*3.1.1.8 Conflict management*

Open communication is essential for high-performing teams. A diverse multidisciplinary team may have conflicting individual ideas or priorities at times. Team members must feel comfortable and supported to communicate their concerns about team processes and direction of patient care. The team must have consistent channels for communication, ideally with regularly scheduled meetings. Conflicting ideas must be identified and discussed early. It is important for the team leader to embrace but depersonalise diverse views. They will manage relationships amongst the team members and address any obstacles that may hinder group performance. Professionalism supports should be funded and made available including specific

training courses, facilitated debriefing, mentoring and referral to counselling. These measures may be co-facilitated by the human resources department in the hospital, as there may be overlap with employment issues.

## *3.1.1.9 Outcome measurement*

Any high-performance team should have a measurement system in place to determine their success. This allows for timely and reliable feedback to the team regarding their successes and failures. Local metrics foster an environment of continual improvement and learning. Most intensive care units collect a vast amount of data on patient admissions, and this contributes to audits. Intensive care units may collaborate and combine their audit information to produce more robust targets and standards e.g., Paediatric Intensive Care Audit Network (PicaNet) in the United Kingdom and Ireland. This means that measurable patient care processes can be audited against the group's agreed standards and amendments made to local processes based upon results. An example of this is the assessment of an unplanned extubation event. Using data from a number of ICUs and from a number of years, it is possible to produce a standardised rate and compare individual units performance each year against this rate. Ideally, outcomes would be validated and internationally recognised to allow the team to compare themselves with similar units in other jurisdictions [6]. Patient's outcomes can be tracked over time and communicated back to the team. Satisfaction of patients, their families and team members can also be measured and followed over time. Staff resigning from work should be offered a confidential interview to ascertain information which might assist in improving team-working and patient care.
