Table 2 Examples of how direct challenges disrupt the image of a competent team
Assumption | Threat | Quotation |
|---|---|---|
Competent teams never disagree or experience awkward moments | Direct challenges threaten interpersonal relationships | “I value the nurses’ challenges, I do. I think that they keep me on my feet… I get the most frustrated and demoralized when they do it in front of the patient… that’s what ruins our interpersonal relationship, the patient’s trust in us, and all of those things that we need to move forward.” OBR003, interview |
Competent teams always have things under control | Direct challenges introduce uncertainty | “You want to look like a solid team, even if it’s nursing-anesthesia, whoever the mix of the team is you’re there for one thing. And you don’t want your patient to feel like everybody is against each other or that they’re not working together to care for her…” N005, interview “…and let’s really try not to raise any sense of uncertainty until we know or, if we have an answer and we can actually give them a concrete plan…we all know when you hear a doctor say I don’t know, I’m not sure, that’s really worrisome for the patient.” OB 011, interview |
Competent teams do not make mistakes | Direct challenges highlight mistakes | “And you’re trying to navigate between keeping the patient calm and not wanting to make it seem like the person in charge maybe is making not the best choices. And that is a very fine line as a nurse to navigate…” N008, interview “I can’t just turn to my colleague in front of our patient and say you’re wrong. I need to find something that is a little bit more eloquent to not completely sever the trust.” MW010, interview |
Competent teams respect hierarchy | Direct challenges disrupt the hierarchy | “Oh, the hierarchy is so deeply built into all of us, that [a direct challenge] would be like swearing at your parents, you just don’t do it.”OBR010, interview “So, you can’t be too loud, you can’t be too vocal, because you don’t want to undermine the patient’s confidence in the team… And so, I tend to not question my consultants in front of patients in order to respect that hierarchy.” OBR007, interview |
Competent teams never deviate from the plan | Direct challenges undermine the plan | “But to stop and be like, ‘[OB] I do not agree with you leaving right now,’ as someone is bleeding out, feels a lot of times wrong. It’s just like, okay, well let’s just do the best that we can in this scenario, and we’ll see what happens.”MW002, interview “I can’t see a resident in front of a patient saying, ‘I’m not sure I would give Hemabate.’” OB008, interview |