Personal Responsibilities
In addition to exercising self-care, maintaining healthy habits and establishing proper communications within the team, other aspects of individual accountability have important roles for minimizing tensions within the workplace.
Among these are self-awareness, attendance, respect for other team members, emotional intelligence, accountability, adherence to program policies, and involvement in peer evaluation and performance reviews.The transport arena is full of emotions for everyone involved: patients, families, referral hospital staff, and transport team members. Although transport professionals are expected to keep emotions in check, feelings are often revealed by nonverbal or verbal (tone, pitch, and pacing of the voice) communications. Emotional intelligence and self-awareness are essential. Stress of both forms (eustress and distress) is dependent on individual perception and may vary from day to day and situation to situation. Knowledge of one's personal motivators, strengths, and vulnerabilities allows the individual to develop mechanisms for dealing with predictable sources of stress. Some common triggers are known by the acronym and the phrase “do not get too hungry, angry, lonely, and tired” or HALT. An individual sensitive to hunger may choose to keep an energy bar available for busy days, and all should recognize that lack of sleep will make adaptation to distress more difficult. A team member who is neat by nature may need to adopt a more relaxed attitude when paired with a partner with messy tendencies. Perspective and a positive outlook can mediate stress. Does the messy partner provide good patient care and excellent customer service? Focus on the positive attributes may promote self-reflection to question: how important is neatness? However, in a different setting, if a partner is not behaving/performing in a patient-/family-centered manner, is not clinically skilled, or is not communicating effectively, then participating in the peer evaluation and performance programs is indicated.
The principle of Just Culture provides a format to clearly set expectations and define consequences for failure to meet standards on the basis of shared organizational and professional values. Managers and medical directors cannot be present on every transport. Peers must be accountable and hold each other accountable in a respectful manner. From the customer service perspective, the transport program is only as good as the last transport. A negative impression from one transport can jeopardize referral patterns and business models for the entire team and institution.Stressful situations, difficult conversations, and challenging medical conditions are often recreated through simulation education. These educational forums allow team members to develop and practice strategies to better prepare for those “unexpected” challenges common to all transport teams. Simulation scenarios and debriefings can also be used to address team and individual work behaviors. With supportive facilitation, team members may identify stress- inducing work habits and begin developing coping mechanisms. By preventing distress, the transport professional can capitalize on the eustress that provides motivation to continue in a job that is inherently “stressful.”
References
1. Selye H. Confusion and controversy in the stress field. J Hum Stress. 1975;1(2):37-44
2. Devilly GJ, Cotton P. Psychological debriefing and the workplace: defining a concept, controversies and guidelines for intervention. Aust Psychol. 2003;38(2):144-150
Selected Readings
Commission on Accreditation of Medical Transport Programs. Accreditation Standards, 8th ed. Anderson, SC: Commission on Accreditation of Medical Transport Programs; 2010
Frazer E, Corbett P. Introduction to Just Culture, a Learning Culture, Looking Beyond Human Error. Pre Conference. Air Medical Physician Association, Critical Care Conference. Nashville, TN; 2011
Johnson-Moore K. I survived the transport but will I survive my partner? Presentation at Airborne Life Support Systems, 9th annual Neonatal/Pediatric Transport Conference, Austin, TX; 2011
Outcome Engineering. Just Culture, Training for Healthcare Managers. Plano, TX: Outcome Engineering; 2007
Team Stepps: http://teamstepps.ahrq.gov
Just Culture: www.justculutre.org