Taking a page from football’s playbook to improve critical care teamwork

For passionate football fans, whether their team wins or loses can seem like a matter of life or death. And with so much invested in the outcome, how to optimize football team performance is intensely analyzed and debated (and not just on Monday mornings), with massive amounts of data driving every decision from equipment choices to roster selection to game plans.

For the healthcare professionals who assemble to provide care for critically ill patients in the intensive care unit (ICU), human life really does hang in the balance of how well these teams perform – yet little is known about how to optimally train or organize these dynamic groups to ensure they can deliver the highest quality care.

What if we devoted the same urgency to studying ICU team performance as we do to the science of football teams, and what lessons about effective teamwork in football can clinicians and researchers adapt to improve patient care in the ICU setting?

In an article published online in the Annals of the American Thoracic Society, Deena Costa, Ph.D., R.N., an assistant professor at the University of Michigan School of Nursing, considers these questions.

“We need a better understanding not only of the characteristics of ICU teams that best promote success, but also how we can ensure these teams that come together often randomly each shift can deliver life-saving care,” Costa says.

“ICU nurses, physicians, respiratory therapists and others work rotating shifts,” she explains. “This means that at each shift, or every 12 hours, there is a new dynamic team caring for the same patient. We don’t yet know how to optimize these dynamic teams for high quality care.”

Above: Costa discusses her work to improve critical care teamwork

Specifically, Costa says, critical care research could learn from football in the areas of optimal team composition, training, and goal setting:

• Both football players and ICU professionals come together in dynamic teams to fulfill various needs during different shifts or plays. While Costa’s research has found that ICU teams made up of a diverse range of health professionals more successfully implement standard care measures, less is known about the ideal composition of these teams, and how this and other factors contribute to their performance.

• In the same way that football teams analyze game footage to improve performance, having ICU team members review and discuss video recordings of their actual interactions on the job – known as video reflexive ethnography – could help improve their communication, which can be one of the most significant barriers to delivering effective care. Ongoing work by Milisa Manojlovich, Ph.D., R.N., is using this technique to break down communication failures between doctors and nurses, one of the primary reasons for patient care errors in the hospital.

• Goal setting in the ICU setting needs to be more responsive to the ever-evolving needs of its patients and take into consideration the random variation of clinicians present each shift, Costa says; more effective use of strategies such as huddles and timeouts may help dynamic teams connect and confirm their game plan in the face of changing targets (or moving goalposts).

• ICU team members generally train within their own professions but have far less experience coming together to work with other professionals in dynamic teams. Enhanced simulation exercises, already used routinely in football training efforts, could help dynamic teams practice how to coordinate effectively within the ICU.

• In our stats-mad, Moneyball era of high-stakes sports outcomes, detailed metrics are used to guide how teams practice and execute on game day. While the individual performance of healthcare providers is evaluated through a variety of measures, team performance, so crucial for ICU outcomes, is rarely assessed, primarily because it is so difficult to quantify. Football has used time-motion methods from industrial engineering as a way to study process, and ICUs may find similar insights through this kind of approach to measuring teamwork and outcomes, Costa says.

“Healthcare has significantly improved quality by looking to other industries for new ideas on how to do things better,” Costa says. “Examining how other teams, in football and beyond, derive success from working together offers many examples for how ICU teams can improve their ability to deliver consistent, safe, high-quality care.”