Connection between just culture, engaged leadership, teamwork, and communication to improve patient and care team satisfaction and safety

In order to improve care, organizations must create a culture of effective teamwork and communication that is consistent across the entire facility. According to Frankel, Allan S et al, healthcare facilities must have structured language, effective assertion/critical language, psychological safety, and effective leadership to achieve this status within their organization. 

Core components of teamwork include learned skills in leadership, group participation, and communication. Leadership involvement is a critical component and leaders can champion process improvement efforts where the care team is provided with the insights and tools needed to make effective teamwork and communication sustainable. Effective leadership has three critical components:

  • Leadership involvement that is visible and consistent 
  • Clinical physician leadership involvement
  • Embedding communication and teamwork tools and behaviors into everyday work

In a clinical setting, getting physicians onboard is critical because physicians are often well respected leaders and set precedent within the organization. Nurses and other members of the care team will adapt to changes if they feel supported by the physicians. SBAR, or situation, background, assessment, and recommendation, is a communication structure template that can be implemented to make communication standardized. Used by the U.S. Nuclear Navy, this technique can also be beneficial to providers because it allows for language to be more organized and better understood by the entire care team.

A structured language will not only allow for easier communication, but also allow for assertion and critical language and psychological safety within the organization. Assertion and critical language is the ability to voice concerns and engage in active communication, and can lead to a reduction in harm. Too many times clinicians are afraid to speak up because of the feared consequences. If the care team feels psychologically safe, they know that they can have constructive conversations and will not be hesitant to report concerns or errors. This could not only decrease the incidence of errors, but also improve processes and increase patient satisfaction and safety.

The care team will be motivated to function as a team if they feel that they have a say in the plan of care, and physicians and leaders can use data points to identify areas in need of improvement, but change cannot be made unless the organization has the ability to adopt these changes. After leaders are aware of performance gaps, tools such as shadowing and asking “What Matters to You?” can be used as a starting point to make these changes happen. To download free resources and tools for building robust communication pathways and trust in your organization visit


Frankel, Allan S et al. “Fair and just culture, team behavior, and leadership engagement: The tools to achieve high reliability.” Health services research vol. 41,4 Pt 2 (2006): 1690-709. doi:10.1111/j.1475-6773.2006.00572.x

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Posted on

May 27, 2022