional identities, and the role of organizations in maintaining these silos. From these observations, a framework for describing these foundations is proposed, which the authors use to evaluate the broader teamwork-in-health-care literature to generate specific recommendations to promote psychological safety in team-based morbidity and mortality conferences.

Conclusion

This framework can be used to postulate strategies for improving the ability for teams to learn from morbidity and mortality conferences. However, future work remains in implementing and studying these recommendations.

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克服专业竖井和心理安全的威胁：一个成功的基于团队的发病率和死亡率会议的概念框架。

背景：在发病率和死亡率会议上经常讨论卫生保健中的不良事件。然而，虽然保健已演变为由跨专业团队提供，但发病率和死亡率会议却迟迟没有包括所有团队成员。举办跨专业团队发病率和死亡率会议的一个特别强大的障碍是团队成员之间缺乏心理安全感。来自不同职业的临床医生在观点、文化、感知等级和对其他职业的假设方面存在差异。这些观点可能为跨专业团队的发病率和死亡率会议带来价值，但它们也可能降低心理安全性。方法：本报告以围手术期病死率会议为例，探讨医疗团队中专业孤岛与心理安全之间的联系。作者借鉴了团队断层线的概念——沿着团队成员特征的潜在分裂，可以将一个团队或团队划分为子组。围手术期专业竖井的根源，定义了这些断层线，然后追溯到卫生保健专业的历史背景，专业身份的个人发展，以及组织在维持这些竖井中的作用。根据这些观察，提出了一个描述这些基础的框架，作者使用该框架来评估更广泛的医疗保健团队合作文献，以产生具体建议，以促进基于团队的发病率和死亡率会议的心理安全。结论：该框架可用于制定策略，提高团队从发病率和死亡率会议中学习的能力。但是，今后的工作仍是执行和研究这些建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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