Nutrition - team working
Mitigating patient safety risks requires collaborative effort in order to be effective. It is dependent on the contributions of many different people from patients and service users, carers and families to volunteers, caterers and healthcare staff. Nutrition and hydration challenges organisations to work across team boundaries and build better relationships to facilitate improvements (Health Foundation 2010).
The value of multidisciplinary team working in problem solving and addressing issues to improve nutritional care is evident in the collaborative work arising from the RCN's Nutrition Now campaign - see Enhancing Nutritional Care booklet (2008, revised 2010) (PDF 840KB).
Teams have structures and dynamics and these can impact significantly on safety issues such as nutrition and hydration (World Health Organization 2009). The structure of a team consists of: a hierarchy, accepted behaviours and roles. The performance of a team and the outcomes the team is striving to achieve, can be influenced by any of these elements.
Role clarity will give staff the confidence to undertake tasks. This applies not only to formal roles (nursing staff, dietician, catering staff, team leader) but also to informal roles that team and inter-team working may require (co-ordinator, motivator, critical friend).
Team dynamics refer to the “psychological processes describing the interactions that occur in a group, evidenced by behaviours associated with coordination, communication, cooperation, conflict management, and decision making” (World Health Organization 2009, p.23). Organisations working in high risk work environments invest heavily in these areas and look for ways to embed tools that support good team work.
The Team Self Review (TSR), for example, provides support for structured briefing and debriefing sessions. Originally developed for surgical teams it has potential for wider application (National Patient Safety Agency 2008).
Improving coordination is about relationships between people. Achieving greater integration of services is likely to result in people working across organisational boundaries in multi-disciplinary teams which will challenge current work practices (National Voices 2011).
This is particularly difficult in a climate where time is at a premium and staff may be uncertain about the benefits for patients or service users. But this is worth striving for when, in the future, healthcare "needs to operate as a value improvement system, which makes the whole healthcare outcome for the patient greater than the sum of the help that each carer provides, and which supports a patient to be independently healthy or more active in their care" (Øvretveit 2011, p.vi).
See also relevant sections in the Patient safety and human factors online resource:
Further case studies illustrating the impact of team working can be found in this resource at Enhancing nutritional care.
References
These resources were last accessed on 31 January 2013. Some of them are in PDF format - see how to access PDF files.
Health Foundation (2010) Safer Clinical Systems. Health Foundation website.
National Patient Safety Agency (2009) Nutrition factsheets. 10 characteristics of good nutritional care. London: NPSA.
Factsheet 03: Good nutritional care.
Factsheet 09: Monitoring and implementing.
Factsheet 10: policy.
National Patient Safety Agency (2008) Team Self Review. London: NPSA.
National Voices (2011) Principles for integrated care (PDF 187.63KB). London: National Voices.
Øvretveit J (2011) Does clinical coordination improve quality and save money? Volume 1: a summary review of the evidence. London: The Health Foundation.
Royal College of Physicians (2011) Acute care toolkit 1: handover. London: RCP.
World Health Organization (2009) Human factors in patient safety. Review of topics and tools (PDF 1.10MB). Geneva: WHO.
Further resources
Royal College of Nursing (2010) Principles of Nursing Practice: Principle G
The Principles describe what everyone can expect from nursing practice, whether colleagues, patients, their families or carers. Principle G encompasses multi-disciplinary and multi-agency working, and co-ordination, integration and continuity of care. This page brings together RCN resources which are particularly relevant to this Principle.