State of science: models and methods for understanding and enhancing teams and teamwork in complex sociotechnical systems

Challenges and opportunities of artificial intelligence implementation within sports science and sports medicine teams

The rapid progress in the development of automation and artificial intelligence (AI) technologies, such as ChatGPT, represents a step-wise change in human's interactions with technology as part of a broader complex, sociotechnical system. Based on historical parallels to the present moment, such changes are likely to bring forth structural shifts to the nature of work, where near and future technologies will occupy key roles as workers or assistants in sports science and sports medicine multidisciplinary teams (MDTs). This envisioned future may bring enormous benefits, as well as a raft of potential challenges. These challenges include the potential to remove many human roles and allocate them to semi- or fully-autonomous AI. Removing such roles and tasks from humans will make many current jobs and careers untenable, leaving a set of difficult and unrewarding tasks for the humans that remain. Paradoxically, replacing humans with technology increases system complexity and makes them more prone to failure. The automation and AI boom also brings substantial opportunities. Among them are automated sentiment analysis and Digital Twin technologies which may reveal novel insights into athlete health and wellbeing and team tactical patterns, respectively. However, without due consideration of the interactions between humans and technology in the broader system of sport, adverse impacts are likely to be felt. Human and AI teamwork may require new ways of thinking.

Exploring the influence of health system factors on adaptive capacity in diverse hospital teams in Norway: a multiple case study approach

OBJECTIVES

Understanding flexibility and adaptive capacities in complex healthcare systems is a cornerstone of resilient healthcare. Health systems provide structures in the form of standards, rules and regulation to healthcare providers in defined settings such as hospitals. There is little knowledge of how hospital teams are affected by the rules and regulations imposed by multiple governmental bodies, and how health system factors influence adaptive capacity in hospital teams. The aim of this study is to explore the extent to which health system factors enable or constrain adaptive capacity in hospital teams.

DESIGN

A qualitative multiple case study using observation and semistructured interviews was conducted between November 2020 and June 2021. Data were analysed through qualitative content analysis with a combined inductive and deductive approach.

SETTING

Two hospitals situated in the same health region in Norway.

PARTICIPANTS

Members from 8 different hospital teams were observed during their workday (115 hours) and were subsequently interviewed about their work (n=30). The teams were categorised as structural, hybrid, coordinating and responsive teams.

RESULTS

Two main health system factors were found to enable adaptive capacity in the teams: (1) organisation according to regulatory requirements to ensure adaptive capacity, and (2) negotiation of various resources provided by the governing authorities to ensure adaptive capacity. Our results show that aligning to local context of these health system factors affected the team's adaptive capacity.

CONCLUSIONS

Health system factors should create conditions for careful and safe care to emerge and provide conditions that allow for teams to develop both their professional expertise and systems and guidelines that are robust yet sufficiently flexible to fit their everyday work context.

When tomorrow comes: A prospective risk assessment of a future artificial general intelligence-based uncrewed combat aerial vehicle system

There are concerns that Artificial General Intelligence (AGI) could pose an existential threat to humanity; however, as AGI does not yet exist it is difficult to prospectively identify risks and develop requisite controls. We applied the Work Domain Analysis Broken Nodes (WDA-BN) and Event Analysis of Systemic Teamwork-Broken Links (EAST-BL) methods to identify potential risks in a future 'envisioned world' AGI-based uncrewed combat aerial vehicle system. The findings suggest five main categories of risk in this context: sub-optimal performance risks, goal alignment risks, super-intelligence risks, over-control risks, and enfeeblement risks. Two of these categories, goal alignment risks and super-intelligence risks, have not previously been encountered or dealt with in conventional safety management systems. Whereas most of the identified sub-optimal performance risks can be managed through existing defence design lifecycle processes, we propose that work is required to develop controls to manage the other risks identified. These include controls on AGI developers, controls within the AGI itself, and broader sociotechnical system controls.

Teaming in Graduate Medical Education: Ward Rounds and Beyond

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

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.

Exploring the role of leaders in enabling adaptive capacity in hospital teams - a multiple case study

Background

Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. Team leaders are seen as central in coordinating clinical care, but research detailing their contributions in supporting adaptive capacity has been limited. This study aims to explore and describe how leaders enable adaptive capacity in hospital teams.

Methods

This article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation and interviews with leaders, followed by a qualitative content analysis.

Results

Leaders contribute in several ways to enhance their teams’ adaptive capacity. This study identified four key enablers; (1) building sufficient competence in the teams; (2) balancing workload, risk, and staff needs; (3) relational leadership; and (4) emphasising situational understanding and awareness through timely and relevant information.

Conclusion

Team leaders are key actors in everyday healthcare systems and facilitate organisational resilience by supporting adaptive capacity in hospital teams. We have developed a new framework of key leadership enablers that need to be integrated into leadership activities and approaches along with a strong relational and contextual understanding.

Modeling and Simulation in an Aircraft Safety Design Based on a Hybrid AHP and FCA Algorithm

Throughout the world, the reliability-based approach to safety design of aircraft systems is quite mature and widely used. However, there are still shortcomings in the reliability-based aircraft system safety analysis method. It cannot dynamically analyze the accident evolution process and lack consideration of the complex situation of multifactor coupling. On the basis of the original aircraft system safety analysis method, this paper innovatively proposes a functional hazard analysis (FHA) method based on the analytic hierarchy process (AHP) and multifactor fuzzy comprehensive assessment (FCA). The purpose is to improve the objectivity and quantification of the FHA method in the safety design of aircraft systems. At the same time, in the terminal airworthiness verification, this paper proposes a repeatable and controllable virtual test flight verification method, which aims to reduce the cost and cycle of the terminal airworthiness verification and expand the coverage of the envelope verification. Finally, combined with the clauses in MIL-HDBK-516B, a case calculation is carried out to verify the feasibility of the proposed method.

SPECTRa: An Online Tool for Simulating Prehospital Patient Care

OBJECTIVES

To (1) develop a simulation software environment to conduct prehospital research during the COVID-19 pandemic on paramedics' teamwork and use of mobile computing devices, and (2) establish its feasibility for use as a research and training tool.

BACKGROUND

Simulation-based research and training for prehospital environments has typically used live simulation, with highly realistic equipment and technology-enhanced manikins. However, such simulations are expensive, difficult to replicate, and require facilitators and participants to be at the same location. Although virtual simulation tools exist for prehospital care, it is unclear how best to use them for research and training.

METHODS

We present SPECTRa-Simulated Prehospital Emergency Care for Team Research-an online simulated prehospital environment that lets participants care concurrently for single or multiple patients remotely. Patient scenarios are designed using Laerdal's SimDesigner. SPECTRa records data about scenario states and participants' virtual interaction with the simulated patients. SPECTRa's supporting environment records participants' verbal communication and their visual and physical interactions with their interface and devices using Zoom conferencing and audiovisual recording. We discuss a pilot research implementation to assess SPECTRa's feasibility.

RESULTS

SPECTRa allows researchers to systematically test small-team interaction in single- or multipatient care scenarios and assess the impact of mobile devices on participants' assessment and care of patients. SPECTRa also supports pedagogical features that could allow prehospital educators to provide individual trainees or teams with online simulation training and evaluation.

CONCLUSIONS

SPECTRa, an online tool for simulating prehospital patient care, shows potential for remote healthcare research and training.