The importance of the team for managing risk and enhancing reliability

Performance management tools and approaches have been implemented in the public administration over the past thirty years in most of OECD countries. This transition puts the pressure on in terms of accountability and excess workloads, which in turn deteriorates wellbeing and dampens motivation among employees.

Organizations are constantly striving to upgrade efficiency while at the same time shrinking organizational slack. (This parameter, which pinpoints surplus resources, is seen as a tool for mitigating the internal and external complexity of the organization.) The result of all this is a higher tendency to make mistakes and a greater risk of serious accidents.

Such a situation, inherently dysfunctional in many PA sectors, becomes unsustainable in complex, high-risk environments such as healthcare, where mistakes and accidents can jeopardize the lives of patients. In these contexts, it is crucial to compensate for the negative effects of the drive to efficiency by pursuing the goal of organizational reliability. The key to achieving this is to maximize the role of teams (both mono-professional and - more importantly - multi-professional), which in turn can have a positive influence on the behaviors of individuals. A team-oriented work environment, characterized by effective human resource management and deep empathy among co-workers, forms the basis for better individual outcomes, in particular with regard to safety issues.

Healthcare is by nature a high-risk sector. As such, it represents the perfect vantage point for analyzing the dynamics described above, because individuals almost always work in teams, and rarely alone. For our research, we compiled a sample of survey responses from 225 physicians and nurses working in the surgical ward of one of the biggest public hospitals in Italy. Our findings highlight the interconnections and influences that exists between teamwork, the culture of safety, and individual psychological capital (i.e. the dimension of the individual characterized by self-efficacy, optimism, hope and resilience).

The main contribution of our analyses, which we conducted using a mixed methodology combining qualitative and quantitative approaches, was to reveal the positive effect of teamwork on safety behaviors among individual professionals. This effect occurs both directly, thanks to more widespread communication throughout the team and better personal relationships, and indirectly, by reinforcing individual psychological capital. Healthcare workers in highly collaborative teams experience enhanced levels of self-efficacy, optimism, hope and resilience. What’s more, they are more willing to overcome organizational challenges such as issues relating to safety management.

Our research also demonstrated that teamwork encourages a high degree of conformity to safety procedures. Not only that, healthcare professionals who work in virtuous contexts will take the initiative and propose more effective procedures autonomously.

An analysis of participants’ responses corroborated other factors that have already emerged in the scientific literature on this topic: the organizational culture of healthcare organizations encourages collaborative learning, which is critical for communication and the dissemination of knowledge; the high level of specialization and interdependence among healthcare professionals also underpins the relationship of trust they enjoy with their patients, a key ingredient in their safety; careful and constant internal communication diminishes the likelihood of negative events and at the same time boosts the capacity to predict possible adverse events; last of all, in hospitals, teamwork advances the ability of individuals to face and deal with internal conflicts (growing empathy inside the team), as well as to implement effective new safety procedures.

In high-risk organizations, promoting team work is a vital step in the direction of establishing more solid reliability. Managers are called on to create the right organizational climate to enable their people to work in a more cohesive way. These companies should expand the opportunities for personnel training, using this as a lever to advance trust-based relationships and team communication to guarantee better process safety.

The practices trialed in public healthcare can also be extended to other PA sectors, so as to enhance organizational resilience and operational readiness in these settings as well.