Facilitators and barriers to ad hoc team performance

The impact of video consultation on interprofessional collaboration and professional roles: a simulation-based study in prehospital stroke chain of care

Healthcare is often conducted by interprofessional teams. Research has shown that diverse groups with their own terminology and culture greatly influence collaboration and patient safety. Previous studies have focused on interhospital teams, and very little attention has been paid to team collaboration between intrahospital and prehospital care. Addressing this gap, the current study simulated a common and time-critical event for ambulance nurses (AN) that also required contact with a stroke specialist in a hospital. Today such consultations are usually conducted over the phone, this simulation added a video stream from the ambulance to the neurologist on call. The aim of this study was to explore interprofessional collaboration between AN's and neurologists when introducing video-support in the prehospital stroke chain of care. The study took place in Western Sweden. The simulated sessions were video recorded, and the participants were interviewed after the simulation. The results indicate that video has a significant impact on collaboration and can help to facilitate better understanding among different professional groups. The participants found the video to be a valuable complement to verbal information. The result also showed challenges in the form of a loss of patient focused care. Both ANs and neurologists saw the video as benefiting patient safety.

'Corridor care' in the emergency department: managing patient care in non-clinical areas safely and efficiently

Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end - or at least reduce - corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs.

Reliability and validity testing of team emergency assessment measure in a distributed team context

Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.

Moving beyond teamwork in the operating room to facilitating mutual professional respect

Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member's perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.

Factors related to implementation of an interprofessional communication concept in thoracic oncology: a mixed-methods study

Background

An innovative patient-centred interprofessional communication concept with advanced lung cancer patients (Heidelberg Milestone Communication Approach, MCA) has been developed and implemented. Role changes and interprofessional communication are challenging in a busy outpatient oncology service. The aim of the study was to present attitudes to interprofessional collaboration of professions in thoracic oncology during the implementation of MCA and to explore factors and experiences healthcare team members associate with its implementation.

Methods

In a longitudinal study, 3 of the 4 subscales of the validated German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D) were collected prior to implementation of MCA (t0) with follow-up data collections at 4 months (t1), 10 months (t2) and 17 months (t3). Descriptive analysis included calculating subscale sum scores and categorizing each subscale into positive, neutral and negative attitudes. Interviews and focus groups on implementation and interprofessional collaboration in the context of MCA were conducted with healthcare staff. The topics were analysed deductively, guided by the Professional Interactions factor of the Tailored Implementation for Chronic Diseases (TICD) framework.

Results

The survey with 87 staff (44 nurses, 13 physicians, 12 psycho-social staff, 7 therapists, and 11 others) participating at least once found heterogeneous attitudes. ‘Communication and Teamwork’ and ‘Interprofessional Relationships’ were characterized by primarily positive attitudes. Neutral attitudes to ‘Interprofessional Interaction’ were indicated by the majority of respondents. There were no differences between collection times. Fifteen staff members participated in the interviews and focus groups. The main interprofessional interaction factors associated with implementation concerned the knowledge of the MCA and the impact of the intervention on team roles, on information sharing and on transfer processes between wards. Adaptive processes led to a shift in the perception of responsibilities and interprofessional collaboration.

Conclusions

Positive experiences and potential shortfalls in the implementation were observed. Future introductions of interprofessional communication concepts require further activities which should address the attitudes of healthcare professionals towards interprofessional care.

Trial registration

DRKS00013469 / Date of registration: 22/12/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00977-6.

What Is Teamwork? A Mixed Methods Study on the Perception of Teamwork in a Specialized Neonatal Resuscitation Team

INTRODUCTION

Neonatal resuscitation is a team-based activity involving many decisions and tasks. Non-technical factors, such as teamwork, are increasingly recognized as impacting how well-neonatal resuscitation is performed, and therefore influencing infant outcomes. Prior studies on teamwork in neonatal resuscitation have focused on quantification of teamwork behaviors, or the effects of team training. This study aimed to explore healthcare providers' own perception of teamwork in this specialized environment to identify perceived barriers and facilitators to effective team functioning.

METHODS

This single-center exploratory sequential mixed methods study used two phases. First, semi-structured interviews were conducted, and thematic analysis used to identify themes. Subsequently, interview data informed the development of quantitative surveys to explore selected themes in the wider team.

RESULTS

From ten semi-structured interviews, seven themes were identified including: (1) Team Composition, (2) Effective Communication, (3) Team leadership, (4) Hierarchy, (5) Team Training, (6) Debriefing, and (7) Physical Environment. Perceived teamwork facilitators include role assignment, familiarity, team composition, talking out loud to maintain shared mental models, leadership, and team training. Perceived barriers included time pressures, ad hoc team, ineffective leadership, and space limitations. Selected themes (Communication, Speaking up, Hierarchy, and Leadership) were further explored via electronic surveys distributed via email to all members of the resuscitation team. There were 105 responses; a response rate of ~53%. All respondents agreed or strongly agreed that speaking up is important; however, not all felt comfortable doing so. Neonatal fellows (14%) and nurses (12%) were most likely to report not feeling comfortable speaking up. All respondents agreed that team communication is important to an effective resuscitation. Most respondents (91.5%) agreed that a hierarchy exists within the team; 54.3% believed that hierarchy positively contributes to effective resuscitation. All respondents agreed or strongly agreed that having a clearly defined leader is important in delivery room resuscitations. Ineffective leadership was the most cited reason for poor team communication.

CONCLUSIONS

In this mixed methods study of perceptions of teamwork within a specialized, multi-disciplinary neonatal resuscitation team, communication, hierarchy, and leadership were positively perceived and facilitates teamwork. However, even in this environment, some nurses and trainees expressed discomfort with speaking up.

„Entrustable professional activities“ für NotfallsanitäterInnen

Hintergrund

Wie in vielen medizinischen Berufen wird auch bei den NotfallsanitäterInnen (NotSan) der Kompetenzbegriff verwendet. Eine Möglichkeit, diese Kompetenz schrittweise entwickeln und messen zu können, steht aus. Ten Cate et al. schlagen hier das Konzept der „entrustable professional activities“ (EPA) vor. Ziel der Studie war, einen Katalog von relevanten Einsatzsituationen zu entwickeln, der die Grundlage für eine EPA-Integration in die Ausbildung ermöglicht.

Methode

Die Erarbeitung des EPA-Katalogs erfolgte über ein 2‑stufiges Verfahren mittels webbasierter Fragebögen. Nach einer eDelphi-Analyse mit Praxisanleitenden im Rettungsdienst, wurden die Items in einem großen Kollektiv hinsichtlich der Relevanz validiert. Anschließend wurden Faktoren identifiziert und Skalen gebildet.

Ergebnisse

Nach Validierung der Ergebnisse der eDelphi-Analyse ergaben sich fünf Skalen mit 22 Items. Sie umfassen die Bereiche „Behandlung spezieller Krankheitsbilder-NACA IV“, „Kommunikation“, „Einbinden von Medizinprodukten in die Patientenbehandlung“, „symptomorientiertes Handeln“ und „Leitsymptom Schmerz“. Die Items beschreiben 59 % der Gesamtvarianz und entsprechen einer stabilen Faktorenlösung.

Schlussfolgerung

Es konnte ein Katalog von relevanten Einsatzsituationen in der NotSan-Ausbildung entwickelt werden, der sich zur weiteren Entwicklung von EPA eignet. Diese sollten flächendeckend und organisationsübergreifend einheitlich genutzt werden. Die Nutzung sollte didaktisch wissenschaftlich begleitet werden.

Effect of simulation-based team training in airway management: a systematic review

Major complications associated with airway management are rare but often have serious consequences. Complications frequently result from failures in communication and teamwork. We performed a systematic review on the effect of simulation-based team training on patient outcomes, healthcare professionals' clinical performance and preparedness for airway management. We included studies with simulation-based team training in airway management as the educational intervention, using any comparator, outcome and design. Two authors independently selected articles and assessed risk of bias using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education. We screened 1248 titles and evaluated 116 full-text articles. Twenty-two studies were included. The Kirkpatrick model for evaluation of training was used to organise outcomes. Four studies reported patient-centred outcomes (Kirkpatrick level 4), and three studies' outcomes related to healthcare professionals' clinical performance (Kirkpatrick level 3). The results were ambiguous and the studies had significant methodological limitations, making it difficult to draw conclusions on the effect of simulation-based team training. To describe preparedness for airway management, we used outcomes related to participants' attitudes or perceptions and outcomes related to knowledge or skills demonstrated in a test setting (Kirkpatrick level 2). Most studies reporting these outcomes were in favour of simulation-based team training, but were prone to bias. We consider the current evidence to be weak and recommend that future research should be based on randomised study designs and patient-centred outcomes.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams

AIM

Describe brief (less than half a day) interventions aimed at improving healthcare team functioning.

METHODS

A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken.

RESULTS

Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported.

DISCUSSION

Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time.

CONCLUSION

Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.

Working With Interpreters as a Team in Health Care (WITH Care) Curriculum Tool Kit for Oral Health Professions

INTRODUCTION

Limited English proficiency (LEP) patients face multiple care barriers and disproportionate risks for communication errors. Working with trained interpreters as a health care team can improve communication and drive high-quality care for LEP patients. Simulation and interprofessional education provide key strategies to address the critical training gap that exists at the intersection of patient safety, interprofessional practice, and cultural competence.

METHODS

Using action research principles across 16 months, we created a 3.5-hour simulation-based training for oral health and interpreting learners. The curriculum included profession-specific orientations with didactic and experiential content, three immersive simulations using start-stop-rewind methodology, virtual scenarios, and summary reflection discussions. A comprehensive tool kit facilitated curriculum implementation and standardization.

RESULTS

Forty-nine students from dentistry (first- through third-year predoctoral), dental hygiene, and dental therapy participated in this elective training during the 2017-2018 academic year; as required training, 126 third-year dental students participated in fall 2018. Students' familiarity with provider and interpreter best practices, appreciation of challenges faced by LEP patients, and confidence in skills working with spoken language interpreters increased. For all evaluation parameters, pre- and postsurvey ratings were statistically significant (chi-square tests, p < .001).

DISCUSSION

The curriculum efficiently and effectively develops oral health and interpreting learners' abilities to work as a team with LEP patients. Curriculum design and resources address key barriers to feasibility and sustainability. The curriculum informs communication across all patient populations, revealing that getting by with partial understanding can be insufficient for any patient and any health care team.

An observational study of ad-hoc anaesthesia teams

BACKGROUND

Anaesthesia teams are temporarily assembled to cooperate with teams in emergency departments in the immediate management of events compromising patients’ airway, ventilation and circulation.

PURPOSE

The aim was to describe a temporary ad-hoc anaesthesia team’s performance.

DESIGN

An observational study was conducted.

METHODS

Data, collected with 12 non-participatory observations, were analysed using both an thematic method, and a validated assessment tool, the Team Emergency Assessment Measure.

RESULTS

Three themes were identified: (1) flexibility in assuming varying roles, (2) expertise in verbal and non-verbal communication and (3) skills dealing with the challenges of working in unfamiliar dynamic environments. Ninety per cent of anaesthesia teams scored 7.6 (0–10) on the overall assessment according to the Team Emergency Assessment Measure rating.

CONCLUSION

Ad-hoc anaesthesia team members communicated in various ways and the anaesthesia team adapted well to the unpredictable environment in the emergency department.

Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine

BACKGROUND

The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams.

PURPOSES

Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem.

METHODOLOGY

The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams.

FINDINGS

The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices.

PRACTICE IMPLICATION

The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.