Familiarity between medical staff betters team performance, study shows

Increased familiarity between residents and nurses led to better performance in medical simulations, according to research published in JAMA Internal Medicine.

Though “teamwork is critical in delivering quality medical care,” large teaching hospitals typically have “transiently formed interprofessional teams as residents rotate through clinical floors, each with its own nursing staff,” Christiana A. Iyasere, MD, MBA, of Massachusetts General Hospital and the department of general internal medicine at Harvard Medical School, and colleagues wrote.

This can lead to a lack of familiarity among team members — which is risky because familiarity can create an environment in which members feel safe speaking up and asking for help, the researchers wrote.

“Speaking up is critical for patient safety, as failure to identify or synthesize relevant clinical information often comes from fear of disclosing poor understanding,” they added. “Open discussion of problems among team members may account for why familiar teams acquire new knowledge more quickly when working on complex tasks requiring the sharing of expertise.”

To better assess if and how familiarity improves team performance, Iyasere and colleagues conducted a 12-month randomized clinical trial that included 91 general medicine nurses and 33 internal medicine residents. It was completed at an inpatient general medical service at a large academic medical center from June 2019 to June 2020.

The researchers randomly assigned 15 residents to complete all 16 weeks on one nursing floor — an intervention group with 43 nurses. The 18 other residents represented usual care and completed the 16 weeks across four different general medical floors with 48 nurses.

Iyasere and colleagues measured interprofessional communication with a time-motion study of individual resident clinical work and work rounds. Psychological safety and culture were assessed with surveys taken by both nurses and residents. The primary outcome — team performance — was measured with blinded rated observations of study teams in simulation scenarios at 6- and 12-month marks.

During the first simulation, there was no overall difference in team performance. After a year, however, the teams that underwent the intervention achieved a higher mean overall score in:

• leadership and management (2.47 vs. 2.17; P = .045);
• working as one unit (100% vs. 62%; P = .003);
• supporting other team members (61% vs. 24%; P = .02); and
• communicating as a team (56% vs. 19%; P = .02).

They were also more successful during a simulation in which they negotiated with a patient regarding insulin dosage (61% vs. 10%; P = .001) and convinced the patient to take the correct insulin dose (67% vs. 14%; P = .001).

Though the differences diminished at the 12-month survey, at 6 months, nurses in the intervention arm were more likely to “feel that the input of all clinical practitioners was valued” (95% vs. 53%; P < .001), report that “feedback between practitioners was delivered in a way to promote positive interactions” (90% vs. 60%; P = .003) and rate their relationships with residents as excellent or outstanding (74% vs. 40%; P = .003).

Notably, the researchers did not observe significant differences in patient outcomes.

Iyasere and colleagues wrote that the findings indicate both early and late benefits, emphasizing the critical relationship between team performance and familiarity. They also said that factors promoting familiarity should be taken into consideration when building medical teams and staffs, particularly in training.

“In this randomized clinical trial, increased familiarity between nurses and residents promoted more rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations,” the researchers wrote. “Medical centers should consider team familiarity as a potential metric to improve physician-nursing teamwork and patient care.”