Treatment team perceptions

The perception on the part of the treatment team member that what leadership says is consistent with what leadership does an explicit measure of the gap between what leadership says it will do and what it in fact does. 

The treatment team member s perception of his or her relationship with others on the treatment team. How well do they get along To what degree do they treat each other with respect, listen to each other s ideas, help one another, and follow through on commitments made ... 

Understanding culture from the treatment team members viewpoint can be achieved using a diagnostic instrument that measures their perceptions and compares them with normative scales from other organizations. These relative comparisons allow the safety leader to develop an intervention plan to make improvements. 

The nine dimensions of culture map to the first three relationships by measuring treatment team members perceptions of the relationships (Table 3-3). The focus of each dimension is either organizational or safety-specific. 

The team dimensions include two aspects of treatment team functioning—how effectively the team gets work done (teamwork) and how well the team members get along (treatment team relations). Perceptions of these aspects are highly related but distinguishable. For instance, a team could be unproductive or ineffective but have members who get along well with each other. Alternatively, team members may not play nice with one another but may prove to be highly effective. 

The two team dimensions are affected by perceptions of more fundamental issues in the organization (the organizational dimensions discussed earlier). An organization that has fair procedures, good relations between treatment team members and superiors, trustworthy leaders, and concern for team members tends to have well-functioning teams. Not surprisingly, how team members are treated sets the stage for team effectiveness and cohesion. 

Team functioning also affects perceptions of the value the organization places on patient safety, the climate around raising patient safety issues, and the likelihood of team members talking to one another about safety-related behavior. These perceptions, in turn, affect safety outcomes, so teamwork and treatment team relations have both direct and indirect effects on patient safety outcomes (level of safe behavior, injuries, and preventable adverse event reporting). 

A leader creates organizational culture with his every thought, word, and deed. He sets organizational direction explicitly. He establishes priorities for the people who work for him and determines what they regard as important. Treatment team members and employees perceptions about what is important to the leader constitute the safety climate. As the leader maintains his focus and sustains a strong safety climate, the organization s culture gradually absorbs the climate s values and comes to support safety. 

Consistency in the messages provided by the health-care team is crucial in developing credibility and clarity for the patient. Patients expect clear communication or patient education value from their health-care team (Box 3.2). Clinicians anticipate increased patient motivation and compliance when, in their perception, the education and communication provided was effective. A patient may be more likely to respond positively to his or her treatment plan, resulting in fewer complications, when communication and education is clear. Patient satisfaction with health-care providers is also improved when the information imparted addresses the patient s concerns. 

The sense of responsibility is strongly influenced by perceptions of the safety climate, which also affect the dimensions of upward communication and approaching others. Relations with superiors and other team members as well as the sense of fair treatment by the organization and superiors all affect whether team members are likely to raise their concerns regarding patient safety. 

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