Does team training improve team performance? A meta-analysis

Changing Systems Through Effective Teams: A Role for Simulation

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

Enhancing the Effectiveness of Work Groups and Teams: A Reflection

Teamwork has been at the core of human accomplishment across the millennia, and it was a focus of social psychological inquiry on small group behavior for nearly half a century. However, as organizations world-wide reorganized work around teams over the past two decades, the nature of teamwork and factors influencing it became a central focus of research in organizational psychology and management. In this article, I reflect on the impetus, strategy, key features, and scientific contribution of "Enhancing the Effectiveness of Work Groups and Teams," by Kozlowski and Ilgen, a review monograph published in Psychological Science in the Public Interest in 2006.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis

BACKGROUND

In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs.

METHODS

We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method.

RESULTS

We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present.

CONCLUSIONS

Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.

High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance

Background

High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management.

Method

Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader’s frequency of shared mental model behavioral markers.

Results

The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information (“push” of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior. When separating the sample into higher versus lower performing teams, the higher performing teams had leaders who displayed a greater frequency of “push” of information and communication of SA and supportive behavior. No difference was found for the behavioral marker of team initiative, measured as bringing up suggestions to other teammembers.

Conclusion

The results of this study emphasize the team leader’s role in initiating and updating a team’s shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.

Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project

Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

Context in Quality of Care: Improving Teamwork and Resilience

Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety.

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center

PROBLEM

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired.

METHODS

Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities.

RESULTS

Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care.

IMPLICATIONS FOR PRACTICE

Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.

Interprofessional Team Training at the Prelicensure Level: A Review of the Literature

PURPOSE

The authors undertook a descriptive analysis review to gain a better understanding of the various approaches to and outcomes of team training initiatives in prelicensure curricula since 2000.

METHOD

In July and August 2014, the authors searched the MEDLINE, PsycINFO, Embase, Business Source Premier, and CINAHL databases to identify evaluative studies of team training programs' effects on the team knowledge, communication, and skills of prelicensure students published from 2000 to August 2014. The authors identified 2,568 articles, with 17 studies meeting the selection criteria for full text review.

RESULTS

The most common study designs were single-group, pre/posttest studies (n = 7), followed by randomized controlled or comparison trials (n = 6). The Situation, Background, Assessment, Recommendation communication tool (n = 5); crisis resource management principles (n = 6); and high-fidelity simulation (n = 4) were the most common curriculum bases used. Over half of the studies (n = 9) performed training with students from more than one health professions program. All but three used team performance assessments, with most (n = 8) using observed behavior checklists created for that specific study. The majority of studies (n = 16) found improvements in team knowledge, communication, and skills.

CONCLUSIONS

Team training appears effective in improving team knowledge, communication, and skills in prelicensure learners. Continued exploration of the best method of team training is necessary to determine the most effective way to move forward in prelicensure interprofessional team education.

Staff perception of interprofessional working relationships after a work redesign intervention in a Danish orthopaedic hand unit outpatient clinic

There is evidence that clinical pathways improve quality of care; however, knowledge is limited concerning the influence on and the benefits experienced by the interprofessional teams working with these pathways. Our working methods in a hand unit in an orthopaedic outpatient clinic in Denmark were redesigned to include, among other changes, the introduction of clinical pathways. Changes included standardising treatment and communication methods, delegating tasks from medical specialists to nurses, and providing nurses with their own consultation room. Using focus group interviews before and after the implementation of the new working methods, we investigated staff-perceived experiences of the effects on working relationships and the utilisation of professional skills and attitudes, resulting from the mentioned change in working methods. The results were changes in daily communication methods among healthcare staff and improvements in the actual communication and collaborative problem solving skills concerning standard patients with simple hand pathology; however, there are still challenges for patients with more complex hand pathology. Though this new interprofessional arrangement improves the use of nurse and medical specialist professional competencies, it also requires a high degree of trust among the team members.

Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care

OBJECTIVE

To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient.

MATERIALS AND METHODS

Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool.

RESULTS

Content overlap scores did not change post-implementation. The average number of discrepancies nearly doubled following the implementation (from 0.76 discrepancies per handoff group pre-implementation to 1.17 discrepancies per handoff group post-implementation); however, this change was not statistically significant (p=0.37). Discrepancies classified as related to dosage of treatment or procedure and to patients' symptoms increased in frequency post-implementation.

DISCUSSION

The results suggest that the Handoff Tool did not have the desired positive impact on SMM within patient care teams. Future electronic tools for facilitating team handoff may need longer implementation times, complementary changes to handoff process and structure, and improved designs that integrate a common core of shared information with discipline-specific records.

CONCLUSION

While electronic handoff tools provide great opportunities to improve communication and facilitate the formation of shared mental models within patient care teams, further work is necessary to realize their full potential.

The Effectiveness of Teamwork Training on Teamwork Behaviors and Team Performance: A Systematic Review and Meta-Analysis of Controlled Interventions

The objective of this study was to conduct a systematic review and meta-analysis of teamwork interventions that were carried out with the purpose of improving teamwork and team performance, using controlled experimental designs. A literature search returned 16,849 unique articles. The meta-analysis was ultimately conducted on 51 articles, comprising 72 (k) unique interventions, 194 effect sizes, and 8439 participants, using a random effects model. Positive and significant medium-sized effects were found for teamwork interventions on both teamwork and team performance. Moderator analyses were also conducted, which generally revealed positive and significant effects with respect to several sample, intervention, and measurement characteristics. Implications for effective teamwork interventions as well as considerations for future research are discussed.

S-TEAMS: A Truly Multiprofessional Course Focusing on Nontechnical Skills to Improve Patient Safety in the Operating Theater

BACKGROUND

Possessing adequate nontechnical skills (NTS) in operating theaters is of increasing interest to health care professionals, yet these are rarely formally taught. Teams make human errors despite technical expertise and knowledge, compromising patient safety. We designed a 1-day, multiprofessional, multidisciplinary course to teach, practice, and apply these skills through simulation.

METHODS

The course, "S-TEAMS," comprised a morning of lectures, case studies, and interactive teamworking exercises. The afternoon divided the group into multiprofessional teams to rotate around simulated scenarios. During the scenarios, teams were encouraged to focus on NTS, including communication strategies, situational awareness, and prompts such as checklists. A thorough debrief with experienced clinician observers followed. Data was collected through self-assessments, immediate and 6-month feedback to assess whether skills continued to be used and their effect on safety.

FINDINGS

In total, 68 health care professionals have completed the course thus far. All participants felt the course had a clear structure and that learning objectives were explicit. Overall, 95% felt the scenarios had good or excellent relevance to clinical practice. Self-assessments revealed a 55% increase in confidence for "speaking up" in difficult situations. Long-term data revealed 97% of the participants continued to use the skills, with 88% feeling the course had prevented them from making errors. Moreover, 94% felt the course had directly improved patient safety.

CONCLUSIONS

There is a real demand and enthusiasm for developing NTS within the modern theater team. The simple and easily reproducible format of S-TEAMS is sustainable and inclusive, and crucially, the skills taught continue to be used in long term to improve patient safety and teamworking.

Interprofessional simulation training for perioperative management team development and patient safety

Establishment of a perioperative management team construct including anaesthesiologists, surgeons, nurses, and other medical staff is essential to optimize safe surgical care. Simulation based education and training provides a unique and effective approach to development of competency and application of relevant technical and non-technical perioperative professional skills such as meta-cognitive ability, caution, shared decision-making, leadership and communication. Development of high functioning perioperative teams can be accomplished through simulation based training.

Neonatology faculty development using simulation

The goal of faculty development activities is to supply the public with knowledgeable, skilled, and competent physicians who are prepared for high performance in the dynamic and complex healthcare environment. Current faculty development programs lack evidence-based support and are not sufficient to meet the professional needs of practicing physicians. Simulation activities for faculty development offer an alternative to traditional, teacher-centric educational offerings. Grounded in adult learning theory, simulation is a learner-centric, interactive, efficient, and effective method to train busy professionals. Many of the faculty development needs of clinical neonatologists can be met by participating in simulation-based activities that focus on technical skills, teamwork, leadership, communication, and patient safety.

Cluster randomized trial to evaluate the impact of team training on surgical outcomes

Background

The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.

Methods

A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.

Results

Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.

Conclusion

Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).

Yes, we complain … so what?

Purpose

The purpose of this paper is to theorize and test a model concerning the role of complaining behaviors in work teams. Despite the prevalence of workplace complaining, there is no consensus in the literature regarding the consequences of those behaviors and the extent to which they are harmful.

Design/methodology/approach

Using a multisource approach and a team-level design, the authors collected data from 82 teams (i.e. 394 members and their 82 immediate superiors) working in a Canadian public safety organization.

Findings

The results show that complaining behaviors are negatively related to two effectiveness outcomes (i.e. team performance and team process improvement) and that meaningfulness mediates these relationships. The results also reveal that task interdependence moderates the relationship between complaining behaviors and meaningfulness. More specifically, complaining behaviors have a stronger relationship with meaningfulness when the level of task interdependence is high.

Originality/value

The present study contributes to the literature on counterproductive behaviors by deepening the understanding of emergent states and outcomes stemming from workplace complaining, particularly in work teams. The findings of this study highlight the negative consequences that complaining behaviors may have in a team setting, the underlying mechanism involved in these relationships, and the moderating role of task interdependence.

The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment

OBJECTIVES

To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors.

SETTING

Controlled laboratory environment with well-appointed, quiet rooms and video and audio equipment.

PARTICIPANTS

Clinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions.

INTERVENTIONS

Participants engaged in one of three team tasks, and their performance was video-recorded and assessed.

PRIMARY AND SECONDARY MEASURES

Primary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants' individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted.

RESULTS

At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).

CONCLUSIONS

Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals' or professions' characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.

Crew Resource Management for Obstetric and Neonatal Teams to Improve Communication During Cesarean Births

OBJECTIVE

To assess the effectiveness of crew resource management training and interventions on the quality and quantity of communication during cesarean births in a tertiary academic hospital's labor and birthing services.

DESIGN

A prospective pre-post crew resource management training intervention.

SETTING

Tertiary academic hospital in the Western United States.

PARTICIPANTS

All members of obstetric and neonatal teams that participated in cesarean births.

METHODS

Over a 5-month time period, all obstetric and neonatal staff were required to participate in team training in crew resource management critical language, communication, and team structure. Trained observers collected baseline data (n = 52) for 3 months on the quantity and quality of communications that occurred during cesarean births. Postintervention data (n = 50) were gathered for 3 months after team training. Analysis approach included use of Fisher's exact test, independent-samples t test, and multilevel generalized linear regression models with Poisson distribution.

RESULTS

There was a statistically significant increase in quantity and quality of communication from pre- to postintervention assessment for obstetric and neonatal staff. Although the increase in quality was similarly great between both types of teams, increase in quantity was more substantial in obstetric staff.

CONCLUSION

Principles of team communication training shown to be effective in increasing communication among team members in a variety of clinical areas were also effective in improving communication in the labor and birth setting during cesarean births.

Reflections From the Intersection of Health Professions Education and Clinical Practice: The State of the Science of Interprofessional Education and Collaborative Practice

This informed reflection, from the intersection of health professions education and clinical practice, takes stock of the state of the field of interprofessional education (IPE) and collaborative practice (CP) (together IPECP) by answering the following three questions: (1) As a field of study, where is IPECP? (2) As a research enterprise, what are the current analytical gaps? (3) Scientifically, what needs to be done going forward? While IPE and CP, as well as IPECP, have been areas of scholarly inquiry for nearly 50 years, they have collectively and individually had a limited sphere of influence. Analytical gaps identified include little research dealing with big picture health-related outcomes; mixed results on the effectiveness of health care teams; increasing recognition that additional IPECP competencies might be needed; a gap between the identification and application of educational best practices; and the need for sound, reliable, and validated tools for measuring IPECP. The authors outline the work of the National Center for Interprofessional Practice and Education at the University of Minnesota, which is focused on filling the identified analytical gaps by way of strategic actions organized around three domains-(1) developing an IPECP research agenda, (2) nurturing IPECP intervention research grounded in comparative effectiveness research study designs and the assumptions of critical realism, and (3) the creation of a sound informatics platform. The authors argue that filling these gaps is important because if the effectiveness of IPE on CP and of CP on health outcomes is ever to be ascertained, generalizable findings are paramount.

Comparing the Effectiveness of Individual Coaching, Self-Coaching, and Group Training: How Leadership Makes the Difference

Few empirical studies have used a randomized controlled design to evaluate the impact of coaching, and there are even fewer that have compared coaching with other interventions. In the current field study, we investigated the relative effectiveness of coaching as an intervention to reduce procrastination. In a randomized controlled study, participants (N = 84) were assigned to an individual coaching, a self-coaching, a group training, or a control group condition. Results indicate that individual coaching and group training were effective in reducing procrastination and facilitating goal attainment. Individual coaching created a high degree of satisfaction and was superior in helping participants attaining their goals, whereas group training successfully promoted the acquisition of relevant knowledge. The results for the self-coaching condition show that independently performing exercises without being supported by a coach is not sufficient for high goal attainment. Moreover, mediation analysis show that a coach’s transformational and transactional leadership behavior influenced participants’ perceived autonomy support and intrinsic motivation, resulting in beneficial coaching outcomes. The results may guide the selection of appropriate human resource development methods: If there is a general need to systematically prepare employees to perform on specific tasks, group training seems appropriate due to lower costs. However, when certain aspects of working conditions or individual development goals are paramount, coaching might be indicated. However, further research is needed to compare the relative effectiveness of coaching with other interventions in different contexts.

Are we at risk of groupthink in our approach to teamwork interventions in health care?

CONTEXT

The incidence of medical error, adverse clinical events and poor quality health care is unacceptably high and there are data to suggest that poor coordination of care, or teamwork, contributes to adverse outcomes. So, can we assume that increased collaboration in multidisciplinary teams improves performance and health care outcomes for patients?

METHODS

In this essay, the authors discuss some reasons why we should not presume that collective decision making leads to better decisions and collaborative care results in better health care outcomes.

RESULTS

Despite an exponential increase in interventions designed to improve teamwork and interprofessional education (IPE), we are still lacking good quality data on whether these interventions improve important outcomes. There are reasons why some of the components of 'effective teamwork', such as shared mental models, team orientation and mutual trust, could impair delivery of health care. For example, prior studies have found that brainstorming results in fewer ideas rather than more, and hinders rather than helps productivity. There are several possible explanations for this effect, including 'social loafing' and cognitive overload. Similarly, attributes that improve cohesion within groups, such as team orientation and mutual trust, may increase the risk of 'groupthink' and group conformity bias, which may lead to poorer decisions.

CONCLUSIONS

In reality, teamwork and IPE are not inherently good, bad or neutral; instead, as with any intervention, their effect is modified by the persons involved, the situation and the interaction between persons and situation. Thus, rather than assume better outcomes with teamwork and IPE interventions, as clinicians and educators we must demonstrate that our interventions improve the delivery of health care.

Does Transition Experience Improve Newcomer Performance? Evidence From the National Basketball Association

A substantial body of research has highlighted the effects of experience on individual performance in groups. However, the challenges individuals confront after moving between groups require the adoption of more finely grained categorizations of experience to understand how they will help or hinder performance in novel group environments. This article develops a distinct form of experience here termed transition experience to deal specifically with insights individuals accumulate as they shift membership between different groups and contrasts its impact with that of the frequently examined component of related task experience. Player movement data from the National Basketball Association is used to show that related task experience can produce negative consequences, consistent with prior research. Conversely, low to moderate levels of transition experience can aid performance. This holds true for both individual performance and performance more closely related to coordinated actions with teammates.

Interprofessional team management in pediatric critical care: some challenges and possible solutions

BACKGROUND

Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.

METHODS

We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.

FINDINGS

The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one's own unit, engagement of health care professionals occurs and projects become accepted.

CONCLUSION

Bottom-up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety.

Once upon a time

For as long as groups and teams have been the subject of scientific inquiry, researchers have been interested in understanding the relationships that form within them, and the pace at which these relationships develop and change. Despite this interest in understanding the process underlying the unfolding of relationships in teams, current theoretical and operational formulations of team process require greater specificity if they are to truly afford a high-resolution understanding. Most researchers interested in team process, study it as either a snapshot, or as a limited series of snapshots, rather than as a continuous movie displaying the nuanced sequential interactions unfolding among varying subsets of team members. Given the increasing availability of rich data regarding team dynamics, corresponding advances are needed in conceptual and analytic frameworks to utilize continuous-time data to further our understanding of team processes. This paper identifies four challenges that hinder the identification of team process/dynamics and elaborates a theoretical approach with the associated analytic machinery needed to advance a truly time-sensitive understanding of team process.

Leveraging Social Science-Healthcare Collaborations to Improve Teamwork and Patient Safety

Effective teamwork is critical to the provision of safe, effective healthcare. High functioning teams adapt to rapidly changing patient and environmental factors, preventing diagnostic and treatment errors. While the emphasis on teamwork and patient safety is relatively new, significant team-related foundational and implementation research exists in disciplines outside of healthcare. Social scientists, including, organizational psychologists, have expertise in the study of teams, multi-team units, and organizations. This article highlights guiding team science principles from the organizational psychology literature that can be applied to the study of teams in healthcare. The authors' goal is to provide some common language and understanding around teams and teamwork. Additionally, they hope to impart an appreciation for the potential synergy present within clinician-social scientist collaborations.

Teammate familiarity and risk of injury in emergency medical services

OBJECTIVE

We investigated the association between teammate familiarity and workplace injury in the emergency medical services (EMS) setting.

METHODS

From January 2011 to November 2013, we abstracted a mean of 29 months of shift records and Occupational Safety Health Administration injury logs from 14 EMS organisations with 37 total bases located in four US Census regions. Total teammate familiarity was calculated for each dyad as the total number of times a clinician dyad worked together over the study period. We used negative binomial regression to examine differences in injury incidence rate ratios (IRRs) by familiarity.

RESULTS

We analysed 715 826 shift records, representing 4197 EMS clinicians and 60 701 unique dyads. We determined the mean shifts per dyad was (5.9, SD 19.7), and quartiles of familiarity were 1 shift worked together over the study period, 2-3 shifts, 4-9 shifts and ≥10 shifts worked together. More than half of all dyads worked one shift together (53.9%, n=32 739), 24.8% of dyads 2-3 shifts, 11.8% worked 4-9 shifts and 9.6% worked ≥10 shifts. The overall incidence rate of injury across all organisations was 17.5 per 100 full-time equivalent (FTE), range 4.7-85.6 per 100 FTE. The raw injury rate was 33.5 per 100 FTEs for dyads with one shift of total familiarity, 14.2 for 2-3 shifts, 8.3 for 4-9 shifts and 0.3 for ≥10 shifts. Negative binomial regression confirmed that dyads with ≥10 shifts had the lowest incidence of injury (IRR 0.03; 95% CI 0.02 to 0.04).

CONCLUSIONS

Familiarity between teammates varies in the EMS setting, and less familiarity is associated with greater incidence of workplace injury.

Multidisciplinary team training reduces the decision-to-delivery interval for emergency Caesarean section

BACKGROUND

Emergency Caesarean section is performed when the life of the pregnant woman and/or the foetus is considered at risk. A 30-min standard for the decision-to-delivery interval (DDI) is a common practice and is supported by national organisations including The Danish Society of Obstetrics and Gynaecology. Danish obstetric departments report the DDI to a national database. A national arbitrarily set standard recommends that 95% of ECSs should be achieved within the 30-min DDI standard. In 2011, 34.4% of ECSs, performed at our hospital, were achieved within the 30-min time frame. This study aims to evaluate the effect of a simulation-based team training programme on the proportion of ECSs achieved within a 30-min time frame.

METHOD

We performed an interventional before-and-after study. We evaluated a total of one hundred 30-min ECSs before and after the intervention. The primary outcome of interest was the proportion of 30-min ECSs achieved within a 30-min time frame.

RESULTS

A total of 20 team training courses were held during May/June 2013. These courses trained 239 of 252 team members (comprised of: 36 obstetricians, 45 scrub nurses, 83 midwives, 38 anaesthesiologists, 37 nurse anaesthetists) in handling of 30-min ECS. This corresponds to 95% of staff. The proportion of 30-min ECSs achieved within a 30-min time frame was higher after team training (87.5%, 95% CI 79.2-93.4%) compared with before training (74.0%, 95% CI 64.0-82.4%) (P = 0.017).

CONCLUSION

Team training may contribute positively to an increase in the proportion of ECSs achieved within a 30-min time frame.

Beyond the simulation laboratory: a realist synthesis review of clinical outcomes of simulation-based mastery learning

PURPOSE

Translational educational outcomes have been defined as starting in simulation laboratories (T1) and moving downstream to improved patient care practices (T2), patient outcomes (T3), and cost/other value outcomes (T4). The authors conducted a realist synthesis review of the literature to evaluate the translational effect of simulation-based mastery learning (SBML) principles beyond the laboratory. They also sought to address future directions in SBML to improve patient care processes and outcomes and, thus, the quality of health care delivery.

METHOD

The authors searched multiple databases for simulation-based medical education (SBME) studies published through April 2013. They screened articles using the PICO method-population (P), intervention (I), control (C), outcome (O)-to answer the research question: For (P) any health care providers, does the (I) implementation of SBML training, compared with (C) other training methodologies or no extra training, result in (O) a change in patient care practices or T2-T4 outcomes? Studies implementing SBME interventions with training methodologies that met all SBML principles and reporting T2-T4 outcomes were identified.

RESULTS

The 14 included studies used pre/post or cohort study designs; the majority were limited to individual performance and procedural competency. They reported improvement after SBML training in procedure performance, task success, patient discomfort, procedure time, complication rates, or T4 impacts (e.g., cost reduction).

CONCLUSIONS

Findings suggest health professions education conducted using SBML methodology can improve patient care processes and outcomes. Further research is needed to understand the translational impact of SBML for nontechnical skills, including teamwork, and skill retention.

Reflexivity in Teams: A Review and New Perspectives

Team reflexivity posits that the extent to which teams reflect upon and adapt their functioning is positively related to team performance. While remarkable progress has been made to provide evidence of this relationship, the underlying framework is missing elements of current theoretical streams for analyzing and describing teamwork, leaving the diversity of effects of team reflexivity often untouched. In this article, we present an update for this framework, by reviewing previous research on reflexivity, addressing gaps in the literature, and revising the original model by integrating feedback and dynamic team effectiveness frameworks for describing temporal developments of reflexivity. We furthermore propose a new dimensional structure for reflexivity, relying on prior work conceptualizing teams as information-processing systems that learn and advance through social-cognitive elements. Our model is therefore not only suitable for explaining the diverse set of relationships between team reflexivity on outcomes, but also provides valuable directions for viewing reflexivity as process that takes place during both transition and action phases of teamwork. We conclude with implications for managers, identify limitations, and propose an agenda for further research into this area. This article contributes an extended perspective relevant for further theory development and for effectively managing reflexivity in teams.

TeamSTEPPS implementation in community hospitals: adherence to recommended training approaches

PURPOSE

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is being widely promoted in healthcare settings to train staff in evidence-based approaches that promote patient safety. It involves a comprehensive curriculum that spells out key principles and actionable tools for a culture change toward patient-safety-focussed teamwork. Activities begin with selected personnel attending TeamSTEPPS Master Trainer Training (MTT) and then organizing and providing TeamSTEPPS training for staff in their organization. The authors conducted interviews with respondents at community hospitals conducting TeamSTEPPS staff training. To structure the interviews, the authors used 11 key questions identified by Weaver et al. in their in-depth team training literature review. The purpose of this paper is to examine approaches taken by community hospital personnel and compare those to the best practices recommended by Weaver et al.

DESIGN/METHODOLOGY/APPROACH

The authors interviewed 57 staff and administrators at 22 community hospitals sending teams to TeamSTEPPS MTT.

FINDINGS

The authors find that training implementation in community hospitals differs significantly from the established, research-based principles for effective team training described in the research literature, which is largely based in academic medical centers.

ORIGINALITY/VALUE

The current findings suggest that several TeamSTEPPS training features could be enhanced in community hospitals including: choosing staff who have the skills to be effective trainers in this train-the-trainer model; emphasizing active learning; and sustaining lessons through on-the-job application, practice and feedback. These principles apply to many training approaches employed in small healthcare organizations.

Effect of physical exercise on workplace social capital: Cluster randomized controlled trial

AIMS

While workplace health promotion with group-based physical exercise can improve workers' physical health, less is known about potential carry-over effects to psychosocial factors. This study investigates the effect of physical exercise on social capital at work.

METHODS

Altogether, 200 female healthcare workers (nurses and nurse's aides) from 18 departments at three hospitals were randomly allocated at the department level to 10 weeks of (1) group-based physical exercise at work during working hours or (2) physical exercise at home during leisure time. At baseline and follow-up, participants replied to a questionnaire concerning workplace social capital: (1) within teams (bonding); (2) between teams (bridging); (3) between teams and nearest leaders (linking A); (4) between teams and distant leaders (linking B).

RESULTS

At baseline, bonding, bridging, linking A and linking B social capital were 74 (SD 17), 61 (SD 19), 72 (SD 22) and 70 (SD 18), respectively, on a scale of 0-100 (where 100 is best). A group by time interaction was found for bonding social capital (P=0.02), where physical exercise at work compared with physical exercise during leisure time increased 5.3 (95% confidence interval 2.3- 8.2)(effect size, Cohen's d = 0.31) from baseline to follow-up. For physical exercise at home during leisure time and exercise at work combined, a time effect (P=0.001) was found for linking A social capital, with a decrease of 4.8 (95% confidence interval 1.9-7.6).

CONCLUSIONS

Group-based physical exercise at work contributed to building social capital within teams at the workplace. However, the general decrease of social capital between teams and nearest leaders during the intervention period warrants further research.

Multi-Level Efficacy Evidence of a Combined Interprofessional Collaboration and Project Management Training Program for Healthcare Project Teams

Project work is essential for the improvement of healthcare organizations; yet, project management and collaboration in the project context are not taught to healthcare professionals. Three half-day training workshops integrating project management and collaboration were designed and delivered to 14 interprofessional healthcare project teams. Multivariate measures were taken over the course of 36 weeks. Individual, team, and project-level results showed high satisfaction and perceptions of utility; improved self-efficacy for project-specific task work and teamwork; increased goal clarity and coordination; and a significant impact on the functional performance of projects. This study provides initial benchmark measures regarding the pertinence of project management and interprofessional collaboration training for healthcare project teams.

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.