Teamwork: Why there’s actually no “I” in ICU

Peter Brindley MD FRCPC FRCP-Edin Full-time Clinical Doc, and proud of it

Other Stuff:

Professor, Critical Care Medicine, UofA Adjunct Professor, Dossetor Health Ethics Centre

Vice-chair, Canadian Resuscitation Institute

Division of Critical Care Medicine

Declare your biases

Dr Giles Brindley. Physiologist…

NOT related!

Brindley dropped his pants before the audience …a very respectable erection

Prof Alvaro Morales Queen’s University Kingston, Ontario

“it’s amazing how much you can achieve when nobody cares who gets the credit”

Which team do you want?

With thanks to Dr D Paton Gay 0.08-0.38

Pit Stop: 1950 vs 2013

Which team do you want?

With thanks to Dr D Paton Gay 1.46 - End

Pit Stop: 1950 vs 2013

Medicine: the most humane of the sciences;

the most scientific of the humanities

E Pellegrino

The cold-hard truth (baker CMAJ 2004)

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Medical Auto Workplace Air

Deaths

A Ziv With permission

Bridging the “care gap”

Brindley P.G Can J Surg 2011

Some of this is obvious

“Engineering” Medicine

Knowledge exceeds any individual • Craftsmen Guilds Process engineers

Focus on Human factors, Team training • Engineering pressure tests a system- so should we

Brindley P.G Crit Care 2010 Brindley P.G ISICEM Yearbook 2010

W Dunn Chest/ D Angus/N Gibney communication

Personality Team

Culture

Less “me” more “we”

Culture Reinforcement

Can’t rely (only) on most fallible part

People Handshakes 1 0 2 1 3 3 4 6 5 10 6 15 7 21 8 28 9 36 10 45 11 55 12 66

Carl Friedrich Gauss (1777-1855)

“Science of managing complexity”

180 steps/pt/day 13,000 different diseases/syndromes “Too much plane for one man to fly”

A Gawande, P Pronovost, many others

“Science of team performance”

# Steps Probability entire process correct

1 0.95 25 0.28 50 0.08 100 0.06

LL Leape 1994; IHI. Preventing errors: the role of complexity. Pronovost PJ

“A team of experts is not an expert team”

• Obedience

• Milgram & electric shock

• Conformity • Asch

• Play a role • Zimbardo & Stanford Prison

• Performance in different-sized teams

• Dunbar

Human Factors, Crisis Management, Team Work

Brindley. J Crit Care 2010

“Completely preventable ”

“Didn’t take the time to become a team”

US Airways1549: “Miracle on the Hudson”

A Gawande 2009

“Sully Sullenberg”

“Captain America” “Hudson River Hero” “Le Nouveau Heros de l’Amerique”

The Pilot Not Flying fewer planes crash when copilot flies

A Gawande 2009

PATIENT

Surgeons Physicians

Respiratory Therapist

Family Spiritual services

Pharmacy

“Medical Ergonomics”

“Ectopia”: land of danger

De Vita et al. & Trauma.org S

L

A

S

S

Attudinia: equally dangerous! • Task v. Power

• Cognitive Dissonance

• Too early vs too late – The 7 yr hangover

Elaine Bromiley: just a routine operation www.youtube.com/watch?v=JzlvgtPIof4

System A vs System B: Focus vs Vigilance

Agnotology: Proctor & Schiebinger Brindley Crit Care 2010 P Croskerry; AIME text

Fixation Errors in medicine

P Brindley, S Taylor Resuscitation 2008

Blindfolded Simulation

“The blind learner: a unique addition to CRM Brindley, Hudson, Lord, J Crit Care 2008”.

5 dimensions of culture Geert Hofstede

Power distance index (PDI) Inequality/ How the less powerful accept their status

Individualism “Me” vrs “We”; loyalty; everyman for himself

Masculinity Assertive; money-focus; self-centre

Uncertainty Avoidance Comfort with uncertainty; rules versus style

Long term orientation Persistence; sense of shame; sense of face

• “Culture eats data for breakfast”

– Peter Drucker

Drucker 1909 – 2005

Many thanks Questions/comments?