Ebola case shows importance of teamwork in healthcare

The White House’s announcement on Friday that it has Ebola “under control” is patently ridiculous. As we witnessed with the case in Dallas last week, and have been reminded by the failure of a properly deployed Centers for Disease Control and Prevention (CDC) checklist, the system of Ebola transmission is so complex, with so many moving parts, that unless we control each individual’s behavior at every airplane, every hospital, every public place and every private home, there is no way to ensure — or assure — that a deadly virus with no available vaccine or cure is under control.

There is certainly value in quelling fear and panic. Indeed, that is a critical component of the strategy needed to combat any public health emergency and it is hard to fault the White House for attempting this maneuver. But government officials can certainly not guarantee that even the best protective programs in place will be properly executed at every level.

{mosads}If the spread of Ebola to the United States impacts anything (besides highlighting the importance of developing drugs even without a promise of high profit margins), I hope that it will be the recognition of the critical importance of effective interdisciplinary teamwork. I hope that this recognition will promote a change in our typical programs for professional training in healthcare, and more broadly will promote a national culture of interdisciplinary.

Last week’s healthcare team failure in Dallas highlights an important lesson about complex teamwork. In the case of Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, the emergency room nurse properly executed a CDC-supplied checklist to screen emergency patients for signs of Ebola. Atul Gawande (cancer surgeon, author of The Checklist Manifesto and consultant to the CDC’s Ebola checklist) has taught us much about the utility of checklists. Checklists have greatly reduced airplane disasters and lowered rates of surgical infection and wrong-limb amputation. However, checklists are only a tool and are only as useful as the strong communication work of a team, as the Dallas case unfortunately demonstrates. Indeed, Suzanne Gordon and colleagues, authors of Beyond the Checklist, demonstrate that a checklist only works properly if it is used in an interdisciplinary culture of collaboration rather than a control-and-command environment.

In Dallas, we saw the ER nurse properly account for the feverish patient’s recent travel in Africa, but that information did not get communicated to the rest of the team. Instead, Duncan was treated with antibiotics for a presumed run-of-the-mill stomach virus. (The overuse of antibiotics by healthcare providers in an effort to appease the typical American patient’s desire to be treated with a pill of some sort is another problem to discuss at a later time.) Nonetheless, in this case, the checklist was completed, but poor team communication prevented its proper execution.

We must now contemplate the possibility that a widespread outbreak could indeed be seeded here in the United States, and realize that effective team functioning is nothing short of critical. As the Public Health Service and the Department of Homeland Security execute a plan to track and contain possible vectors of Ebola spread, it is of paramount importance that the teams we rely on to protect the public health in the face of a deadly outbreak are prepared to execute effective interprofessional communication where every team member is heard and valued.

Contemporary university education for health professionals includes interprofessional teamwork competencies. But this classroom effort will not touch the myriad professionals who form the front lines of our national health defenses today. Rather, we must count on every individual member of every healthcare team to adopt effective team communication practices today, without a complex years-long curriculum, so that Ebola will not become a problem for the United States as it has in besieged West Africa.

Looking ahead, I hope that this Ebola experience foregrounds how very small our world is and how not even the wealthiest, most secure nation can achieve immunity from deadly disease. With this reality not just at our doorstep but already inside the front hall, I hope that we can now see the paramount importance of interprofessional practice in healthcare (and support it at local, state and national levels). Guest speakers, conferences and seminars are certainly helpful to introduce the idea of culture change to our typically command-and-control style of healthcare teamwork. But clearly that is not enough. If we do not embed a culture of interprofessional care at every level of healthcare professional practice now and in the future, this outbreak of Ebola on our shores will be neither the worst nor the last.

Ross, DNP, is a nurse practitioner in cardiac electrophysiology at Arizona Arrhythmia Consultants and a faculty member at Arizona State University. She teaches in the Doctor of Nursing Practice program, as well as the Master’s in Science and Technology Policy program. In addition to faculty responsibilities, she is also a Ph.D. student in Human and Social Dimensions of Science and Technology, where she studies complex healthcare systems and the social construction of new therapeutic technologies.