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Zorluk: Çok zorInterprofessional Teamwork and Conflict Resolution

A multidisciplinary tumor board is reviewing the case of a 52-year-old man with locally advanced pancreatic adenocarcinoma. The lead surgical oncologist advocates for immediate surgical resection, stating it offers the best chance for survival. The medical oncologist strongly disagrees, pointing out that recent imaging demonstrates subtle superior mesenteric artery encasement, making the tumor unresectable upfront, and insists on neoadjuvant chemotherapy. The surgeon becomes dismissive, stating the medical oncologist is being 'overly cautious,' and announces he will schedule the patient for the operating room the following morning. The radiologist in the room agrees with the medical oncologist's assessment but remains silent. The medical oncologist, who has already clearly voiced the clinical concern and discomfort with the operative plan once, believes that proceeding to surgery will result in severe morbidity and an incomplete resection. Which of the following is the most appropriate next step for the medical oncologist to ensure patient safety?

  1. Reiterate the safety concern a second time explicitly, ensuring the surgeon acknowledges the statementCevap
  2. B
    Contact the hospital's Chief Medical Officer immediately to intervene and cancel the surgical booking
  3. C
    Concede to the surgical plan but schedule an urgent preoperative visit to explain the specific operative risks directly to the patient
  4. D
    File a formal patient safety incident report in the hospital's electronic system before the scheduled surgery
  5. E
    Request that the radiologist formally amend the imaging report to dictate that the patient is not a surgical candidate

Cevap

Reiterate the safety concern a second time explicitly, ensuring the surgeon acknowledges the statement
The correct action is to reiterate the safety concern a second time. This scenario tests the application of the TeamSTEPPS 'Two-Challenge Rule,' a standardized communication framework used to resolve acute interprofessional disagreements regarding patient safety. The rule stipulates that if a team member observes an unsafe situation, it is their responsibility to assertively voice their concern. If the initial assertion is ignored or dismissed (as it was by the surgeon in this vignette), the team member must voice the concern a second time in a clear, explicit manner, and the challenged team member must acknowledge that the concern has been heard. Only if this second challenge fails to adequately address the safety issue should the provider escalate the matter through the formal chain of command (e.g., Department Chair, Chief Medical Officer).

Adım Adım Çözüm

1
Analyze the current state of the conflict and communication.
The medical oncologist has voiced the safety concern one time, which the surgeon subsequently dismissed.
Identifying the current phase of conflict resolution dictates the precise next step required by standardized safety protocols.
2
Apply the appropriate interprofessional teamwork framework (TeamSTEPPS).
The situation requires the application of the 'Two-Challenge Rule.'
When a team member's initial assertion of a critical safety concern is ignored or dismissed, standardized protocols mandate a specific sequential response to prevent patient harm.
3
Determine the exact next action required by the Two-Challenge Rule.
The medical oncologist must assertively voice the concern a second time to ensure it has been heard, and the surgeon must acknowledge it.
The rule requires two clear attempts to resolve the issue directly with the team member before escalating through the formal chain of command.

Anahtar Kavram

The Two-Challenge Rule in Interprofessional Conflict Resolution
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Konular

Interprofessional Teamwork and Conflict Resolution

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