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“If you focus on individual performance, you may have All-Americans and, if you're very lucky, once in a career, a Heisman Trophy winner. But you will never have a team capable of greatness.”

Lou Holtz1

“Alone we can do so little. Together we can do so much.”

Helen Keller2

“It's amazing how much can be accomplished if no one cares who gets the credit.”

Harry S. Truman3

“Teams do not build character. They reveal it.”

John Wooden4

It Takes a Team

The care of emergency patients is always, by nature, delivered by teams. Nurses, physicians, and essential services personnel (laboratory, radiology, ED [emergency department] technicians, unit secretaries, registration, inpatient admissions, housekeeping, and the like) must function as a team in order to deliver quality patient care in a predictable, reliable, and sustainable fashion. Patient care simply cannot be provided without coordination and collaboration among these diverse—and sometimes disparate—groups of people. Beyond the technical training, patient care requires multiple interdependent processes carried out by individuals, each with independent decision-making capacity. Teamwork is the foundation and fundamental building block of these operational decisions. Physicians, nurses, technicians, clerical, and other personnel working together as a team can create high-performance EDs that set themselves apart from the ones that struggle to merely survive.

Each team member brings his/her own unique talents, skills, abilities, background, and motivation for a shared common purpose. While members of high-performance ED teams may not contribute equally, all contribute uniquely—and to the best of their abilities—for a single, clear, measurable common purpose—to benefit the patients and families whose care is entrusted to the team. The care and caring of those patients and their families are the raison détre of emergency medicine.

The difficult work of patient care is exponentially easier if teamwork is a fundamental value of the ED staff. The ED staff's ability to consistently deliver clinical and service excellence to patients is substantially enhanced in a work environment characterized by teamwork, which itself becomes a source of ongoing professional satisfaction. As Box 12-1 illustrates, both a commitment to the primacy of the patient and to the team caring for the patient are necessary for a high-performance team to exist. Without effective teamwork, critical strategic ED initiatives such as enhanced throughput, patient satisfaction, core measures, and so on are likely to fail or founder.

Box 12-1 Focus on the Patient First

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