Publish Date: December 6, 2017
You are a clinically competent nurse. You have the skills and knowledge to work safely and effectively in your role. But how collectively competent is the team you work in? And what is your contribution to that collective competence? For instance, how good is your situational awareness—your ability to work with an ear cock to the activities around you and respond well in the face of change or disruption?
It’s this ability to be competent as a collective team that Lorelei Lingard, PhD, professor of medicine and director at the Centre for Education Research and Innovation at Western University in Ontario Canada, believes is the key to achieving truly effective teamwork in all aspects of health care, including for the surgical team.
In coining the phrase collective competence, Lingard hopes to introduce new language to the paradigm of competence in health care to help health care professionals think not only about training for individual competence but also about supporting collective competence.
This attention is needed, as Lingard has observed in her work studying teamwork and communication within surgical teams. “Time and time again I see individual team members who are clinically competent in their individual roles, but are incompetent in working collectively.”
Understanding the Power of the Collective
Building on her twenty years of research in health care teamwork, including her early research in the OR, Lingard believes a focus on collective competence can help health care professionals as they struggle to work collaboratively to deliver high quality patient care. She suggests that some common barriers to collective competence are rooted in the way perioperative professionals learn their practice. These barriers include:
- Different language and professional values—surgeons and nurses learn different specialized vocabularies and are trained to emphasize different aspects of surgical care.
- Different work structure—aspects of daily work such as differences in scheduling can impact the way different members of the team communicate and interact.
However, these barriers don’t always prevent collective competence in the OR, In fact, Lingard says perioperative nurses see the power of the collective team every day.
“A key example would be the strength of a team member’s situational awareness to anticipate and respond to change and communicate in a way that reduces the impact of the change on all team members,” Lingard suggests. “If a nurse is going to have a break and will get replaced, how well does she anticipate the impact of that on the collective and what does she do to safeguard that performance.”
In certain cases, Lingard sees stronger collective competence among different teams working in the same facility. She gives the example of how different teams work with a problematic team member.
“On one team, a problematic individual (lacking in competence or possessing difficult personality traits) can completely unhinge the team from working effectively throughout the day. But on another team, this same problematic individual will be neutralized: the team is able to compensate for the individual, carry on with effective work and sometimes even bring that individual up to a higher level. The difference is not the individual: the difference is something in the collective response to that individual. My research seeks to understand what makes one team a stronger collective.”
Resisting the Urge to Simplify
She suggests collective competence not be considered in terms of skills but as practices and structures in place.
“Too often in health care we see quick fixes applied to solve complex problems, and if we’re not careful, they can actually impair a team’s ability to improve,” Lingard explains.
She gives the example of oversimplifying the surgical safety checklist to the point that it becomes just a compliance step, not a mutually informative preoperative briefing to share critical information and resolve incompatible assumptions.
“The move toward collectively competent surgical care is happening. The more we talk about what it is and what it can mean for patient care, practitioner satisfaction, and trainee education, the closer we will be to making it an established approach to perioperative care.”
Learn more from Lingard about collective competence at AORN’s 2018 Global Surgical Conference & Expo in New Orleans, March 24–28.
Read more from Lingard on reframing the team competence conversation.
Read recent research from Lingard on the pitfalls associated with simplifying the narrative and application of the surgical safety checklist.