Crit Care Nurs Clin N Am 14 (2002) 333 – 340

A teamwork model to promote patient safety in critical care

Gwen Sherwood, PhD, RN, FAANa,*, Eric Thomas, MD, MPHb,
Debora Simmons Bennett, MSN, RN, CCRN, CCNSc,
Patricia Lewis, MS, RN, CNAAd
a
The University of Texas Health Science Center School of Nursing, 1100 Holcombe Blvd., 5.510 Houston, TX 77030, USA
b
The University of Texas Health Science Center Medical School, 6431 Fannin, Houston, TX 77030, USA
c
The Institute for Health Care Excellence at The University of Texas, M.D. Anderson Cancer Center,
1515 Holcombe Blvd., Houston, TX 77030, USA
d
The Methodist Hospital, 6565 Fannin, Houston, TX 77030, USA

The first ethical principle of healthcare is to do
no harm, which seems contradictory to current reports
of violations of patient safety. Teamwork behaviors
adapted from the highly successful aviation model are
merged with relationship-centered care to dem-
onstrate how changes in attitudes and interactions in
the complex critical care environment can improve
safety. Creating a lasting culture change requires new
provider skills based on the development of emo-
tional competencies to support critical intelligence in
a value-based healthcare organization.
Delivering the right care to the right patient at the
right time in the right way to achieve the right out-
come has always been a major goal of health care.
The complexities and achievements of modern health
care, the human/technology interface, and the explo-
sion of new information achieve miraculous results
but increase the challenge. Critical care environments
are fast paced with intense decision-making coordi-
nated by a constantly changing network of providers
with little attention to the human factors involved.
Regulatory agencies and institutional policies provide
constant oversight to insure competent care, yet near
misses, mistakes, and untoward outcomes that are as
high as 1.7 errors per patient per day violate the basic
ethical principle of health care—to do no harm [1].
Communication and the way health care providers
work together are major variables in health care safe-
* Corresponding author.
E-mail address: gwen.sherwood@uth.tmc.edu
ty [2], particularly in critical care units [1]. Many in
health care are looking to the aviation industry for
insights in creating systems that identify and measure
threats to patient safety. Refocusing crew training to
include strategies for communication and working
together resulted in striking improvements in air
safety [2]. Could adaptation of these models accom-
plish similar outcomes for health care? This article
examines adaptation of the aviation model to health
care and proposes a values-based approach to team-
work in critical care settings to improve patient safe-
ty. Special attention is given to how the aviation model
can be melded with nursing perspectives on caring
and relationship-oriented care to improve teamwork
and outcomes.
Issue of safety in health care delivery
The widely reported in-depth study from the In-
stitute of Medicine (IOM), ‘‘To Err is Human: Build-
ing a Safer Health Care System’’ [2], mandates action
for needed change to improve health care safety. It
summarizes research that sparked a growing aware-
ness of errors in health care and the high price of
adverse events in human and economic terms. Patient
safety refers to the process that guards against
adverse consequences of health care interventions
and accidental injury [2]. Patients’ lack of trust in
caregivers, patients’ physical and psychological suf-
fering, health care professionals’ low morale and
constant frustration, loss of worker productivity, and

0899-5885/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved.
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