Collaborative Team-Based Healthcare in Canada
Since at least 2003,5 the Canadian health system has transitioned from a pyramid model of healthcare delivery to a collaborative care approach, which is defined as the “positive interaction of two or more health professionals, who bring their unique skills and knowledge, to assist patients/clients and families with their health decisions.”6
While such team-based care carries with it the promise of delivering superior care to Canadians, “poorly functioning, in particular poorly communicating teams, increase safety risks for patients.”7 The functioning of healthcare teams relies not only on technical skill, but also on clear and comprehensive written and verbal communication. When communication from one team member is incomplete or inaccurate, other team members may be forced to rely on incorrect assumptions and a fragmented understanding of the complete clinical picture.
Courts across Canada have repeatedly held that effective inter- and intra-professional communication is a responsibility of reasonably competent physicians8 and nurses,9 and comprises the relevant standard of care. Over time, courts have developed a greater appreciation for why this communication is important within a team-based setting: in particular, because members of the team must be able to rely on what is told to them in order to fulfill their own clinical duties.
The oft-cited case in this regard is Granger (Litigation guardian of) v. Ottawa General Hospital,10 which centred around a nurse’s failure to communicate repeated decelerations in the fetal heart rate to the obstetrician. As the court in that case found:
… One of the hallmarks of the Canadian health system … is that those involved in obstetrics work as a team and that the interaction between members of that team is vitally important particularly in terms of reliance on one another for the provision of accurate information. … We cannot expect the staff doctor to question the professional capabilities of others on the obstetrical team. … The staff obstetrician should be entitled to rely upon the information being given to him or her by the staff nurse on the understanding that the nurse, assigned by the hospital to these duties, has been properly trained, is sufficiently experienced and knows what he or she is doing at all times within the scope of his or her professional responsibilities.11
