The science of teamwork

Can technology be used to improve teamwork in health care? 

The answer is yes, according to Ken Catchpole, Ph.D., S.C. SmartState Endowed Chair in Clinical Practice and Human Factors at the Medical University of South Carolina. But only if the technology has been developed with the needs of the team in mind.

People should come first when designing technologies for health care, according to Catchpole. If technologies are not designed with users in mind, they are unlikely to be effective. 

“A lot of health care IT falls down either because it wasn’t designed with people in mind in the first place or, when it was implemented, not enough attention is given to integrating the device into the rest of the work,” said Catchpole.

As a human factors specialist, Catchpole looks at how technologies can be adapted to providers’ needs instead of asking providers to adapt to the technology. "Instead of saying what can the technology do, we say how can this technology help providers do their job and how can we fit this technology to the provider."

Adopting this user-centered design approach and using funding from a pilot grant from the South Carolina Clinical and Translational Research Institute, Catchpole and MUSC Health trauma surgeon Alicia R. Privette, M.D., designed a smartphone app to improve teamwork and communication in trauma care. Their app took top honors for Innovation in the Great Team Science Contest sponsored by the National Center for Advancing Translational Sciences. Winners of the contest were announced at the Fall CTSA Program Director’s meeting in Washington, D.C.

Catchpole had already spent time watching trauma care in action in his previous position at Cedars Sinai. He noted that the reliance on phone-based communication made it difficult for the trauma care team to efficiently share needed information, prepare for the patient’s arrival or plan a treatment strategy. When the emergency department is notified that a trauma patient is en route, an emergency department resident or other provider pages the trauma team as well as the operating room and specialist surgery teams.

However, that page includes very little information about the patient,  making it difficult for the trauma team to prepare for the patient’s arrival or for the operating room and specialty surgery teams to assess whether, and when, their services are likely to be needed. Follow-up calls to the emergency department seeking more information about the patient disrupt care. 

While at Cedars Sinai, Catchpole had suggested that the emergency department resident write down details about the patient on a whiteboard to better inform the care team. That greatly helped the trauma team prepare for the patient but did little to serve the operating room team or specialty service teams located elsewhere in the hospital. At MUSC, Catchpole and Privette first considered an electronic whiteboard but finally settled on an app to improve teamwork and communication.

Using the app, the emergency department resident sends out information about the incoming trauma patient, including age, condition, and mechanism of injury to all members of the team. This helps, for example, the operating room team to assess, based on the severity of the injury, whether it should begin readying a room. The app also enables all members of the trauma care team to send HIPAA-compliant text messages to one another. The app arranges these messages by patient, enabling team members to “brief” one another on each stage of the patient’s care and to better judge when they are needed in the emergency department. They can also post photographs of the patient’s medical imaging to better inform those further down the care pathway.

A three-month trial of the app at MUSC, a Level I trauma center, enhanced teamwork, streamlined workflows and reduced patients’ stays in the emergency department. That data has not yet been published. Providers also found the app useful, particularly the operating room and specialty surgery teams that would otherwise have little ability to track the patient through the care pathway.

For Catchpole, the success of the app shows that technology designed with a user-centered approach can enhance teamwork in health care. “Teamwork is not just about training people about how to interact with one another,” said Catchpole. “It’s about how we can use technologies to improve how they communicate remotely.”