In April 2018, the engine on Southwest Airlines Flight 1380 exploded as the plane approached cruising altitude. The explosion ruptured a window midflight and killed a passenger, a 43-year-old mother of two, who was partially sucked from the plane. “‘Southwest 1380 has an engine fire’, Captain [Tammie Jo] Shults radioed to air traffic controllers, not a hint of alarm in her voice. ‘Descending’.”1 Despite the chaos of the event, the captain performed an emergency landing in Philadelphia as the flight attendants circulated through the aisle to make sure that passengers were secure, performed cardiopulmonary resuscitation (CPR) on the woman who had been pulled from the plane, and instructed passengers to position themselves for a crash landing.2 No one on that flight, including the pilot, had ever been through anything like that. How did that team of people—the pilot, the copilot, and the flight attendants—succeed in landing the plane safely, despite terror, unfamiliarity, and loss of life?
Teams in healthcare are everywhere, and like the crew on Southwest Airlines flight 1380, many must function in high-stress, unfamiliar situations. Nursing and physician trainees are routinely thrown into new and terrifying clinical circumstances and must rely on their healthcare teams to keep control of the situation and keep patients safe. When healthcare teams fail, patients are put at direct risk.
How do we think about teams in healthcare? This chapter will address various types of these teams and the features of those teams, what teams need in order to succeed, what other industries have done to look at how teams function, and where healthcare is in this process. The previous chapter already began to dissect the ways in which hierarchy can overtly and subtly influence how teams function, including the idea of expectation states theory. As this chapter launches into a discussion of healthcare teams, consider how the inherent hierarchies of healthcare (e.g., between providers, between trainees and senior physicians, and between healthcare management and physician organizations) intersect with the urgency of the work of teams in healthcare.
In the 1950s, the Tavistock Institute began studying British coal mines. Previously, British coal miners performed their work deep in the mine, in small social groups that functioned independently from one another. However, after World War II, mining technology changed with the introduction of new coal-cutters and machinery that conveyed coal out of the mine. Now the mining company required that miners work in shifts and focus their energy on specialized tasks like cutting or loading. This new system eliminated many existing social networks, and as miners became increasingly unhappy, the mine saw rising absenteeism. The Tavistock Institute, conducting research on the mines, put forward a solution to this problem. They proposed giving more responsibility back to the teams while still maintaining some degree of specialization, a compromise that recognized the intersection between the mining teams and ...