The influence of shared mental models on team process and performance

Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis

BACKGROUND

Accurate and timely diagnosis relies on sharing perspectives among team members and avoiding information asymmetries. Patients/Families hold unique diagnostic process (DxP) information, including knowledge of diagnostic safety blindspots-information that patients/families know, but may be invisible to clinicians. To improve information sharing, we co-developed with patients/families an online tool called 'Our Diagnosis (OurDX)'. We aimed to characterise patient/family contributions in OurDX and how they differed between individuals with and without diagnostic concerns.

METHOD

We implemented OurDX in two academic organisations serving patients/families living with chronic conditions in three subspecialty clinics and one primary care clinic. Prior to each visit, patients/families were invited to contribute visit priorities, recent histories and potential diagnostic concerns. Responses were available in the electronic health record and could be incorporated by clinicians into visit notes. We randomly sampled OurDX reports with and without diagnostic concerns for chart review and used inductive and deductive qualitative analysis to assess patient/family contributions.

RESULTS

7075 (39%) OurDX reports were submitted at 18 129 paediatric subspecialty clinic visits and 460 (65%) reports were submitted among 706 eligible adult primary care visits. Qualitative analysis of OurDX reports in the chart review sample (n=450) revealed that participants contributed DxP information across 10 categories, most commonly: clinical symptoms/medical history (82%), tests/referrals (54%) and diagnosis/next steps (51%). Participants with diagnostic concerns were more likely to contribute information on DxP risks including access barriers, recent visits for the same problem, problems with tests/referrals or care coordination and communication breakdowns, some of which may represent diagnostic blindspots.

CONCLUSION

Partnering with patients and families living with chronic conditions through OurDX may help clinicians gain a broader perspective of the DxP, including unique information to coproduce diagnostic safety.

AI-teaming: Redefining collaboration in the digital era

Integrating artificial intelligence (AI) into human teams, forming human-AI teams (HATs), is a rapidly evolving field. This overview examines the complexities of team constellations and dynamics, trust in AI teammates, and shared cognition within HATs. Adding an AI teammate often reduces coordination, communication, and trust. Further, trust in AI tends to decline over time due to initial overestimation of capabilities, impairing teamwork. Despite AI's potential to enhance performance in contexts like chess and medicine, HATs frequently underperform due to poor team cognition and inadequate mutual understanding. Future research must address these issues with interdisciplinary collaboration between computer science and psychology and advance robust theoretical frameworks to realize the full potential of human-AI teaming.

How to strengthen societal impact of research and innovation? Lessons learned from an explanatory research-on-research study on participatory knowledge infrastructures funded by the Netherlands Organization for Health Research and Development

BACKGROUND

Scientific research and innovation can generate societal impact via different pathways. Productive interactions, such as collaboration between researchers and relevant stakeholders, play an important role and have increasingly gained interest of health funders around the globe. What works, how and why in research partnerships to generate societal impact in terms of knowledge utilisation is still not well-known. To explore these issues, the Netherlands Organization for Health Research and Development (ZonMw) initiated an exploratory research-on-research study with a focus on participatory knowledge infrastructures (PKIs) that they fund in the field of public health and healthcare. PKIs are sustainable infrastructures in which knowledge production, dissemination and utilisation takes place via committed collaboration between researchers and stakeholders from policy, practice and/or education. Examples are learning networks, academic collaborative centres, care networks and living labs. The aim of the study was twofold: to gain insights in what constitutes effective collaboration in PKIs; and to learn and improve the research governance, particularly of ZonMw as part of their dissemination and implementation activities.

METHODS

During 2020-2022, we conducted a literature review on long-term research partnerships, analysed available documentation of twenty ZonMw-funded PKIs, surveyed participants of the 2021 European Implementation Event, interviewed steering committee members, organized a Group Decision Room with lecturers, and validated the findings with key experts.

RESULTS

We identified eight mechanisms ('how and why') that are conditional for effective collaboration in PKIs: transdisciplinary collaboration; defining a shared ambition; doing justice to everyone's interests; investing in personal relationships; a professional organisation or structure; a meaningful collaborative process; mutual trust, sufficient time for and continuity of collaboration. Several factors ('what') may hinder (e.g., lack of ownership or structural funding) or facilitate (e.g., stakeholder commitment, embeddedness in an organisation or policy) effective collaboration in research partnerships.

CONCLUSION

To use the study results in policy, practice, education, and/or (further) research, cultural and behavioural change of all stakeholders is needed. To facilitate this, we provide recommendations for funding organisations, particularly ZonMw and its partners within the relevant knowledge ecosystem. It is meant as a roadmap towards the realisation and demonstration of societal impact of (health) research and innovation in the upcoming years.

Knowing your team in the intensive care unit: an ethnographic study on familiarity

Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes.

EveryBOTy Counts: Examining Human-Machine Teams in Open Source Software Development

In this study, we explore the future of work by examining differences in productivity when teams are composed of only humans or both humans and machine agents. Our objective was to characterize the similarities and differences between human and human-machine teams as they work to coordinate across their specialized roles. This form of research is increasingly important given that machine agents are becoming commonplace in sociotechnical systems and playing a more active role in collaborative work. One particular class of machine agents, bots, is being introduced to these systems to facilitate both taskwork and teamwork. We investigated the association between bots and productivity outcomes in open source software development through an analysis of hundreds of project teams. The presence of bots in teams was associated with higher levels of productivity and higher work centralization in addition to greater amounts of observed communication. The adoption of bots in software teams may have tradeoffs, in that doing so may increase productivity, but could also increase workload. We discuss the theoretical and practical implications of these findings for advancing human-machine teaming research.

The Impact of Neuroanesthesia Fellowship Training and Anesthesiologist-Surgeon Dyad Volume on Patient Outcomes in Adult Spine Surgery: A Population-Based Study

INTRODUCTION

Extensive research has explored the impact of surgeons' characteristics on patient outcomes; however, the influence of anesthesiologists remains understudied. We performed a population-based retrospective cohort study to investigate the impact of anesthesiologists' characteristics on in-hospital morbidity after spine surgery.

METHODS

Adult patients who underwent spine surgery at the London Health Science Centre, Ontario, Canada between January 1, 2010 and June 30, 2023 were included in this study. Data was extracted from the local administrative database. Five anesthesiologists' characteristics (neuroanesthesia fellowship and residency training backgrounds, surgeon familiarity, annual case volume, and sex) were examined as primary exposures. The primary outcome was composite in-hospital morbidity, encompassing 141 complications. Multivariable logistic regression was performed to assess the association between anesthesiologists' characteristics and postoperative morbidity with adjustment of patients' sex, Charlson Comorbidities Index, surgical complexity, and surgeon characteristics.

RESULTS

A total of 7692 spine surgeries were included in the analysis. Being a neuroanesthesia fellowship-trained anesthesiologist and high anesthesiologist-surgeon annual dyad volume were associated with reduction in in-hospital comorbidity; adjusted odds ratio (95% CI) of 0.58 (0.49-0.69; P<0.001) and 0.93 (0.91-0.95; P<0.001), respectively. Conversely, anesthesiologist annual case volume, characteristics of residency training and anesthesiologist sex showed only nuanced associations with outcomes.

CONCLUSIONS

Neuroanesthesia fellowship training and high surgeon-anesthesiologist dyad familiarity was associated with a reduction in in-hospital morbidity following spine surgery. These findings underscore the superiority of structured fellowship education over case exposure experience alone, advocate for dedicated neuroanesthesia teams with high surgeon-anesthesiologist dyad volume and recognize neuroanesthesia as a crucial subspecialty in spine surgery.

Team Dynamics and Collaborative Problem-Solving for Lunar Construction: Lessons From Complex Construction Scenarios on Earth

OBJECTIVE

This paper surveys the existing literature surrounding problem-solving and team dynamics in complex and unpredictable scenarios, and evaluates the applicability of studying Earth-based construction teams to identify training needs for Lunar construction crews.

BACKGROUND

Lunar and other space exploration construction crews will work in extreme environments and face unpredictable challenges, necessitating real-time problem-solving to address unexpected contingencies. This work will require coordination with Mission Control and autonomous assistants, so crew training must account for multi-agent, distributed teamwork.

METHOD

A narrative literature review identified processes, attributes, and skills necessary for the success of Lunar construction teams. We summarized relevant frameworks and synthesized collective findings into over-arching trends and remaining research gaps.

RESULTS

While significant literature exists surrounding team performance, very little systematic inquiry has been done with a focus on Lunar construction crews and operations, particularly with respect to dynamic problem-solving and team-based decision-making. Established and standardized metrics for evaluating team performance are lacking, resulting in significant variation in reported outcomes between studies.

CONCLUSION

Lunar and other space exploration construction teams will need training that focuses on developing the right approach to team-based problem-solving, rather than on preparing response execution for known contingencies. An investigation of successful Earth-based construction crews may facilitate the development of relevant metrics for training future Lunar construction crews.

APPLICATION

Metrics and team training protocols developed for future Lunar construction teams may be adaptable and applicable to a wide range of extreme teams facing uncertain challenges, such as aircrews, surgical teams, first responders, and construction crews.

Flipped Classroom: Improved team performance during resuscitation training through interactive pre-course content - a cluster-randomised controlled study

BACKGROUND

Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training.

METHODS

A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome.

RESULTS

The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool.

CONCLUSION

Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance.

TRIAL REGISTRATION

German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00013096 ).

Increased team familiarity for surgical time savings: Effective primarily in complex surgical cases

BACKGROUND

Cohesion between team members is critical for surgical performance. Our previous study has shown that the experience of working together (measured by Team Familiarity Score, TFS) helps reduce procedure time (PT). However, that conclusion was found in a relatively small sample size. With a large dataset including mixed general surgical procedures, we hypothesize that team familiarity makes a significant contribution to the improvement of team performance in complex cases, rather than in medium or basic surgical cases, measured by the procedure time, length of hospital stays (LOS), and surgical cost (COST).

STUDY DESIGN

Patient demographics, operation, and patient outcome data of 922 general surgery cases were included. The cases were divided into three subgroups, including basic, medium, and complex surgical procedures. TFS and an Index of Difficulty of Surgery (IDS) were calculated for each procedure. Simple linear regression and random forest regressions were performed to analyze the association between surgical outcomes and all included independent variables (TFS, IDS, patient age, patient weight, and team size).

RESULTS

When applied to complex cases, procedure time (r = -0.21) and cost (r = -0.23) dropped as TFS increases. In basic and medium surgical cases, increasing team familiarity failed to shorten the procedure time on average.

CONCLUSION

Team familiarity is more important in complex cases because there is greater potential for improvement through team collaboration compared to basic and medium cases. Caution will be needed when applying team familiarity scores for examining surgical team performance in large databases with skewed to basic surgical cases.

Team Stress and Its Impact on Interprofessional Teams: A Narrative Review

Phenomenon: Interprofessional healthcare team (IHT) collaboration can produce powerful clinical benefits for patients; however, these benefits are difficult to harness when IHTs work in stressful contexts. Research about stress in healthcare typically examines stress as an individual psychological phenomenon, but stress is not only a person-centered experience. Team stress also affects the team's performance. Unfortunately, research into team stress is limited and scattered across many disciplines. We cannot prepare future healthcare professionals to work as part of IHTs in high-stress environments (e.g., emergency medicine, disaster response) unless we review how this dispersed literature is relevant to medical education. Approach: The authors conducted a narrative review of the literature on team stress experienced by interprofessional teams. The team searched five databases between 1 Jan 1990 and 16 August 2021 using the search terms: teams AND stress AND performance. Guided by four research questions, the authors reviewed and abstracted data from the 22 relevant manuscripts. Findings: Challenging problems, time pressure, life threats, environmental distractors, and communication issues are the stressors that the literature reports that teams faced. Teams reacted to team stress with engagement/cohesion and communication/coordination. Stressors impact team stress by either hindering or improving team performance. Critical thinking/decision-making, team behaviors, and time for task completion were the areas of performance affected by team stress. High-quality communication, non-technical skills training, and shared mental models were identified as performance safeguards for teams experiencing team stress. Insights: The review findings adjust current models explaining drivers of efficient and effective teams within the context of interprofessional teams. By understanding how team stress impacts teams, we can better prepare healthcare professionals to work in IHTs to meet the demands placed on them by the ever-increasing rate of high-stress medical situations.

Firefighters and police search dog handlers' experiences working closely with paramedics in urban search and rescue incidents: a qualitative focus group study from Oslo

BACKGROUND

Rescue operations are in Norway defined as situations where patients are difficult to access or that more resources are needed than the health services alone possess and can put in operation (Bull A, Redningshåndboken er endelig her! [Internet]. Hovedredningssentralen. 2018 [cited 2023 May 15]. Available from: https://www.hovedredningssentralen.no/redningshandboken-er-endelig-her/ ). Rescue operations after large incidents may include civil protection, military forces, non-governmental organizations and other resources, but the initial rescue effort must be performed by the emergency services as time often is of essence. The central area of an accident where special training and personal protection equipment is necessary or mandatory is called the Hot Zone. This study examines Urban Search And Rescue (USAR) firefighters and police officers reported experiences from ambulance personnel's contribution in the Hot Zone.

METHODS

We conducted five focus group interviews with USAR-trained firefighters and police officers. The interviewees were those on duty on the agreed dates. The interviews were taped, transcribed, and analysed using thematic analysis as described by Braun & Clarke.

RESULTS

Three themes were identified; Feeling safe during missions, Building USAR capacity, and Trust-building within USAR-teams. The firefighters and police officers reported their and the patients' safety are best managed by EMS-personnel, whose presence strongly contributes to their own feeling of safety in a dangerous area. When EMS handles victims and injured emergency workers, firefighters and police officers can focus on their own primary tasks. Indeed, interviewees reported that building a USAR capacity depends on having USAR-trained EMS-personnel in the Hot Zone. The interviewees have clear and consistent opinions on how to establish an interagency USAR capacity effectively. Trust is paramount to the interviewees, and they express a high degree of trust within USAR Oslo.

CONCLUSIONS

Firefighters and police officers regard USAR-trained EMS-personnel as a natural and integrated part in urban search and rescue teams. EMS-personnel in the dangerous area deliver safety and medical professional assistance to both rescue workers and patients. Informants in this study had clear opinions on how to establish and maintain such a service.

Comparative Analysis of the Functions Work Groups and Informal Subgroups Carry out in Relation to their Members: The Essence, Conditions of Implementation, Effects, and Dysfunctions

In this article, we attempt to integrate and further develop conceptual ideas about functions of small groups and the informal subgroups that arise within them in relation to their respective members, namely, the functions of: (1) creating possibilities for realizing individual goals and meeting individual needs; (2) providing protection from external and intragroup social threats; (3) providing information to members; (4) educating members; (5) providing adaptive capacities to members; and (6) providing control and regulation. First, drawing on a functional analysis, we defined the concept of "function." Next, we touched upon such issues as: the essence of each function; conditions for implementing the functions; the difference between an informal subgroup and a small group in how they implement the functions for their respective members; the effects of implementing the functions; and the related dysfunctions. This versatile account of the functions that small groups and informal subgroups implement in relation to their members allowed us to expand our understanding of these functions and their effects on attitudes, activities and the development of group (subgroup) members, as well as of some aspects of group and subgroup processes and performance. We conclude by presenting both theoretical and practical applications of the analysis of the functions of groups and subgroups and, accordingly, posed some important questions for further research and discussion.

Structured Callouts, the Shared Mental Model, and Teamwork: A Video-Based Study in a Pediatric Emergency Department

OBJECTIVES

The shared mental model is essential to high-quality resuscitations. A structured callout (SCO) is often performed to establish the shared mental model, but the literature on SCOs is limited. The objectives of this study are to describe performance of SCOs during pediatric medical emergencies and to determine whether a SCO is associated with better teamwork.

METHODS

This was a retrospective study in the resuscitation area of an academic pediatric emergency department, where performance of a SCO is a standard expectation. Only medical or nontrauma patients were eligible for inclusion. Data collection was performed by structured video review by 2 observers and verified by a third blinded observer. A SCO was defined as team leader (Pediatric Emergency Medicine fellow or faculty physician) verbalization of at least 1 element of the patient history/examination or an assessment of patient physiology and 1 element of the diagnostic or therapeutic plan. We independently measured teamwork using the Teamwork Emergency Assessment Measure (TEAM) tool.

RESULTS

We reviewed 60 patient encounters from the pediatric emergency department resuscitation area between April 2018 and June 2020. Median patient age was 6 years; the team leader was a Pediatric Emergency Medicine fellow in 55% of encounters. The physician team leader performed a SCO in 38 (63%) of patient encounters. The TEAM scores were collected for 46 encounters. Mean TEAM score (SD) was 42.3 (1.7) in patients with a SCO compared with 40.0 (3.0) in those without a SCO ( P = 0.007).

CONCLUSIONS

Performance of a SCO was associated with better teamwork, but the difference was of unclear clinical significance.

Twelve tips for integrating medical students into specialty clinics

The specialty clinic is an excellent educational environment for medical students. However, preceptors face several challenges as they seek to balance treating complex system-specific conditions with effective teaching, including time constraints, clinical tasks, engaging multi-level learners, and perhaps a lack of guidelines for or training in outpatient medical education. We thus propose twelve tips for integrating medical students into specialty clinics in a feasible and mutually fulfilling way. The first three tips focus on planning the session and setting expectations, the next seven tips detail specific, actionable strategies for enhancing learning while maximizing efficiency, and the final two tips discuss how to optimally close the session with feedback and debriefing.

Team Efficacy Profiles: Congruence Predicts Objective Performance of Athlete Pairs

Efficacy beliefs targeting personal (self-efficacy), teammates' (other-efficacy), and conjoint (collective efficacy) abilities are each associated with performance of athlete pairs. The purpose of this study was to examine (a) congruence/incongruence of efficacy beliefs between athletes in a pair as a predictor of quality of individual and team performance and (b) quality of performance relative to efficacy congruence at high, moderate, and low levels of efficacy. Eighty-two cheerleading pairs, composed of one base and one flyer, completed questionnaires assessing self-, other, and collective efficacy prior to a national collegiate competition. Individual and team performances were assessed using objective criteria. Polynomial regression analyses indicated that team performance was predicted by congruence of (a) both athletes' collective efficacy beliefs and (b) base self-efficacy and flyer other efficacy. Findings supported that congruence at moderate to high levels of efficacy was associated with better performance relative to incongruent efficacy beliefs across the two athletes.

Considerations on the Use of Neonatal and Pediatric Resuscitation Guidelines for Hospitalized Neonates and Infants: On Behalf of the American Heart Association Emergency Cardiovascular Care Committee and the American Academy of Pediatrics

Between 0.25% and 3% of admissions to the NICU, PICU, and PCICU receive cardiopulmonary resuscitation (CPR). Most CPR events occur in patients <1 year old. The incidence of CPR is 10 times higher in the NICU than at birth. Therefore, optimizing the approach to CPR in hospitalized neonates and infants is important. At birth, the resuscitation of newborns is performed according to neonatal resuscitation guidelines. In older infants and children, resuscitation is performed according to pediatric resuscitation guidelines. Neonatal and pediatric guidelines differ in several important ways. There are no published recommendations to guide the transition from neonatal to pediatric guidelines. Therefore, hospitalized neonates and infants can be resuscitated using neonatal guidelines, pediatric guidelines, or a hybrid approach. This report summarizes the current neonatal and pediatric resuscitation guidelines, considers how to apply them to hospitalized neonates and infants, and identifies knowledge gaps and future priorities. The lack of strong scientific data makes it impossible to provide definitive recommendations on when to transition from neonatal to pediatric resuscitation guidelines. Therefore, it is up to health care teams and institutions to decide if neonatal or pediatric guidelines are the best choice in a given location or situation, considering local circumstances, health care team preferences, and resource limitations.

Examining the fluidity of innovation teams: a conceptual framework

As innovative endeavors have become more complex and time-intensive, there has become an increasing reliance on expert teams in organizations. Expert innovation teams are comprised of team members with extensive experience and mastery in a particular discipline. These teams utilize fluid membership that expands the available knowledge of the team but creates challenges for effective teamwork. We argue that the mechanism for creating an enduring impact and developing a product to fruition requires the cognitive and social integration of fluid team members. This article focuses on how teams effectively integrate knowledge with diverse, and possibly fluid, team members and how teams can organize knowledge through planning and reflection to implement the idea successfully. Knowledge integration and team reflexivity are considered in tandem to emphasize the multi-faceted nature of generating and implementing innovative solutions and the conflicting teamwork processes that hinder innovative efforts. To understand how these competing teamwork processes required for successful innovation interact, we developed a framework that considers resilience as the factor that elicits team creative performance. In doing so, we discuss how innovation teams build resilience over time and how creative failure can lead to greater levels of innovation.

Distributed team processes in healthcare services: a scoping review

Objective

High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services.

Methods

Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria.

Results

Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes.

Conclusion

The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.

The Impact of Training on Human-Autonomy Team Communications and Trust Calibration

OBJECTIVE

This work examines two human-autonomy team (HAT) training approaches that target communication and trust calibration to improve team effectiveness under degraded conditions.

BACKGROUND

Human-autonomy teaming presents challenges to teamwork, some of which may be addressed through training. Factors vital to HAT performance include communication and calibrated trust.

METHOD

Thirty teams of three, including one confederate acting as an autonomous agent, received either entrainment-based coordination training, trust calibration training, or control training before executing a series of missions operating a simulated remotely piloted aircraft. Automation and autonomy failures simulating degraded conditions were injected during missions, and measures of team communication, trust, and task efficiency were collected.

RESULTS

Teams receiving coordination training had higher communication anticipation ratios, took photos of targets faster, and overcame more autonomy failures. Although autonomy failures were introduced in all conditions, teams receiving the calibration training reported that their overall trust in the agent was more robust over time. However, they did not perform better than the control condition.

CONCLUSIONS

Training based on entrainment of communications, wherein introduction of timely information exchange through one team member has lasting effects throughout the team, was positively associated with improvements in HAT communications and performance under degraded conditions. Training that emphasized the shortcomings of the autonomous agent appeared to calibrate expectations and maintain trust.

APPLICATIONS

Team training that includes an autonomous agent that models effective information exchange may positively impact team communication and coordination. Training that emphasizes the limitations of an autonomous agent may help calibrate trust.

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol

BACKGROUND

Half of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services' intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended.

METHODS

Using a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services' intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed.

DISCUSSION

By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes.

TRIAL REGISTRATION

NCT05629013. Approval date: November 28, 2022 (version 1).

TRIAL SPONSOR

University of California, San Diego.

RESPONSIBLE PARTY

Danielle Fettes.

On the edge of decision-making in trauma care: A focus group study on radiographers' experiences of interprofessional collaboration

INTRODUCTION

The temporary trauma teams in trauma alerts consist of a diverse group of unique professionals requiring interprofessional collaboration and coordination to achieve efficient, high-quality care. The uncertain situation and complex care environment impose high demands on team dynamics such as individual attitudes and team behaviours. Within interprofessional teams, interaction and coordination reflect the collective success of collaboration and the achievement of goals. Interactions with radiographers have increased in trauma teams given computed tomography's prominent role in providing crucial knowledge for decision-making in trauma care. This study aimed to explore radiographers' experiences of interprofessional collaboration during trauma alerts.

METHOD

The study was designed with focus group methodology, including 17 radiographers participating in five focus groups, analysed with an inductive focus group analysis.

RESULTS

An overarching theme, "On the edge of decision-making", emerged along with three sub-themes: "Feeling included requires acknowledgement", "Exclusion precludes shared knowledge", and "Experience and mutual awareness facilitate team interaction".

CONCLUSIONS

Interprofessional collaboration from the radiographer's perspective within trauma teams requires a sense of inclusion and the ability to interact with the team. Exclusion from vital decision-making obstructs radiographers' comprehension of situations and thereby the interdependence in interprofessional collaboration.

IMPLICATIONS FOR PRACTICE

Common platforms are needed for knowledge sharing and team practices, including radiographers' areas of responsibility and relational coordination to foster interprofessional relationships. Through these means interdependence through awareness and shared knowledge can be facilitated on trauma teams.

Human-AI teams-Challenges for a team-centered AI at work

As part of the Special Issue topic "Human-Centered AI at Work: Common Ground in Theories and Methods," we present a perspective article that looks at human-AI teamwork from a team-centered AI perspective, i. e., we highlight important design aspects that the technology needs to fulfill in order to be accepted by humans and to be fully utilized in the role of a team member in teamwork. Drawing from the model of an idealized teamwork process, we discuss the teamwork requirements for successful human-AI teaming in interdependent and complex work domains, including e.g., responsiveness, situation awareness, and flexible decision-making. We emphasize the need for team-centered AI that aligns goals, communication, and decision making with humans, and outline the requirements for such team-centered AI from a technical perspective, such as cognitive competence, reinforcement learning, and semantic communication. In doing so, we highlight the challenges and open questions associated with its implementation that need to be solved in order to enable effective human-AI teaming.

Twelve tips to develop entrustable professional activities

Entrustable professional activities (EPAs), units of professional practice that require proficient integration of multiple competencies and can be entrusted to a sufficiently competent learner, are increasingly being used to define and inform curricula of health care professionals. The process of developing EPAs can be challenging and requires a deep yet pragmatic understanding of the concepts underlying EPA construction. Based on recent literature and the authors' lessons learned, this article provides the following practical and more or less sequential recommendations for developing EPAs: [1] Assemble a core team; [2] Build up expertise; [3] Establish a shared understanding of the purpose of EPAs; [4] Draft preliminary EPAs; [5] Elaborate EPAs; [6] Adopt a framework of supervision; [7] Perform a structured quality check; [8] Use a Delphi approach for refinement and/or consensus; [9] Pilot test EPAs; [10] Attune EPAs to their feasibility in assessment; [11] Map EPAs to existing curriculum; [12] Build a revision plan.

Team- and task-related knowledge in shared mental models in operating room teams: A survey study

Objective

The operating room is a highly complex environment, where patient care is delivered by interprofessional teams. Unfortunately, issues with communication and teamwork occur, potentially leading to patient harm. A shared mental model is one prerequisite to function effectively as a team, and consists of task- and team-related knowledge. We aimed to explore potential differences in task- and team-related knowledge between the different professions working in the operating room. The assessed team-related knowledge consisted of knowledge regarding other professions' training and work activities, and of perceived traits of a high-performing and underperforming colleague. Task-related knowledge was assessed by mapping the perceived allocation of responsibilities for certain tasks, using a Likert-type scale.

Design

A single sample cross-sectional study.

Setting

The study was performed in three hospitals in the Netherlands, one academic center and two regional teaching hospitals.

Participants

106 health care professionals participated, of four professions. Most respondents (77%) were certified professionals, the others were still in training.

Results

Participants generally were well informed about each other's training and work activities and nearly everyone mentioned the importance of adequate communication and teamwork. Discrepancies were also observed. The other professions knew on average the least about the profession of anesthesiologists and most about the profession of surgeons. When assessing the responsibilities regarding tasks we found consensus in well-defined and/or protocolized tasks, but variation in less clearly defined tasks.

Conclusions

Team- and task-related knowledge in the operating room team is reasonably well developed, but irregularly, with potentially crucial differences in knowledge related to patient care. Awareness of these discrepancies is the first step in further optimization of team performance.

Temporal development of high-performance translational teams

Successful translation involves the coupled application of knowledge-generating research with product development to advance a device, drug, diagnostic, or evidence-based intervention for clinical adoption to improve human health. Critical to the success of the CTSA consortium, translation can be more effectively accomplished by training approaches that focus on improving team-emergent knowledge skills and attitudes (KSAs) linked to performance. We earlier identified 15 specific evidence-informed, team-emergent competencies that facilitate translational team (TT) performance. Here, we examine the SciTS literature describing developmental, temporal dynamics, and adaptive learning stages of interdisciplinary teams and integrate these with real-world observations on TT maturation pathways. We propose that TTs undergo ordered developmental phases, each representing a learning cycle that we call Formation, Knowledge Generation, and Translation. We identify major activities of each phase linked to development goals. Transition to subsequent phases is associated with a team learning cycle, resulting in adaptations that enabling progression towards clinical translation. We present known antecedents of stage-dependent competencies and rubrics for their assessment. Application of this model will ease assessment, facilitate goal identification and align relevant training interventions to improve performance of TTs in the CTSA context.

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

Importance

The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room.

Objective

To examine the association between surgeon-anesthesiologist dyad familiarity-as the number of times working together-with short-term postoperative outcomes for complex gastrointestinal cancer surgery.

Design, Setting, and Participants

This population-based retrospective cohort study based in Ontario, Canada, included adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer from 2007 through 2018. The data were analyzed January 1, 2007, through December 21, 2018.

Exposures

Dyad familiarity captured as the annual volume of procedures of interest done by the surgeon-anesthesiologist dyad in the 4 years before the index surgery.

Main Outcomes and Measures

Ninety-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression.

Results

Seven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity.

Conclusions and Relevance

Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.

Sociotechnical system design to support disaster intervention development teams

Teams are critical in developing effective responses to various disasters and crises. This study defines a new type of response team: a disaster intervention development team, charged with rapidly developing emergent and innovative interventions to aid disaster response. In this case study, we analyzed the SHIELD Enterprise, a disaster intervention development team that developed and deployed a diagnostic testing system for community surveillance and diagnosis to respond to the COVID-19 infectious disease outbreak. We conducted interviews with 27 team members to identify the work system barriers and facilitators they experienced and to analyze the influence on team performance to inform sociotechnical system design for future teams. We identified 215 barriers and 238 facilitators, which we inductively categorized into eight overarching groups, i.e., categories, that included ambiguity, team processes, technology, design and project requirements, knowledge and expertise, organization, task work and environment. Our findings led to eight sociotechnical system design principles to support future disaster intervention development teams.

The Relative Importance of Temporal Leadership and Initiating Structure for Timely Project Completion

We assess the relative usefulness of temporal leadership and initiating structure in predicting timely team project completion. Drawing on the functional approach to team leadership as well as the concept of team performance episodes, we hypothesize that two facets of temporal leadership, temporal planning at project initiation and temporal reminders midway through project execution, will be better predictors of timely project completion than will traditional task-oriented leadership in the form of initiating structure delivered at the same two project stages. Results from 62 application development project teams surveyed across the life of a project showed that the two facets of temporal leadership together accounted for 91.7% of the predicted variance in timely project completion, with temporal planning being more important. Initiating structure accounted for the remaining small and nonsignificant amount of the predicted variance. We conclude that temporal leadership is a new construct that is a highly useful approach to leader behavior in the context of teams working on time-limited projects.

Impact of Shared Leadership Quality on Agile Team Productivity and Project Results

Drawing on leadership theory, this research verified what makes shared leadership an effective form of leadership for agile project teams, and whether using it influences the outcomes achieved by such teams as well as the more distal outcomes. Survey data were collected from 251 members of agile project teams implementing projects of an iterative and incremental character. Structural equation modeling (PLS-SEM) was adopted to test the hypotheses. Our research confirms that shared leadership is an effective form of leadership for agile project teams whose members are empowered to engage in leadership functions or processes. The findings confirm a positive direct impact of shared leadership on the performance of agile project teams and indirect impact on project efficiency and effectiveness. The research results also confirm the influence of project team–related contextual moderators on shared leadership inputs and outputs. The study contributes to leadership theory in the plural leadership research stream and confirms the shift from individual leadership to collective leadership as a result of the growing popularity of the agility paradigm.

Competencies supporting high-performance translational teams: A review of the SciTS evidence base

A translational team (TT) is a specific type of interdisciplinary team that seeks to improve human health. Because high-performing TTs are critical to accomplishing CTSA goals, a greater understanding of how to promote TT performance is needed. Previous work by a CTSA Workgroup formulated a taxonomy of 5 interrelated team-emergent competency "domains" for successful translation: 1). affect, 2). communication, 3). management, 4). collaborative problem-solving, and 5). leadership. These Knowledge Skills and Attitudes (KSAs) develop within teams from the team's interactions. However, understanding how practice in these domains enhance team performance was unaddressed. To fill this gap, we conducted a scoping literature review of empirical team studies from the broader Science of Team Science literature domains. We identified specific team-emergent KSAs that enhance TT performance, mapped these to the earlier "domain" taxonomy, and developed a rubric for their assessment. This work identifies important areas of intersection of practices in specific competencies across other competency domains. We find that inclusive environment, openness to transdisciplinary knowledge sharing, and situational leadership are a core triad of team-emergent competencies that reinforce each other and are highly linked to team performance. Finally, we identify strategies for enhancing these competencies. This work provides a grounded approach for training interventions in the CTSA context.

Clarifying the muddy concept of home healthcare coordination: A comprehensive theoretical framework

Effective healthcare coordination is vital when such care is provided as a collaborative effort by many individuals and their task activities are interdependent. Coordination is necessary to ensure that care not only meets the needs of patients, but also avoids negative consequences for them due to omitted, inefficient, unnecessary, or even incorrect treatments. It also helps conserve resources. This has contributed to a rapid increase in articles on this subject. Still, while care coordination topics are gaining the attention of researchers, there are a number of issues experienced, including the delineation of limitations, inconsistent definitions, and problems with measurement. Therefore, the aim of this article is to refine the concept of homecare coordination and provide a comprehensive theoretical framework, illustrated with examples from practice. Focusing on this goal, we have reviewed the extant literature on the subject to develop a theoretical homecare coordination framework. The first intermediary goal was to integrate relevant concepts across multiple theories and frameworks into a unified synthesis. We do so in two parts: (1) analysis of extant coordination frameworks and theories; and (2) the presentation of our newly developed theoretical framework for homecare coordination. The new framework differentiates clearly between coordination as a process-i.e., what people do to coordinate and coordination as an outcome-i.e., the state of coordination. Applying this distinction to both, measurement and interpretation of results helps avoid misleading conclusions. As a research outcome, our framework builds upon the extant coordination literature, considers the complex relationships among the various coordination-related factors and, while focusing on homecare, is applicable to various healthcare settings in general. A nuanced differentiation and explanation of the elements involved enable a more consistent operationalization of the coordination concept. Additionally, as they explicitly address the healthcare system's micro, meso, and macro levels, they can be applied across diverse healthcare settings to investigate homecare coordination.

Developing local crisis leadership - A research and training agenda

The crisis triggered by Covid-19 has exposed the interdependencies of modern society and sparked interest in local response to protracted and complex crisis situations. There has been a growing awareness and interest in the key roles of political and professional stakeholders, their emotional regulation and how they influence team performance and outcomes in dealing with uncertainty and complex crisis situations. While cognitive and behavioral aspects of crisis leadership are well researched, less is understood about how one can mitigate negative emotions, instill trust, or restore public faith and support of security forces and emergency response teams during crises. In addressing this gap, we propose a simplified conceptual roadmap for research and training of local crisis leadership. In this, we emphasize complex problem solving, team interaction, team context and technology and team training design. These four factors represent significant barriers if neglected. On the other side, they may be considerable force multipliers when better understood and managed. We suggest how seven research and training questions could be linked to the four conceptual factors and guide an evidence-based approach to develop local crisis leadership.

A Qualitative Examination of Interprofessional Teamwork for Infection Prevention: Development of a Model and Solutions

Health care-associated infections (HAIs), such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), are associated with patient mortality and high costs to the health care system. These are largely preventable by practices such as prompt removal of central lines and Foley catheters. While seemingly straightforward, these practices require effective teamwork between physicians and nurses to be enacted successfully. Understanding the dynamics of interprofessional teamwork in the HAI prevention context requires further examination. We interviewed 420 participants (physicians, nursing, others) across 18 hospitals about interprofessional collaboration in this context. We propose an Input-Mediator-Output-Input (IMOI) model of interprofessional teamwork in the context of HAI prevention, suggesting that various organizational processes and structures facilitate specific teamwork attitudes, behaviors, and cognitions, which subsequently lead to HAI prevention outcomes including timeliness of line and Foley removal, ensuring sterile technique, and hand hygiene. We then propose strategies to improve interprofessional teamwork around HAI prevention.

Planning and performance in teams: A Bayesian meta-analytic structural equation modeling approach

We meta-analyzed the relationship between team planning and performance moderated by task, team, context, and methodological factors. For testing our hypothesized model, we used a meta-analytic structural equation modeling approach. Based on K = 33 independent samples (N = 1,885 teams), a mixed-effects model indicated a non-zero moderate positive effect size (ρ = .31, 95% CI [.20, .42]). Methodological quality, generally rated as adequate, was unrelated to effect size. Sensitivity analyses suggest that effect sizes were robust to exclusion of any individual study and publication bias. The statistical power of the studies was generally low and significantly moderated the relationship, with a large positive relationship for studies with high-powered (k = 42, ρ = .40, 95% CI [.27, .54]) and a smaller, significant relationship for low-powered studies (k = 54, ρ = .16, 95% CI [.01, .30]). The effect size was robust and generally not qualified by a large number of moderators, but was more pronounced for less interdependent tasks, less specialized team members, and assessment of quality rather than quantity of planning. Latent class analysis revealed no qualitatively different subgroups within populations. We recommend large-scale collaboration to overcome several methodological weaknesses of the current literature, which is severely underpowered, potentially biased by self-reporting data, and lacks long-term follow-ups.

Do inconsistent mental models impact performance? Moderating effects of managerial interpretation and practice sets

Deviant cognition, referring to team members' different understanding of goals or rules, results in inconsistent mental models among the team. Although previous studies have examined the negative effects of inconsistent mental models on deviant behavior and performance in the workplace, they have failed to consider their positive effects and moderating mechanisms, thus limiting our understanding of how to manage inconsistent mental models and deviant cognition. To address this research gap, this study builds on the interpretation and information processing theory, which regards mental models as the result of information processing, especially involving interactions where interpretation of the information is required. The study initially recruited 174 team managers as participants to identify instances of managerial interpretation. The team managers' interpretation modes were then categorized into four types (absorb, shift, limit, and explore), and a questionnaire was developed to measure them. The moderating effects of the modes on execution and innovation performance were also examined. Matched data were then collected from interviews with 104 team managers and 312 of their team members. The regression results showed that absorb, shift, and limit interpretation modes, as well as the practice sets involving managers and members, attenuated the negative relationship between inconsistent mental models and execution performance. The explore interpretation mode and the practice sets enhanced the positive relationship between inconsistent mental models and team innovation. The findings of this study help to understand the cognitive level of deviance in teams and the moderating effects of managerial interpretation on the relationship between deviant cognition, or inconsistent mental models, and performance, suggesting the need to study and utilize the positive roles of inconsistent mental models or deviance through managerial interpretation. The results also call for firms to train managers' interpretation skills and design close working links with team members.

Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management

Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART.

How can the transition from office to telework be managed? The impact of tasks and workplace suitability on collaboration and work performance

COVID-19 made evident the need for workplace digital transformation due to a rapid transition from office to remote work. Therefore, employers must make telework suitable for office workers who suddenly became permanent teleworkers. By using partial least squares path modeling, this article suggests the defining of telework tasks suitability and of telework workplace suitability by performing an empirical study with 691 employees who had experienced a rapid transition from office work to remote work during the pandemic. Both telework tasks suitability and telework workplace suitability are found to have a positive relationship with collaboration and work performance. Employers should therefore especially focus on communication technology when expecting employees work from home to improve work performance and enable collaboration to prevent them from feeling isolated. This study is the first to define telework tasks suitability and workplace suitability for enabling collaboration and improving work performance of teleworkers after an enforced transition from office working to teleworking.

Team Performance: Nature and Antecedents of Nonnormal Distributions

Team research typically assumes that team performance is normally distributed: teams cluster around average performance, performance variability is not substantial, and few teams inhabit the upper range of the distribution. Ironically, although most team research and methodological practices rely on the normality assumption, many theories actually imply nonnormality (e.g., performance spirals, team composition, team learning, punctuated equilibrium). Accordingly, we investigated the nature and antecedents of team performance distributions by relying on 274 performance distributions including 200,825 teams (e.g., sports, politics, firefighters, information technology, customer service) and more than 500,000 workers. First, regarding their overall nature, only 11% of the distributions were normal, star teams are much more prevalent than predicted by normality, the power law with an exponential cutoff is the most dominant distribution among nonnormal distributions (i.e., 73%), and incremental differentiation (i.e., differential performance trajectories across teams) is the best explanation for the emergence of these distributions. Second, this conclusion remained unchanged after examining theory-based boundary conditions (i.e., tournament versus nontournament contexts, performance as aggregation of individual-level performance versus performance as a team-level construct, performance assessed with versus without a hard left-tail zero, and more versus less sample homogeneity). Third, we used the team learning curve literature as a conceptual framework to test hypotheses and found that authority differentiation and lower temporal stability are associated with distributions with larger performance variability (i.e., a greater proportion of star teams). We discuss implications for existing theory, future research directions, and methodological practices (e.g., need to check for nonnormality, Bayesian analysis, outlier management).

On the same page? A qualitative study protocol on collaboration in a multi-laboratory preclinical study

INTRODUCTION

Medical advancements are slow to reach the patient bedside due to issues with knowledge translation from preclinical studies. Multi-laboratory preclinical studies are a promising strategy for addressing the methodological deficiencies that weaken the translational impact of single laboratory findings. However, multi-laboratory preclinical studies are rare and difficult, requiring strong collaboration to plan and execute a shared protocol. In multiteam systems such as these, collaboration is enhanced when members have cohesive ways of thinking about their goals and how to achieve them-that is, when they have "shared mental models". In this research project, we will examine how members of Canada's first multi-laboratory preclinical study build shared mental models and collaborate in the execution of their study.

METHODS

Six independent labs in Canada will conduct a preclinical study using a common protocol. To investigate mental models and collaboration in this multiteam system we will conduct a longitudinal qualitative study involving interviews at four time points, team observation, and document analysis. We will analyze interview transcripts using deductive coding to produce a matrix analysis of mental model content over time and inductive coding to produce a thematic analysis of members' experiences of collaboration over time. We will also triangulate data sources to "tell the story" of teamwork, capturing events and contextual information that explain changes in mental models and collaboration over time.

DISCUSSION

This study will be one of the most comprehensive longitudinal analyses of a real-world multiteam system, and the first within a preclinical laboratory setting. The results will contribute to our understanding of collaboration in multiteam systems, an organizational form increasingly used to tackle complex scientific and social problems. The results will also inform the implementation of future multi-laboratory preclinical studies, enhancing the likelihood of effective collaboration and improved 'bench to bedside' translation.

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis

Background

The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention.

Methods

A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review.

Results

Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring.

Conclusion

Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced.

Trial registration

https://doi.org/10.1136/bmjopen-2016-012874