Grand Rounds Recap 7.4.18

Teamwork WITH DR. Palmer

Teamwork means everything in the ED environment. We work in a setting where stress is high, and situations are often life and death scenarios. In order to be an effective leader and clinician, we must learn to work effectively as a team.

Why is teamwork important? Medicine is so complex that you cannot do it alone. Over the years, access to care has improved, so volumes in the emergency department are up and demands of regulatory bodies must be balanced. There is also a significant increase in specialized and subspecialized care, adding layers of complexity to patient visits. Electronic medical records provide access to countless amounts of information while patient acuity is continually increasing.

However, bad things happen with all these complexities when teams do not function well. There is one study to suggest that deaths due to medical error contribute to about 250,000 deaths annually (1). Similarly, communication errors are the leading cause of events reported to the Joint Commission (2). With optimal teamwork and communication, patient, provider, and staff satisfaction increases. In addition, financial performance increases as well because inefficient workflows and ineffective communication leads to worse revenue generation.

Remember that you are not bigger than your team. Do not forget that patients and families are part of your team; include them. You cannot accomplish anything without the dynamics of the team working together, and their success is your success. It is important to have a knowledge of your strengths but be aware of how you are viewed by others. Often, you may use faculty and mentors to help you develop your emotional intelligence and awareness of this.

How can we improve our teamwork? Every team you have ever been on has one thing in common: you. The key principle to successful teams is trust. Trust can be seen at various levels: self, relationship, organization, market.

Self-trust: There are four core principles that are required in order to have trust in one’s self.

  1. Integrity: Be honest and humble. Do what you say you will do, and always strive to do what is right. Make a commitment to yourself and be disciplined about your work.
  2. Intent: Assess your motives, agenda, and behaviors in your interactions. How do you go about what you are doing, and what is your motive behind it? You get to choose your attitude and response to situations. Remember that.
  3. Capabilities: You must trust in your abilities and talent, something that is being developed throughout residency. Be confident in your skills, knowledge, style, and creativity.
  4. Results: Be aware of your results and if you are getting them. Take responsibility for your results (not your activities) and be proud of them.

Relationship-trust: In order to develop your relationship trust, the following principles are crucial.

  1. Character-based behaviors: Talk straight but show respect to others. Be transparent in your interactions. Right your wrongs and show loyalty in your relationships with others.
  2. Competency-based behaviors: Deliver results but work to get better. Confront reality and set expectations in your interactions. Practice accountability.
  3. Always keep your commitments.

Organizational-trust: At the organizational level, trust can be manifested as growth, innovation, and collaboration. However, a low-trust organization will likely be manipulative, withholding of information, and resistant to change.

Market-trust: Finally, market trust develops once you developed organizational trust. A community will begin to see an organization as trustworthy, and this helps you develop a brand. For example, clinical providers are a small but essential component of the larger healthcare organization which would like to be seen as caring, knowledgeable, and effective to the community.


  • Shared goals: They must reflect patient and family values and be clearly articulated and supported by all members of the team.
  • Clear roles: Define the expectations for each team member’s responsibility and accountability. This allows for appropriate division of labor and best utilization of skills. It requires knowledge of others’ roles to allow for flexibility. Ultimately, leadership should be defined by the needs of the team, not the hierarchy of it.
  • Mutual trust/effective communication: see above regarding trust
  • Measurable outcomes: Provide reliable and timely feedback on team functioning and achievement of goals.


  1. Makary MA, Daniel M. Medical error the third leading cause of death in the U.S. The BMJ, 2016(353):2139.
  2. Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.

Healthcare Analytics WITH DR. Doerning

Why should you care about analytics? Hospitals use various forms of analytics to improve patient care, delivery of care, and even clinical decision making. It affects finances for patients because it can impact work-ups (think MD-Calc and how certain scores can impact a patient’s work-up in the emergency department). It is estimated that healthcare expenditures could be reduced by utilizing more analytics in the healthcare environment.

What is analytics? An example of analytics at work is Netflix or Hulu. These websites can suggest certain movies and television shows based on what you previously had watched, and by utilizing analytic software. Simplified, analytics uses population studies to determine and occasionally predict individual outcomes.

The goal of analytics is to build insights from data and have an actionable item from the data. In healthcare, the goal is to provide personalized medicine based on the data. For example, what if a computer could predict that a patient will become hypotensive 15 minutes before they actually do? Then the provider could act on this information and potentially change a patient’s course.

This is a growing field with a promising future. In the end though, merely predicting risk does not change it. In order for analytics to really permeate a clinical environment, it requires buy-in from the clinical users.

Professionalism WITH DR. McDonough

One’s level of professionalism relates to one’s ability to be a leader, but what is professionalism? It is difficult to define, but you know it when you see it. Professionalism is a milestone upon which residents are evaluated. According to the ACGME, professionalism is defined as “demonstrat[ing] compassion, integrity, and respect for others as well as adherence to the ethical principles relevant to the practice of medicine" (1). To simplify, professionalism entails showing respect for others, yourself, your patients, etc.

Why does it matter? Because our work matters. Our behavior affects the quality of the work that we do, and it informs who we are as leaders. Professional behavior demonstrates and garners respect from others.

Exhibiting professional behavior when you arrive for a shift entails being on time, being well groomed, well rested, and mentally ready to go. It is important to realize, however, that group culture can define professionalism standards. Therefore, pay attention to what a group expects. For example, what time is expected when showing up for a shift? Is it five minutes early, ten minutes, on time? Understanding the expectations of your professional behavior from the group should inform our own professional behavior.

When you are signing out, professional behavior involves being prepared, organized, and reliable. Timely chart completion is an expectation because it is important for patient care. It is also reflective of one’s organizational skills, responsibility, and work ethic.

To provide excellent patient care, be respectful to your patients and around your patients. Be respectful to all members of the patient care team, demonstrate integrity, maintain confidentiality, and always do what is best for your patients. We should all strive to be the best emergency physicians we can be.

Social media can be an asset to or be detrimental to one’s professionalism. It is a great networking and educational source, however be cautious about it and always remember patient privacy. Negative attitudes are always detrimental to professionalism. Be wary of projecting onto the innocent bystander. Negativity is infectious, and it hurts team morale and performance. Remember that your attitude reflects leadership. Maintain your professionalism even when someone is unprofessional to you.


1. Ludwig S, Day S. New Standards for resident professionalism: discussion ad justification. Accessed from[1].pdf on July 5, 2018.