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Theissen A, Fuz F, Carbonne B, Bonnet L, Rouquette-Vincenti I, Niccolai P, Raucoules-Aime M. [Closed claims in obstetrics: A study based on French Sham insurance data]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2015; 45:54-61. [PMID: 25863577 DOI: 10.1016/j.jgyn.2015.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/14/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the medicolegal claims related to obstetrics in French hospitals. MATERIAL AND METHODS We did retrospective study on insurance claims provided by Sham insurances and which has been settled by a court over a 3-year period (2004-2006). RESULTS We analyzed 66 closed claims that occurred between 1983 and 2005 in French hospitals (54 general hospitals and 12 academic). The average time between the declaration of the claim and the court conviction was 6 years. The average amount of compensation per claim was 500,000 €. The damage occurred during vaginal delivery (n=44), planned (n=5) or unplanned (n=4) cesarean. The more often claims are fetal asphyxia (n=24) or shoulder dystocia (n=8). The consequences are very important: cerebral palsy (16), death of the newborn (12), death of the mother (2) or brachial plexus injuries (6). CONCLUSION The causes identified by the expert are always multifactorial with generally a misdiagnosis (n=27), a decision making error (n=36), a care error by the midwife (n=21) and/or a delay in medical care (n=13). These data should help strengthen the quality approach in obstetrics.
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Affiliation(s)
- A Theissen
- Service d'anesthésie-réanimation, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, Monaco.
| | - F Fuz
- Sham, service gestion des risques, 69008 Lyon, France
| | - B Carbonne
- Unité d'obstétrique, maternité de l'hôpital Trousseau, université Pierre et Marie Curie, Paris 6, 75012 Paris, France
| | - L Bonnet
- Service d'anesthésie-réanimation, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, Monaco
| | - I Rouquette-Vincenti
- Service d'anesthésie-réanimation, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, Monaco
| | - P Niccolai
- Service d'anesthésie et chirurgie ambulatoire, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, Monaco
| | - M Raucoules-Aime
- Département d'anesthésie-réanimation, CHU, hôpital Archet 2, 151, route Saint-Antoine de Ginestière, 06200 Nice, France
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202
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Guchait P, Lei P, Tews MJ. Making Teamwork Work: Team Knowledge for Team Effectiveness. THE JOURNAL OF PSYCHOLOGY 2015; 150:300-17. [PMID: 25856724 DOI: 10.1080/00223980.2015.1024596] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study examined the impact of two types of team knowledge on team effectiveness. The study assessed the impact of taskwork knowledge and teamwork knowledge on team satisfaction and performance. A longitudinal study was conducted with 27 service-management teams involving 178 students in a real-life restaurant setting. Teamwork knowledge was found to impact both team outcomes. Furthermore, team learning behavior was found to mediate the relationships between teamwork knowledge and team outcomes. Educators and managers should therefore ensure these types of knowledge are developed in teams along with learning behavior for maximum effectiveness.
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Wooten KC, Calhoun WJ, Bhavnani S, Rose RM, Ameredes B, Brasier AR. Evolution of Multidisciplinary Translational Teams (MTTs): Insights for Accelerating Translational Innovations. Clin Transl Sci 2015; 8:542-52. [PMID: 25801998 DOI: 10.1111/cts.12266] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There is growing consensus about the factors critical for development and productivity of multidisciplinary teams, but few studies have evaluated their longitudinal changes. We present a longitudinal study of 10 multidisciplinary translational teams (MTTs), based on team process and outcome measures, evaluated before and after 3 years of CTSA collaboration. Using a mixed methods approach, an expert panel of five judges (familiar with the progress of the teams) independently rated team performance based on four process and four outcome measures, and achieved a rating consensus. Although all teams made progress in translational domains, other process and outcome measures were highly variable. The trajectory profiles identified four categories of team performance. Objective bibliometric analysis of CTSA-supported MTTs with positive growth in process scores showed that these teams tended to have enhanced scientific outcomes and published in new scientific domains, indicating the conduct of innovative science. Case exemplars revealed that MTTs that experienced growth in both process and outcome evaluative criteria also experienced greater innovation, defined as publications in different areas of science. Of the eight evaluative criteria, leadership-related behaviors were the most resistant to the interventions introduced. Well-managed MTTs demonstrate objective productivity and facilitate innovation.
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Affiliation(s)
- Kevin C Wooten
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,School of Business, University of Houston-Clear Lake, Houston, Texas, USA
| | - William J Calhoun
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
| | - Suresh Bhavnani
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Robert M Rose
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | - Bill Ameredes
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
| | - Allan R Brasier
- Institute for Translational Sciences, University of Texas Medical Branch (UTMB), Galveston, Texas, USA.,Department of Internal Medicine, UTMB, Galveston, Texas, USA
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205
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Bongiovanni T, Long T, Khan AM, Siegel MD. Bringing Specialties Together: The Power of Intra-Professional Teams. J Grad Med Educ 2015; 7. [PMID: 26217416 PMCID: PMC4507920 DOI: 10.4300/jgme-d-14-00509.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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206
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Fransen AF, Banga FR, van de Ven J, Mol BWJ, Oei SG. Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Annemarie F Fransen
- Máxima Medical Centre; Department of Obstetrics and Gynaecology; De Run 4600 Veldhoven Noord-Brabant Netherlands 5504 DB
| | - Franyke R Banga
- Máxima Medical Centre; Department of Obstetrics and Gynaecology; De Run 4600 Veldhoven Noord-Brabant Netherlands 5504 DB
| | - Joost van de Ven
- Máxima Medical Centre; Department of Obstetrics and Gynaecology; De Run 4600 Veldhoven Noord-Brabant Netherlands 5504 DB
| | - Ben Willem J Mol
- The University of Adelaide; The Robinson Institute, School of Paediatrics and Reproductive Health; Level 3, Medical School South Building Frome Road Adelaide South Australia Australia SA 5005
| | - S Guid Oei
- Máxima Medical Centre; Department of Obstetrics and Gynaecology; Department of Electrical Engineering (University of Technology, Eindhoven); De Run 4600 Veldhoven Noord-Brabant Netherlands 5504 DB
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207
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Davies A, Davies J. Initial steps in designing a simulation center and program to support the opening of a new women and children's hospital in Qatar. AVICENNA 2015. [DOI: 10.5339/avi.2015.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Designing and building a simulation program and center is a complex endeavor. This is considerably compounded by the simultaneous planning and construction of new hospital in which it will be house. To support the opening of a new healthcare facility in Doha, Qatar, simulation was chosen as a primary educational solution for the required onboarding of an international workforce, and to help collect data on systems to ensure processes and systems are optimal for patient safety. The following article provides a high-level overview of some of the key considerations and solutions that were made to overcome the many variables that are inherent in the planning phase of designing a center and program for a new hospital.
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208
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Hedlund E, Börjesson M, Österberg J. Team Learning in a Multinational Military Staff Exercise. SMALL GROUP RESEARCH 2015. [DOI: 10.1177/1046496414568462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
International operations have become one of the main tasks for the Swedish Armed Forces (SAF). The SAF and Swedish National Defence College organize annual international staff exercises with the purpose of training officers to carry out effective staff work. This study analyzed a staff exercise using Edmondson’s team learning model in a military setting. The model was developed by including group cohesion. As defensive routines are a threat to team learning behavior, the possible presence of these was examined. The results indicate that team leader coaching is crucial to support all the variables in the model. The added variable of group cohesion contributed with insights on how the commander used task solving to create group cohesion. Some examples of defensive routines were also revealed but there seemed to be challenges in identifying such routines in this type of exercise setting.
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Affiliation(s)
- Erik Hedlund
- The Swedish National Defence College, Stockholm, Sweden
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209
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Gosai J, Purva M, Gunn J. Simulation in cardiology: state of the art. Eur Heart J 2015; 36:777-83. [DOI: 10.1093/eurheartj/ehu527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/27/2014] [Indexed: 01/01/2023] Open
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Yammarino FJ, Salas E, Serban A, Shirreffs K, Shuffler ML. Collectivistic Leadership Approaches: Putting the “We” in Leadership Science and Practice. INDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY-PERSPECTIVES ON SCIENCE AND PRACTICE 2015. [DOI: 10.1111/j.1754-9434.2012.01467.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We introduce the notion of “we” or collectivistic leadership. A general collectivistic approach to leadership is developed and contrasted with traditional and contemporary approaches to leadership. An overview of five collectivistic leadership approaches—team, network, shared, complexity, and collective leadership—is then presented. Key notions, constructs, and levels of analysis; the role of a focal leader; operationalizations and empirical results; and implications for leadership development, assessment, and practice of each approach are summarized. Common themes across, and our perspective on, the approaches and future directions for collectivistic leadership science and practice are discussed.
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211
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The effects of culture and gender on perceived self-other similarity in personality. JOURNAL OF RESEARCH IN PERSONALITY 2014. [DOI: 10.1016/j.jrp.2014.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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212
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O'Leary JD, O'Sullivan O, Barach P, Shorten GD. Improving clinical performance using rehearsal or warm-up: an advanced literature review of randomized and observational studies. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1416-1422. [PMID: 24988420 DOI: 10.1097/acm.0000000000000391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether rehearsal (the deliberate practice of skills specific to a procedure) or warm-up (the act or process of warming up by light exercise or practice) prior to performing complex clinical procedures on patients can improve the task performance of operators and operating teams. METHOD The authors performed an advanced literature search for clinical studies published between 1975 and October 2012 using MEDLINE, EMBASE, the Cochrane Controlled Trials Register, ISI Web of Knowledge, and clinicaltrials.gov. They identified randomized controlled trials and observational studies that evaluated the effects of physical rehearsal or warm-up prior to performing complex clinical procedures. Two reviewers independently reviewed titles and abstracts and then full texts before abstracting data using a standardized form. They resolved disagreements by consensus. RESULTS The authors identified 1,886 potential articles and included 7 in their review (2 randomized controlled trials and 5 observational studies). All reported that rehearsal or warm-up by operators or operating teams is feasible. Only two clinical studies objectively demonstrated that warm-up can improve overall technical performance. Other objective evidence supporting the positive effects of rehearsal or warm-up for other team or nontechnical outcomes was limited. CONCLUSIONS The potential benefits of and optimal techniques for performing physical rehearsal and warm-up have not been established. Preliminary findings suggest that preoperative rehearsal or warm-up can improve the performance of operators or operating teams, but there is a paucity of objective evidence and comparative clinical studies in the existing literature to support their routine use.
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Affiliation(s)
- James D O'Leary
- Dr. O'Leary is assistant professor, Department of Anesthesia, University of Toronto, and staff anesthesiologist, Hospital for Sick Children, Toronto, Ontario, Canada. Dr. O'Sullivan is research fellow, Department of Anesthesia, University College Cork, Cork, Ireland. Dr. Barach is anesthesiologist and visiting professor, University College Cork, Cork, Ireland. Professor Shorten is professor of anesthesia and dean, School of Medicine, University College Cork, Cork, Ireland
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213
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Excellence in Perioperative Management: Establishing a Culture of Safety. AORN J 2014; 100:1-3. [DOI: 10.1016/j.aorn.2014.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/21/2014] [Indexed: 11/19/2022]
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214
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Rentsch JR, Delise LA, Mello AL, Staniewicz MJ. The Integrative Team Knowledge Building Training Strategy in Distributed Problem-Solving Teams. SMALL GROUP RESEARCH 2014. [DOI: 10.1177/1046496414537690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Team knowledge building requires teams to discuss all available pertinent task information. However, teams tend to extract information ineffectively due to impediments including the sampling advantage of common information and differential schema structures among team members. In addition, distributed teams have difficulty building knowledge due to constraints associated with low-bandwidth computer-mediated communication. Therefore, we tested a team training strategy aimed at facilitating team knowledge building in distributed teams. Data were collected from 40 teams of three distributed members. Teams were assigned to a training or control condition, and they completed a realistic problem-solving task. Training condition teams were trained to build knowledge by creating a knowledge object integrated with schema-enriched communication behaviors in text chat. Control condition teams communicated using chat only and received no training. Results indicated trained teams, relative to untrained teams, shared more unique information, transferred more knowledge, developed higher cognitive congruence, and produced higher quality solutions.
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215
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Kelling NJ, Gaalema DE, Kelling AS. A modified operational sequence methodology for zoo exhibit design and renovation: Conceptualizing animals, staff, and visitors as interdependent coworkers. Zoo Biol 2014; 33:336-48. [DOI: 10.1002/zoo.21134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/28/2014] [Accepted: 04/14/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Diann E. Gaalema
- Department of Psychiatry; University of Vermont; Burlington Vermont
| | - Angela S. Kelling
- Department of Psychology; University of South Florida - Lakeland; Lakeland FL
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216
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Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf 2014; 23:359-72. [PMID: 24501181 PMCID: PMC3995248 DOI: 10.1136/bmjqs-2013-001848] [Citation(s) in RCA: 297] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 12/06/2013] [Accepted: 01/12/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. METHODS A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes. RESULTS Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice. CONCLUSIONS Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.
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Affiliation(s)
- Sallie J Weaver
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, Maryland, USA
| | - Sydney M Dy
- Department of Health Policy & Management, Oncology, and Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, Baltimore, Maryland, USA
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217
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Long T, Dann S, Wolff ML, Brienza RS. Moving from silos to teamwork: integration of interprofessional trainees into a medical home model. J Interprof Care 2014; 28:473-4. [PMID: 24593328 DOI: 10.3109/13561820.2014.891575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As the United States faces an impending shortage in the primary care workforce, interprofessional teamwork training to improve clinic efficiency and health outcomes is becoming increasingly important. Currently there is limited integration of interprofessional training in educational models for health professionals. The implementation of Patient Aligned Care Teams at the Department of Veterans Affairs (VA) has provided an opportunity for interprofessional collaboration among trainee and faculty providers within the VA system. However, integration of interprofessional education is also necessary to train future providers in order to provide effective team-based care. We describe a transportable educational model for health professional collaboration from our experience as a VA Center of Excellence in Primary Care Education, including a complementary novel one-year post-Master's adult nurse practitioner interprofessional clinical fellowship. With growing recognition that interprofessional care can improve efficiency and outcomes, there is an increasing need for programs that train future providers in collaboration and team-based care.
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Affiliation(s)
- Theodore Long
- Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven , CT , USA
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218
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Abstract
Purpose
– Computer-mediated communication systems (CMCSs) have become the standard for supporting virtual teamwork. However, interpersonal trust formation though CMCSs is impaired due to limited media richness of the communication channels. The aim of this paper is to identify trust forming cues that occur naturally in face-to-face environments and are suitable to include in CMCSs design, to facilitate greater trust in virtual teams.
Design/methodology/approach
– To select cues that had a strong effect on fostering trust behaviour, a non-participatory ethnographic study was conducted. Two student teams at the University of Waterloo were observed for 6-12 months. Researchers identified mechanisms used for building trust and bridging team developmental barriers.
Findings
– The paper identifies five trust tokens that were effective in developing trust and bridging team developmental barriers: expertise, recommendations, social capital, willingness to help/benevolence, and validation of information. These behavioural cues, or behavioural trust tokens, which are present in face-to-face collaborations, carry important trust supporting information that leads to increased trust, improved collaboration, and knowledge integration. These tokens have the potential to improve CMCSs by supplementing the cues necessary for trust formation in virtual environments.
Practical implications
– This study identifies important mechanisms used for fostering trust behaviour in face-to-face collaborations that have the potential to be included in the design of CMCSs (via interface design objects) and have implications for interface designers, team managers, and researchers in the field of teamwork.
Originality/value
– This work presents the first ethnographic study of trust between team members for the purpose of providing improved computer support for virtual collaboration via redesigned interface components.
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A Randomized, Controlled Trial of In Situ Pediatric Advanced Life Support Recertification (“Pediatric Advanced Life Support Reconstructed”) Compared With Standard Pediatric Advanced Life Support Recertification for ICU Frontline Providers*. Crit Care Med 2014; 42:610-8. [DOI: 10.1097/ccm.0000000000000024] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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220
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Wahr JA, Abernathy JH. Improving Patient Safety in the Cardiac Operating Room: Doing the Right Thing the Right Way, Every Time. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0052-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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221
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222
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Brown CJ, Miltner RS. Hospital Falls. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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223
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Clay-Williams R, Greenfield D, Stone J, Braithwaite J. On a wing and a prayer: an assessment of modularized crew resource management training for health care professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:56-67. [PMID: 24648364 DOI: 10.1002/chp.21218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Evidence suggests that Crew Resource Management (CRM), a form of team training, is beneficial. In CRM training, participants learn individual portable team skills such as communication and decision making through group discussion and activities. However, the usual 1-day course format is not always compatible with health care organizational routines. A modular training format, while theoretically sound, is untested for interprofessional team training. The aim of this study was to explore the potential for modularized CRM training to be delivered to a group of interprofessional learners. METHOD Modularized CRM training, consisting of two 2-hour workshops, was delivered to health care workers in an Australian tertiary hospital. Kirkpatrick's evaluation model provided a framework for the study. Baseline attitude surveys were conducted prior to each workshop. Participants completed a written questionnaire at the end of each workshop that examined their motivations, reactions to the training, and learner demographics. An additional survey, administered 6 weeks post training, captured self-assessed behavior data. RESULTS Twenty-three individuals from a range of professions and clinical streams participated. One in 5 participants (22%) reported that they translated teamwork skills to the workplace. While positive about the workshop format and content, many respondents identified personal, team, and organizational barriers to the application of the workshop techniques. DISCUSSION CRM training when delivered in a modular format has positive outcomes. Following the training, some respondents overcame workplace barriers to attempt to change negative workplace behavior. This progress provides cautious optimism for the potential for modular CRM training to benefit groups of interprofessional health staff.
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224
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Patterson PD, Pfeiffer AJ, Lave JR, Weaver MD, Abebe K, Krackhardt D, Arnold RM, Yealy DM. How familiar are clinician teammates in the emergency department? Emerg Med J 2013; 32:258-62. [PMID: 24351519 DOI: 10.1136/emermed-2013-203199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Lack of familiarity between teammates is linked to worsened safety in high risk settings. The emergency department (ED) is a high risk healthcare setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterise familiarity between clinician teammates in one urban teaching hospital ED over a 22 week study period. METHODS We used a retrospective study design of shift scheduling data to calculate the mean weekly hours of familiarity between teammates at the dyadic level, and the proportion of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity at any given hour during the study period. RESULTS Mean weekly hours of familiarity between ED clinician dyads was 2 h (SD 1.5). At any given hour over the study period, the proportions of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity were 80%, 51%, 27% and 0.8%, respectively. CONCLUSIONS In our study, few clinicians could be described as having a high level of familiarity with teammates. The limited familiarity between ED clinicians identified in this study may be a natural feature of ED care delivery in academic settings. We provide a template for measurement of ED team familiarity.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony J Pfeiffer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Judith R Lave
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kaleab Abebe
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Krackhardt
- David A Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Division of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
Although many analysts recognize that team-level learning is reliant on the acquisition of learning content by individuals, very little research has examined individual-level learning during team training. In a sample of 70 teams ( N = 380) that participated in a simulation-based team training setting designed to teach strategic decision-making, we examined how self-regulation during team training influenced the extent to which team members subsequently demonstrated individual mastery of the team training content. We also investigated the extent to which team characteristics moderated the relationships between self-regulation and learning outcomes. Multilevel mediation results indicated that self-efficacy fully mediated the effects of metacognition, or self-monitoring of learning, on individual declarative and procedural knowledge of team training content. The results also revealed that these individual-level relationships were moderated by the team context. In particular, a team’s overall performance and quality of cooperation amplified the positive effects of individual self-regulation. Implications for team training research and practice are discussed.
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Evaluation of a Computer-Based Educational Intervention to Improve Medical Teamwork and Performance During Simulated Patient Resuscitations. Crit Care Med 2013; 41:2551-62. [DOI: 10.1097/ccm.0b013e31829828f7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Paull DE, Deleeuw LD, Wolk S, Paige JT, Neily J, Mills PD. The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients. J Contin Educ Nurs 2013; 44:516-24. [PMID: 24024501 DOI: 10.3928/00220124-20130903-38] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 07/30/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many adverse events in health care are caused by teamwork and communication breakdown. This study was conducted to investigate the effect of a point-of-care simulation-based team training curriculum on measurable teamwork and communication skills in staff caring for postoperative patients. METHODS Twelve facilities involving 334 perioperative surgical staff underwent simulation-based training. Pretest and posttest self-report data included the Self-Efficacy of Teamwork Competencies Scale. Observational data were captured with the Clinical Teamwork Scale. RESULTS Teamwork scores (measured on a five-point Likert scale) improved for all eight survey questions by an average of 18% (3.7 to 4.4, p < .05). The observed communication rating (scale of 1 to 10) increased by 16% (5.6 to 6.4, p < .05). CONCLUSION Simulation-based team training for staff caring for perioperative patients is associated with measurable improvements in teamwork and communication.
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Patterson MD, Geis GL. On the Move: Simulation to Improve and Assure Transport Team Performance. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wahr JA, Prager RL, Abernathy JH, Martinez EA, Salas E, Seifert PC, Groom RC, Spiess BD, Searles BE, Sundt TM, Sanchez JA, Shappell SA, Culig MH, Lazzara EH, Fitzgerald DC, Thourani VH, Eghtesady P, Ikonomidis JS, England MR, Sellke FW, Nussmeier NA. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation 2013; 128:1139-69. [PMID: 23918255 DOI: 10.1161/cir.0b013e3182a38efa] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Eddy ER, Tannenbaum SI, Mathieu JE. Helping Teams to Help Themselves: Comparing two Team-Led Debriefing Methods. PERSONNEL PSYCHOLOGY 2013. [DOI: 10.1111/peps.12041] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomas L, Galla C. Republished: Building a culture of safety through team training and engagement. Postgrad Med J 2013; 89:394-401. [DOI: 10.1136/postgradmedj-2012-001011rep] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
BACKGROUND Critical incident analysis reveals that poor performance in 'human-factor' or non-technical skills, such as decision making, leadership, teamwork and situational awareness, are frequently identified as key underlying features leading to adverse events. Simulation technology is a rapidly emerging modality used to develop technical and non-technical skills within specialist training as increasing shift-pattern work reduces work-based exposure and learning opportunities. To date, however, there is little literature regarding its use within core medical training to develop crisis resource management skills and medical registrar competency. STUDY DESIGN We present results from a pilot in situ high-fidelity, multidisciplinary, simulation training course in which core medical trainees practised the role of a medical registrar within challenging crisis scenarios. RESULTS Twenty-one trainees completed the simulation course. All trainees agreed that the course improved their clinical skills and knowledge, concentrated on key non-technical skills that are important in crisis management and, importantly, would change their clinical practice and improve patient safety. Trainee overall performance strongly correlated with assessment of non-technical skills during the simulation scenario. Trainees invited to return for a repeat session after previous concerns and specific feedback showed a visible improvement in performance, with an objective improvement in self-assessed performance. CONCLUSION This pilot programme shows the benefits of a high-fidelity, in situ, multidisciplinary simulation training course for core medical trainees in developing the key crisis resource management skills necessary at medical registrar level. As a historical apprenticeship model of training becomes increasingly variable and absent, we present a novel complimentary training strategy for tomorrow's medical registrars.
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Affiliation(s)
- Anand Shah
- Postgraduate Medical Education Centre, North-West London Hospitals NHS Trust, London, UK.
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Lee PT, Friedberg MW, Bowen JL, Day SC, Kilo CM, Sinsky CA. Training Tomorrow's Comprehensive Primary Care Internists: A Way Forward for Internal Medicine Education. J Grad Med Educ 2013; 5:187-91. [PMID: 24404257 PMCID: PMC3693678 DOI: 10.4300/jgme-d-12-00134.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Topjian AA, Berg RA, Nadkarni VM. Advances in recognition, resuscitation, and stabilization of the critically ill child. Pediatr Clin North Am 2013; 60:605-20. [PMID: 23639658 DOI: 10.1016/j.pcl.2013.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advances in early recognition, effective response, and high-quality resuscitation before, during, and after cardiac arrest have resulted in improved survival for infants and children over the past 10 years. This review addresses several key factors that can make a difference in survival outcomes, including the etiology of pediatric cardiac arrests in and out of hospital, mechanisms and techniques of circulation of blood flow during cardiopulmonary resuscitation (CPR), quality of CPR, meticulous postresuscitative care, and effective training. Monitoring and quality improvement of each element in the system of resuscitation care are increasingly recognized as key factors in saving lives.
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Affiliation(s)
- Alexis A Topjian
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA 19063, USA
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Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety. Clin Orthop Relat Res 2013; 471:1792-800. [PMID: 23224770 PMCID: PMC3706678 DOI: 10.1007/s11999-012-2719-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. QUESTIONS/PURPOSES We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. METHODS We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. RESULTS Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. CONCLUSIONS Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
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Reeves S, Kitto S, Masiello I. Crew resource management: How well does it translate to an interprofessional healthcare context? J Interprof Care 2013; 27:207-9. [DOI: 10.3109/13561820.2012.748722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Weller J, Shulruf B, Torrie J, Frengley R, Boyd M, Paul A, Yee B, Dzendrowskyj P. Validation of a measurement tool for self-assessment of teamwork in intensive care. Br J Anaesth 2013; 111:460-7. [PMID: 23558846 DOI: 10.1093/bja/aet060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Teamwork is an important contributor to patient safety and a validated teamwork measurement tool could help healthcare teams identify areas for improvement and measure progress. We explored the psychometric properties of a teamwork measurement tool when used for self-assessment. We hypothesized that the tool had a valid factor structure and that scores from participants and external assessors would correlate. METHODS Forty intensive care teams (one doctor, three nurses) participated in four simulated emergencies, and each independently rated their team's performance at the end of each case using the teamwork measurement tool, without prior training in the use of the tool. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and compared factor structure between participants and external assessors (using previously reported data). Scores from participants and external assessors were compared using Pearson's correlation coefficient. RESULTS EFA demonstrated items loaded onto three distinct factors which were supported by the CFA. We found significant correlations between external and participant scores for overall teamwork scores and the three factors. Participants agreed with external assessors on the ranking of overall team performance but scored themselves significantly higher than external assessors. CONCLUSIONS The teamwork measurement tool has a valid structure when used for self-assessment. Participant and external assessor scores correlated significantly, suggesting that participants could discriminate between different levels of performance, although leniency in self-assessed scores indicated the need for calibration. This tool could help structure reflection on teamwork and potentially facilitate self-directed, workplace-based improvement in teamwork.
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Affiliation(s)
- J Weller
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92-019, Auckland 1142, New Zealand.
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Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways. Med Care 2013; 51:99-107. [DOI: 10.1097/mlr.0b013e3182763312] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chung HS, Issenberg SB, Phrampus P, Miller G, Je SM, Lim TH, Kim YM. International collaborative faculty development program on simulation-based healthcare education: a report on its successes and challenges. KOREAN JOURNAL OF MEDICAL EDUCATION 2012; 24:319-27. [PMID: 25813328 PMCID: PMC8813360 DOI: 10.3946/kjme.2012.24.4.319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/15/2012] [Accepted: 08/18/2012] [Indexed: 05/21/2023]
Abstract
PURPOSE Countries that are less experienced with simulation-based healthcare education (SBHE) often import Western programs to initiate their efforts to deliver effective simulation training. Acknowledging cultural differences, we sought to determine whether faculty development program on SBHE in the United States could be transported successfully to train faculty members in Korea. METHODS An international, collaborative, multi-professional program from a pre-existing Western model was adapted. The process focused on prioritization of curricular elements based on local needs, translation of course materials, and delivery of the program in small group facilitation exercises. Three types of evaluation data were collected: participants' simulation experience; participants' ratings of the course; and participant's self-assessment of the impact of the course on their knowledge, skills, and attitudes (KSA) toward simulation teaching. RESULTS Thirty faculty teachers participated in the course. Eighty percent of the participants answered that they spent less than 25% of their time as simulation instructors. Time spent on planning, scenario development, delivering training, research, and administrative work ranged from 10% to 30%. Twenty-eight of 30 participants agreed or strongly agreed that the course was excellent and relevant to their needs. The participants' assessment of the impact of the course on their KSA toward simulation teaching improved significantly. CONCLUSION Although there were many challenges to overcome, a systematic approach in the adaptation of a Western simulation faculty development course model was successfully implemented in Korea, and the program improves self-confidence and learning in participants.
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Affiliation(s)
- Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Corresponding Author: Hyun Soo Chung Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonjuro, Gangnamgu, Seoul, Korea 135-720 Tel: +82.2-2019-3030 Fax: +82.2-2019-4820
| | - S. Barry Issenberg
- Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, USA
| | - Paul Phrampus
- Peter M. Winter Institute for Simulation Education and Research, University of Pittsburgh, Pittsburgh, USA
| | - Geoff Miller
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, USA
| | - Sang Mo Je
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Min Kim
- Department of Emergency Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
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Mahoney JS, Ellis TE, Garland G, Palyo N, Greene PK. Supporting a psychiatric hospital culture of safety. J Am Psychiatr Nurses Assoc 2012; 18:299-306. [PMID: 22967939 DOI: 10.1177/1078390312460577] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concerns for patient safety have risen to the forefront of health care, including mental health care. Safe patient care depends, to a large extent, on high functioning teams, yet team training is lacking in basic professional training programs. To address the need for team training, one psychiatric hospital adopted the Team Strategies and Tools to Enhance Performance and Patient Safety program (TeamSTEPPS). OBJECTIVES To describe the implementation of TeamSTEPPS throughout the organization and to describe the differences in team attributes prior to and following implementation of TeamSTEPPS. DESIGN Quality improvement project using a pre-post survey design. RESULTS TeamSTEPPS was successfully implemented, and changes in all team attributes trended in a positive direction with 5 of 7 subscales reaching significance (p ≤ .01). CONCLUSIONS TeamSTEPPS provided a practical approach for our hospital to systematically weave safety throughout the culture and improve team functioning and other attributes of highly effective teams.
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Seims LRK, Alegre JC, Murei L, Bragar J, Thatte N, Kibunga P, Cheburet S. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach. HUMAN RESOURCES FOR HEALTH 2012; 10:25. [PMID: 22931468 PMCID: PMC3463420 DOI: 10.1186/1478-4491-10-25] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 07/04/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. METHODS The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention) against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. RESULTS Results showed significant increases in health-service coverage at the district level (p = <0.05) in the intervention teams compared to the comparison teams. Similarly, there were significant increases in the number of client visits at the facility level in the intervention group versus comparison facilities (P < 0.05). CONCLUSIONS Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.
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Affiliation(s)
- La Rue K Seims
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA
| | - Juan Carlos Alegre
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA
| | - Lily Murei
- Management Sciences for Health, Kenya (former), Box 61379, Nairobi, 00200, Kenya
| | - Joan Bragar
- Management Sciences for Health, 784 Memorial Drive, Cambridge, MA, 02139, USA
| | - Nandita Thatte
- Public Health Institute Global Health Fellow, US Agency for International Development, Office of Population and Reproductive Health, United States Agency for International Development, 1300 Pennsylvania Avenue, Washington, DC, 20523, USA
| | - Peter Kibunga
- Management Sciences for Health, ACK Garden House, Block A, 6th Floor, First Ngong Road Avenue, off Bishops Road, PO Box 8700-00100, Nairobi, Kenya
| | - Sammuel Cheburet
- Ministry of Health, Afya House, Cathedral Road, PO Box: 30016-00100, Nairobi, Kenya
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Haerkens MHTM, Jenkins DH, van der Hoeven JG. Crew resource management in the ICU: the need for culture change. Ann Intensive Care 2012; 2:39. [PMID: 22913855 PMCID: PMC3488012 DOI: 10.1186/2110-5820-2-39] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/06/2012] [Indexed: 11/23/2022] Open
Abstract
Intensive care frequently results in unintentional harm to patients and statistics don't seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up.
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Affiliation(s)
- Marck HTM Haerkens
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Braspenninglaan 2, 5337, NK ‘s-Hertogenbosch, The Netherlands
| | - Donald H Jenkins
- Division of Trauma and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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245
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Dierdorff EC, Ellington JK. Members Matter in Team Training: Multilevel and Longitudinal Relationships Between Goal Orientation, Self-Regulation, and Team Outcomes. PERSONNEL PSYCHOLOGY 2012. [DOI: 10.1111/j.1744-6570.2012.01255.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bergström J, Dekker S, Nyce JM, Amer-Wåhlin I. The social process of escalation: a promising focus for crisis management research. BMC Health Serv Res 2012; 12:161. [PMID: 22704075 PMCID: PMC3407787 DOI: 10.1186/1472-6963-12-161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 06/15/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. DISCUSSION Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. IMPLICATIONS The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
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Affiliation(s)
- Johan Bergström
- Lund University Centre for Risk Assessment and Management, PO-Box 118, SE-22100, Lund, Sweden
| | - Sidney Dekker
- Griffith University, School of Humanities, Brisbane, Australia
| | - James M Nyce
- Ball State University, Department of Anthropology, Muncie, IN, USA
| | - Isis Amer-Wåhlin
- Karolinska Institute, Department of Women and Child Health, Stockholm, Sweden
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Deneckere S, Euwema M, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. The European quality of care pathways (EQCP) study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes. Implement Sci 2012; 7:47. [PMID: 22607698 PMCID: PMC3444891 DOI: 10.1186/1748-5908-7-47] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 05/01/2012] [Indexed: 11/29/2022] Open
Abstract
Background Although care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP) study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process. Methods/design An international post-test-only cluster Randomised Controlled Trial (cRCT), combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal. Teams caring for proximal femur fracture (PFF) patients and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease (COPD) will be randomised into an intervention and control group. The intervention group will implement a care pathway for PFF or COPD containing three active components: a formative evaluation of the actual teams’ performance, a set of evidence-based key interventions, and a training in care pathway-development. The control group will provide usual care. A set of team input, process and output indicators will be used as effect measures. The main outcome indicator will be relational coordination. Next to these, process measures during and after pathway development will be used to evaluate the implementation processes. In total, 132 teams have agreed to participate, of which 68 were randomly assigned to the intervention group and 64 to the control group. Based on power analysis, a sample of 475 team members per arm is required. To analyze results, multilevel analysis will be performed. Discussion Results from our study will enhance understanding on the active components of care pathways. Through this, preferred implementation strategies can be defined. Trail registration NCT01435538
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Affiliation(s)
- Svin Deneckere
- Public Health School, Faculty of Medicine, KU Leuven, Kapucijnenvoer, Leuven, Belgium.
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Salas E, King HB, Rosen MA. Improving teamwork and safety: toward a practical systems approach, a commentary on Deneckere et al. Soc Sci Med 2012; 75:986-9. [PMID: 22627017 DOI: 10.1016/j.socscimed.2012.02.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Eduardo Salas
- Department of Psychology, and Institute of Simulation and Training, University of Central Florida, 3100 Technology Drive, Orlando, United States.
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Masiello I. Why simulation-based team training has not been used effectively and what can be done about it. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:279-288. [PMID: 21308482 DOI: 10.1007/s10459-011-9281-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 02/02/2011] [Indexed: 05/30/2023]
Abstract
Advanced medical education simulators are broadly used today to train both technical/procedural and team-based skills. While there is convincing evidence of the benefits of training technical skills, this is not the case for team-based skills. Research on medical expertise could drive the creation of a new regime of simulation-based team training. The new regime includes first the understanding of complex systems such as the hospital and the operating room; then the performance of work-place assessment; thirdly, the deliberate training of weaknesses and team performance skills; and lastly the understanding of the underlying mechanisms of team competence. A new regime of deliberate training proposed by the author, which would need to be evaluated and validated, could elucidate the underlying mechanisms of team competence while providing evidence of the effect of simulation-based team training.
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Affiliation(s)
- Italo Masiello
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Berzelius, Stockholm, Sweden.
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Deneckere S, Euwema M, Van Herck P, Lodewijckx C, Panella M, Sermeus W, Vanhaecht K. Care pathways lead to better teamwork: results of a systematic review. Soc Sci Med 2012; 75:264-8. [PMID: 22560883 DOI: 10.1016/j.socscimed.2012.02.060] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 09/06/2011] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
Care pathways are often said to promote interprofessional teamwork. As no systematic review on pathway effectiveness has ever focused on how care pathways promote teamwork, the objective of this review was to study this relationship. We performed an extensive search of electronic databases and identified 26 relevant studies. In our analysis of these studies we identified 20 team indicators and found that care pathways positively affected 17 of these indicators. Most frequently positive effects were found on staff knowledge, interprofessional documentation, team communication and team relations. However, the level of evidence was rather low. We found Level II evidence for improved interprofessional documentation. We also found Level II evidence for increased workload; improved actual versus planned team size; and improved continuity of care. The studies most frequently mentioned the need for a multidisciplinary approach and educational training sessions in order for pathways to be successful. The systematic review revealed that care pathways have the potential to support interprofessional teams in enhancing teamwork. Necessary conditions are a context that supports teamwork and including appropriate active pathway components that can mediate an effect on team processes. To achieve this, each care pathway requires a clearly defined team approach customized to the individual teams' needs.
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Affiliation(s)
- Svin Deneckere
- Public Health School, Faculty of Medicine, KU Leuven, Belgium.
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