Many hospitals today utilise Medical Emergency Teams (MET) to provide a rapid response resource for wards managing an acutely deteriorating patient or medical emergency. MET teams usually include critical care or specially trained nurses.
In this paper published in Australian Critical Care, the use of shared mental models (SMM’s) is discussed to improve decision making and performance under stress, within MET teams with the goal of enhancing patient outcomes.
SMM’s can be thought of as a preexisting shared understanding of situations and responses and how these sit within team members relationships and responsibilities.
(1) common expectations of roles and responsibilities among team members, (2) in-depth understanding of functions and forms of various subtasks, (3) common expectations for interaction and communication patterns between team members as they accomplish various subtasks, and (4) general agreement on main goals of integrated task performance.
The 6 habits:
The authors propose 6 specific habits to assist in performance improvement of MET teams.
Six habits to enhance the performance of Medical Emergency Teams.
Habit 1: No surprises – principle of shared expectations
Habit 2: Know the endpoints – principle of shared goals
Habit 3: Back yourself – principle of self-efficacy
Habit 4: Confident leaders get hard things done – principle of team leader self-efficacy
Habit 5: Wisdom in asking questions – the principle of reflective practice
Habit 6: The value of mateship – principles of team cohesion
When the team first assembles there should (if possible) be a short pause to enable team members to introduce themselves, establish roles and discuss expectations.
I would also add here the primary importance of introducing the MET team to the staff of the home ward, identifying key staff members from that ward that are involved with the patient care and INCLUDING them as an important part of any MET response.
In this way, shared expectations […] will enhance automatic decision processes reflected in intuitive and automatic thinking. This thinking enables individuals to react effectively and enhances team performance. Such considerations should also promote more rapid and effective integration of information and experience, resulting in faster decisions and higher quality team performance.
Know the endpoints:
The expected clinical endpoints should be made clear to all team members. For example:
If no clear clinical endpoints are established, the member may experience task uncertainty and heightened levels of stress, as they administer fluids without a specific systolic (SBP) or mean arterial blood pressure target. If the team leader clearly outlined a target SBP prior to administering IV fluids, the team member could pay greater attention to administering fluids and gain confidence in expected outcomes.
You must believe in your abilities and skills in managing complex and emergent clinical situations. Such belief is developed by engaging in both formal education/training and experiences in the work environment both real and simulated.
At the team level, high task-specific self-efficacy in regard to action learning processes correlates with the use of non-analytic decision methods. Such methods allow rapid execution of decision strategies in familiar contexts. In situations where teams lack specific knowledge and skill required by the context, action learning suggests that teams will seek to import external resources in the form of new knowledge or additional team members.
Get the hard things done:
The team leader should also be confident in their ability to provide direction and hold leadership in a calm and clear manner.
Leaders must recognise that others can provide answers and assistance from the outset, and that the role of the leaders is to tap into various aspects of knowledge and experience held by team members.
Asking questions | Reflecting on events
Critical reflection and questioning is an essential component of the learning and skill development.
In the sense of asking questions, we refer specifically to the component of reflection that is embedded in action learning process. Reflection is essentially about posing questions to oneself or others. It is often considered part of individual thinking processes. However, team development is often predicated on action learning in team settings.
Building a strong, supportive team who are both comfortable with following direction and feel able to easily communicate. This includes feeding back problems or alternative directions is essential to build an effective and cohesive team.
Wherever possible, the MET leader should reassure team members that they performed well. The leader should also reflects upon his or her own experience or should encourage reflection among the other members of the team.
The authors conclude:
Judgement and decision making under stress is a central attribute of modern METs. The six habits embedded within this paper could be imparted to MET members and tested by health care researchers to assess the utility of this integrated approach. Each habit can be tested within training and development interventions for METs, and the habits provide a series of testable hypotheses for team planning and performance.
Featured image via: DFID
1.Fein EC, Mackie B, Chernyak-Hai L, O’Quinn CRV, Ahmed E. Six habits to enhance MET performance under stress: A discussion paper reviewing team mechanisms for improved patient outcomes. Aust Crit Care. 2016 May;29(2):104–9.
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