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Walter S, Schmutz JB, Grote G. A Safety Approach for Improving Security - Effective Coordination Strategies at the Airport Security Screening Checkpoint. HUMAN FACTORS 2024; 66:1302-1314. [PMID: 36059249 DOI: 10.1177/00187208221121411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to analyze effective teamwork at security checkpoints by investigating how security crews communicate in different (routine and threat) situations. BACKGROUND Working at an airport security screening checkpoint is challenging. Although tasks and processes are highly regulated and standardized due to legal requirements, security screeners must be trained to deal with unforeseen threat situations involving high levels of uncertainty. Therefore, security crews need to engage in flexible and adaptive coordination according to the situation and circumstances. METHOD We conducted a field study with 20 airport security screening crews comprising 100 security screeners. Teamwork in terms of interaction between crew members was measured, differentiating between proactive "push" communication and information on request representing "pull" communication. Furthermore, non-task related communication was assessed. RESULTS While crews showed non-task related communication more in routine situations, both task-related "push" and "pull" communication occurred more in threat situations. In terms of team performance, we could show significant positive effects of proactive "push" communication and non-task related interaction in threat situations. CONCLUSION Our results underscore the specific setting of airport security screening and the challenges that arise for teamwork. This study investigates professional screeners and passengers in the field. In contrast to other high-risk areas, security crews are confronted with a third party that complicates coordination strategies considered effective in previous studies. APPLICATION Our findings recommend situation-specific communication strategies for practical training for airport security screening crews.
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Affiliation(s)
- Stephanie Walter
- Department of Research and Development, Zurich State Police, Zurich, Switzerland
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Jan B Schmutz
- ETH Zurich, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Gudela Grote
- ETH Zurich, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
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Hughes AM, Riska K, Farmer MJS, Krishnakumar D, Shea CM, Hess DR, Lindenauer PK, Stefan MS. Analysis of shared cognitive tasks in the application of non-invasive ventilation to patients with COPD exacerbation. J Interprof Care 2023; 37:576-587. [PMID: 36264072 PMCID: PMC10983066 DOI: 10.1080/13561820.2022.2118681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
Interprofessional teamwork plays a key role in the uptake of evidence-based interventions, such as noninvasive ventilation (NIV) for patients with exacerbated Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify the shared cognitive tasks in interprofessional teams using NIV for patients with COPD exacerbation. We used a cognitive task analysis approach (CTA) to engage nurses, rapid response team members, respiratory therapists, and physicians involved in the use of NIV to treat patients with COPD exacerbation. Clinicians participated in a semi-structured interview (n = 21) that elicited cognitions needed to treat COPD exacerbation. Three shared cognitive tasks were identified: Complete a thorough assessment, Formulate a care plan, and Continuously monitor patient status. Findings attest to the importance of having access to up-to-date information and expertise necessary to make accurate clinical inferences for patient assessment. Shared understanding of the formulated care plan among all members of the care team was important to its execution. Continuous monitoring was crucial; however, this cognitive task relied on patient assessment skills and ongoing collaboration within the clinical care team. Application of NIV for patients with COPD exacerbation may require enhancing collaboration through nontechnical skills and interprofessional training.
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Affiliation(s)
- Ashley M Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago
- Center for Innovations in Chronic, Complex Healthcare, Edward Hines JR VA Medical Center, Hines
| | - Karen Riska
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield
| | - Mary Jo S Farmer
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield
- Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield
| | | | - Christopher M Shea
- Department of Health Policy and Management, Gilling's School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Dean R Hess
- College of Professional Studies, Respiratory Care Leadership, Northeastern University, Boston MS, United States
- Department of Respiratory Care, Massachusetts General Hospital, Boston, MS, United States
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MS, United States
| | - Mihaela S Stefan
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Kämmer JE, Ehrhard S, Kunina-Habenicht O, Weber-Schuh S, Hautz SC, Birrenbach T, Sauter TC, Hautz WE. What factors affect team members' evaluation of collaboration in medical teams? Front Psychol 2023; 13:1031902. [PMID: 36710771 PMCID: PMC9877456 DOI: 10.3389/fpsyg.2022.1031902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Perceived teamwork quality is associated with numerous work-related outcomes, ranging from team effectiveness to job satisfaction. This study explored what situational and stable factors affect the perceived quality of teamwork during a specific team task: when a medical team comprising a senior (supervisor) and a junior (trainee) physician diagnoses a patient. Methods During a field study in an emergency department, multisource data describing the patients, the diagnosing physicians, and the context were collected, including physicians' ratings of their teamwork. The relationships between perceived teamwork quality and situational (e.g., workload) and stable (e.g., seniority) factors were estimated in a latent regression model using the structural equation modeling (SEM) approach. Results Across the N = 495 patients included, SEM analyses revealed that the patient-specific case clarity and urgency influenced the perceived teamwork quality positively, whereas the work experience of the supervisor influenced the perceived teamwork quality of both supervisor and trainee negatively, albeit to different degrees. Discussion Our findings shed light on the complex underpinnings of perceived teamwork quality, a performance-relevant factor that may influence work and organizational effectiveness in healthcare settings.
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Affiliation(s)
- Juliane E. Kämmer
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Simone Ehrhard
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Sabine Weber-Schuh
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Stefanie C. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Marques B, Silva S, Alves J, Araujo T, Dias P, Santos BS. A Conceptual Model and Taxonomy for Collaborative Augmented Reality. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:5113-5133. [PMID: 34347599 DOI: 10.1109/tvcg.2021.3101545] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To support the nuances of collaborative work, many researchers have been exploring the field of Augmented Reality (AR), aiming to assist in co-located or remote scenarios. Solutions using AR allow taking advantage from seamless integration of virtual objects and real-world objects, thus providing collaborators with a shared understanding or common ground environment. However, most of the research efforts, so far, have been devoted to experiment with technology and mature methods to support its design and development. Therefore, it is now time to understand where the field stands and how well can it address collaborative work with AR, to better characterize and evaluate the collaboration process. In this article, we perform an analysis of the different dimensions that should be taken into account when analysing the contributions of AR to the collaborative work effort. Then, we bring these dimensions forward into a conceptual framework and propose an extended human-centered taxonomy for the categorization of the main features of Collaborative AR. Our goal is to foster harmonization of perspectives for the field, which may help create a common ground for systematization and discussion. We hope to influence and improve how research in this field is reported by providing a structured list of the defining characteristics. Finally, some examples of the use of the taxonomy are presented to show how it can serve to gather information for characterizing AR-supported collaborative work, and illustrate its potential as the grounds to elicit further studies.
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Eppich W, Reedy G. Advancing healthcare simulation research: innovations in theory, methodology, and method. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:23. [PMID: 35897062 PMCID: PMC9326413 DOI: 10.1186/s41077-022-00219-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, Waterloo Bridge Wing G7, London, UK
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Evans K, Woodruff J, Cowley A, Bramley L, Miles G, Ross A, Cooper J, Baxendale B. GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review. BMC MEDICAL EDUCATION 2022; 22:537. [PMID: 35818052 PMCID: PMC9272657 DOI: 10.1186/s12909-022-03401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. METHODS A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. RESULTS Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. CONCLUSIONS This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
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Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | | | - Alison Cowley
- Nottingham University Hospitals Trust, Research & Innovation, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Giulia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Joanne Cooper
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
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E-Learning: Direct Effect of Student Learning Effectiveness and Engagement through Project-Based Learning, Team Cohesion, and Flipped Learning during the COVID-19 Pandemic. SUSTAINABILITY 2022. [DOI: 10.3390/su14031724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The cross-impact of project-based learning, team cohesion, and flipped learning was investigated by examining their direct effects on student learning effectiveness, engagement, and engagement effects on learning effectiveness. The results of hypotheses testing were achieved using hierarchical regression analysis with SPSS-25 statistical packages for data analysis. The research model was empirically verified with quantitative data collected from 247 graduate/undergraduate business students based on their own experiences, observations, and engagement. The analysis found that project-based learning (PBL) and team cohesion increased positive direct effects both in student learning effectiveness and engagement. However, flipped learning showed increased positive direct effects in student learning effectiveness and negative effects on engagement. Furthermore, the engagement (itself) had a positive direct effect on student learning effectiveness. The proposed study was performed with the intention to inform practice in terms of increasing retention and enhancing teaching along with student learning quality.
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Olin K, Göras C, Nilsson U, Unbeck M, Ehrenberg A, Pukk-Härenstam K, Ekstedt M. Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study. BMJ Open 2022; 12:e052283. [PMID: 35045998 PMCID: PMC8772415 DOI: 10.1136/bmjopen-2021-052283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care. OBJECTIVE To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process. METHODS Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool. RESULTS High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia. CONCLUSION The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.
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Affiliation(s)
- Karolina Olin
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Administration Centre, Tyks and Hospital District of Southwest Finland, Turku, Finland
| | - Camilla Göras
- Faculty of Medicine, School of Education, Health and Social Studies, Örebro University, Orebro, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
- Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Karin Pukk-Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren's Children's Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Mirjam Ekstedt
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Schmutz JB, Lei Z, Eppich WJ. Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1337-1345. [PMID: 33788785 DOI: 10.1097/acm.0000000000004105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Acute care teams work in dynamic and complex environments and must adapt to changing circumstances. A team process that helps teams process information and adapt is in-action team reflection (TR), defined as concurrent collective reflection on group objectives, strategies, or processes during an ongoing care event. However, the health care field lacks a means for systematically observing and ultimately training in-action TR in acute care teams. To bridge this gap, the authors developed a theoretically and empirically informed framework, Team Reflection Behavioral Observation (TuRBO), for measuring in-action TR. METHOD In 2018 at ETH, Zurich, Switzerland, the authors developed a theoretical framework based on the literature and theory. They then conducted exploratory reviews of preexisting videos of acute care teams training simulated emergencies. The authors adapted observation codes using an iterative approach. Using the developed coding framework, they coded 23 video recordings of acute care teams and provided validity evidence from the 3 sources: content, internal structure (interrater reliability), and relations to other variables. RESULTS The final TuRBO framework consists of 3 general dimensions-seeking information, evaluating information, and planning-that are further specified in 7 subcodes. Interrater agreement of the coding was substantial (κ = 0.80). As hypothesized, the data showed a positive relationship between in-action TR and team performance. Also, physicians spent significantly more time on in-action TR than nurses. CONCLUSIONS The TuRBO framework for assessing in-action TR in acute care teams provides positive validity evidence of the data. TuRBO integrates different team communication and calibration processes under the overarching concept of in-action TR and provides descriptive behavioral markers. TuRBO taps into powerful cultural and normative components of patient safety. This tool can augment team training that allows all team members to serve as an important resource for flexible, resilient, and safer patient care.
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Affiliation(s)
- Jan B Schmutz
- J.B. Schmutz is researcher and lecturer, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland; ORCID: https://orcid.org/0000-0002-0181-807X
| | - Zhike Lei
- Z. Lei is associate professor of applied behavioral science, Graziadio Business School, Pepperdine University, Malibu, California
| | - Walter J Eppich
- W.J. Eppich is professor of simulation education and research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Pasarakonda S, Grote G, Schmutz JB, Bogdanovic J, Guggenheim M, Manser T. A Strategic Core Role Perspective on Team Coordination: Benefits of Centralized Leadership for Managing Task Complexity in the Operating Room. HUMAN FACTORS 2021; 63:910-925. [PMID: 32119581 DOI: 10.1177/0018720820906041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder-that is, the main surgeon-is central to team coordination. BACKGROUND Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder's centrality in team coordination helps teams to handle different types of task complexity. METHOD We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder's coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. RESULTS In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder's coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. CONCLUSION The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. APPLICATION Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.
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Affiliation(s)
| | | | | | | | | | - Tanja Manser
- 30805 University of Applied Science and Arts Northwestern Switzerland, Olten, Switzerland
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Wang D, Gao Q, Tan H, Liu Z, Zhou L, Jia L, Li Z. Coordination breakdowns in nuclear power plant control rooms: cause identification and behaviour-sequence analysis. ERGONOMICS 2020; 63:660-681. [PMID: 32281476 DOI: 10.1080/00140139.2020.1755060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
This study aims to identify the causes of coordination breakdowns among control crews and to understand their coordination-behaviour patterns during emergencies in nuclear power plants (NPPs). On the basis of in-depth interviews with 18 control-crew operators, we identified 25 causes of coordination breakdown related to work processes, personnel, and situation and organisation. In addition, we observed 12 control-crew training sessions that dealt with emergencies and conducted lag-sequential analysis. The levels of coordination effectiveness were evaluated using the proportion of coordination breakdowns and the anticipation ratio. We found that higher-performing teams exhibited more non-random coordination behavioural patterns than did lower-performing teams. Coordination-behaviour patterns specific to the higher-performing teams included adaptive workload management (from senior operators) and proactive seeking performance monitoring (from junior operators). The findings of the study enrich our understanding of the critical factors and processes that influence coordination effectiveness of NPP control crews. Practitioner summary: Causes of coordination breakdowns among control crews of NPPs were identified based on in-depth interviews with control-crew operators, and behavioural-pattern analysis of control crews in 12 training sessions were analysed to reveal the patterns that differentiate higher- and lower-performing teams. The findings of the study enrich our understanding of the critical factors and processes that influence the coordination effectiveness of NPP control crews. Abbreviations: NPP: nuclear power plant; RO: reactor operator; TO: turbine operator; CO: coordinator; SRO: senior reactor operator.
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Affiliation(s)
- Dunxing Wang
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co. Ltd., Shenzhen, Guangdong Province, P. R. China
- Department of Industrial Engineering, Tsinghua University, Beijing, P. R. China
| | - Qin Gao
- Department of Industrial Engineering, Tsinghua University, Beijing, P. R. China
| | - Haibo Tan
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co. Ltd., Shenzhen, Guangdong Province, P. R. China
| | - Zhaopeng Liu
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co. Ltd., Shenzhen, Guangdong Province, P. R. China
| | - Liwei Zhou
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co. Ltd., Shenzhen, Guangdong Province, P. R. China
| | - Liu Jia
- Department of Industrial Engineering, Tsinghua University, Beijing, P. R. China
| | - Zhizhong Li
- Department of Industrial Engineering, Tsinghua University, Beijing, P. R. China
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Krenz H, Burtscher MJ, Grande B, Kolbe M. Nurses’ voice: the role of hierarchy and leadership. Leadersh Health Serv (Bradf Engl) 2020. [DOI: 10.1108/lhs-07-2019-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Voicing concerns and suggestions is crucial for preventing medical errors and improving patient safety. Research suggests that hierarchy in health-care teams impair open communication. Hierarchy, however, can vary with changing team composition, particularly during acute care situations where more senior persons join the team later on. The purpose of this study is to investigate how changes in hierarchy and leadership were associated with nurses’ voice frequency and nurses’ time to voice during simulated acute care situations.
Design/methodology/approach
This study’s sample consisted of 78 health-care providers (i.e. nurses, residents and consultants) who worked in 39 teams performing complex clinical scenarios in the context of interprofessional, simulation-based team training. Scenarios were videotaped and communication behaviour was coded using a systematic coding scheme. To test the hypotheses, multilevel regression analyses were conducted.
Findings
Hierarchy and leadership had no significant effect on nurses’ voice frequency. However, there were significant relationships between nurses’ time to voice and both hierarchy (γ = 30.00, p = 0.002; 95 per cent confidence interval [CI] = 12.43; 47.92) as well as leadership (γ = 0.30, p = 0.001; 95 per cent CI = 0.12; 0.47). These findings indicate that when more physicians are present and leadership is more centralised, more time passes until the first nurses’ voice occurred.
Originality/value
This study specifies previous findings on the relationships between hierarchy, leadership and nurses’ voice. Our findings suggest that stronger hierarchy and more centralised leadership delay nurses’ voice but do not affect the overall frequency of voice.
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Klonek F, Gerpott FH, Lehmann-Willenbrock N, Parker SK. Time to go wild: How to conceptualize and measure process dynamics in real teams with high-resolution. ORGANIZATIONAL PSYCHOLOGY REVIEW 2019. [DOI: 10.1177/2041386619886674] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Team processes are interdependent activities among team members that transform inputs into outputs, vary over time, and are critical for team effectiveness. Understanding the temporal dynamics of team processes and related team phenomena with a high-resolution lens (i.e., methods with high sampling rates) is particularly challenging when going “into the wild” (i.e., studying teams operating in their full situated context). We review quantitative field studies using high-resolution methods (e.g., video, chat/text data, archival, wearables) and map out the various temporal lenses for studying team dynamics. We synthesize these different lenses and present an integrated temporal framework that is of help in theorizing about team dynamics. We also provide readers with a “how to” guide that summarizes four essential steps along with analytical methods (e.g., sequential and pattern analyses, mixed-methods research, abductive reasoning) that are applicable to the broad scope of high-resolution methods.
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Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019; 9:e028280. [PMID: 31515415 PMCID: PMC6747874 DOI: 10.1136/bmjopen-2018-028280] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
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Affiliation(s)
- Jan B Schmutz
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | - Laurenz L Meier
- Department of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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Marques-Quinteiro P, Rico R, Passos AM, Curral L. There Is Light and There Is Darkness: On the Temporal Dynamics of Cohesion, Coordination, and Performance in Business Teams. Front Psychol 2019; 10:847. [PMID: 31068856 PMCID: PMC6491749 DOI: 10.3389/fpsyg.2019.00847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 11/13/2022] Open
Abstract
This study examines teams as complex adaptive systems (tCAS) and uses latent growth curve modeling to test team cohesion as an initial condition conducive to team performance over time and the mediational effect of team coordination on this relationship. After analyzing 158 teams enrolled in a business game simulation over five consecutive weeks, we found that change in team coordination was best described by a continuous linear change model, while change in team performance was best described by a continuous nonlinear change model; and the mediation latent growth curve model revealed a negative indirect effect of team cohesion on the level of change in team performance over time, through the level of change in team coordination. This study contributes to the science of teams by combining the notions of initial conditions with co-evolving team dynamics, hence creating a more refined temporal approach to understanding team functioning.
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Affiliation(s)
| | - Ramón Rico
- Business School, University of Western Australia, Perth, WA, Australia
| | - Ana M Passos
- Business Research Unit, ISCTE - Instituto Universitário de Lisboa, Lisbon, Portugal
| | - Luís Curral
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Tschan F, Semmer NK, Vetterli M, Hunziker PR, Marsch SC. Predicting team-performance and leadership in emergency situations by observing standardised operational procedures: a prospective single-blind simulator-based trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 5:102-107. [DOI: 10.1136/bmjstel-2018-000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
BackgroundPerformance of interdisciplinary teams and their leaders is crucial in acute medical care and can be monitored by observing specific events. Standardised operational procedures (SOP) are easily observable, whereas the unpredictability of medical emergencies makes performance monitoring in these situations difficult. The aim of this study was therefore to assess whether performance in emergency situations can be predicted by performance observed during an SOP.Methods30 intensive care unit teams composed of one staff physician (leader), one resident and three nurses performed a simulated scenario of an elective electrical cardioversion (SOP) followed by a cardiac arrest (emergency). Video recordings obtained during simulations were used for data analysis. The primary outcome was the correlation between performance scores of electrical cardioversion and performance during cardiopulmonary resuscitation (hands-on time, time to first defibrillation).ResultsNone of the cardioversion performance scores significantly correlated with resuscitation performance. Leadership scores during electrical cardioversion correlated positively with leadership scores during cardiopulmonary resuscitation (r=0.365, p=0.047). Moreover, there was a positive correlation of leaders being hands-off during both electrical cardioversion and cardiopulmonary resuscitation (r=0.645, p<0.0001).ConclusionsTeam performance in SOP carried no predictive value for emergency situations. Observing teams in easily observable SOP is therefore no suitable substitute for monitoring the performance in medical emergencies. There was a between-situation consistency for specific elements of leadership.
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Grote G, Kolbe M, Waller MJ. The dual nature of adaptive coordination in teams. ORGANIZATIONAL PSYCHOLOGY REVIEW 2018. [DOI: 10.1177/2041386618790112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adaptive team coordination is a central topic in the team dynamics literature. Most team adaptation research to date addresses team responses to demands for flexibility triggered by dynamic external forces. Little explicit attention has been paid to demands for stability created by continued pressures on efficiency and control. To capture this dual nature of adaptive coordination, we propose to characterize adaptation triggers in terms of stability and flexibility demands and suggest four modes of adaptive coordination that enable teams to adequately balance these demands. Grounded in team as well as organizational literatures, we explicate the specific patterns of coordination mechanisms comprising each mode of coordination, termed experiential, exploitative, exploratory, and ambidextrous coordination. The new insights offered into team adaptive coordination can spur research that further integrates team and organizational perspectives on adaptation processes.
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Cunningham U, Ward ME, De Brún A, McAuliffe E. Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis. BMC Health Serv Res 2018; 18:536. [PMID: 29996820 PMCID: PMC6042358 DOI: 10.1186/s12913-018-3331-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Research on team effectiveness in healthcare has focussed on whether effective teams yield positive outcomes for patients and on the effectiveness of team interventions to improve performance. Limited understanding exists of what works for whom within an effective team, or how and why the context in which the team operates enables team members both as individuals and as a collective to enact behaviours that promote positive outcomes. METHODS This realist synthesis of the literature explores the relationship between team interventions, underlying teamwork mechanisms generated by those interventions, and the resultant impact on patient outcomes in an acute hospital context. A systematic search of five healthcare and healthcare management academic databases: PubMed, PsychINFO, CINAHL, ABInform, Emerald Management and three grey literature databases: ERIC, OpenDOAR and Open Grey was undertaken. Five experts in the field were also contacted to source relevant literature. Using PRISMA guidelines, relevant studies published between January 2006 and January 2017 were systematically searched by a team of three people. Drawing on realist methodology, data were synthesised using context, mechanism and outcome configurations as the unit of analysis to identify enablers and barriers to effective team interventions. RESULTS Out of 3347 papers retrieved, 18 were included in the final synthesis. From these, five contextual enablers were identified: an inter-disciplinary focus and flattened hierarchy; effective communication; leadership support and alignment of team goals with organisational goals; credibility of intervention; and appropriate team composition with physician involvement. Ten recurring mechanisms were identified, the most frequently occurring of which was shared responsibility. CONCLUSIONS The advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.
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Affiliation(s)
- U. Cunningham
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - M. E. Ward
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - A. De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - E. McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Henrickson Parker S, Schmutz JB, Manser T. Training Needs for Adaptive Coordination: Utilizing Task Analysis to Identify Coordination Requirements in Three Different Clinical Settings. GROUP & ORGANIZATION MANAGEMENT 2018. [DOI: 10.1177/1059601118768022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A team’s ability to coordinate and adapt their performance to meet situational demands is critical to excellent patient care. The goal of this article is to identify common coordination characteristics that enable health care action teams to ensure effective patient care and to discuss specific examples of adaptive coordination within the health care setting. Task analyses were conducted to identify situational demands, in three different clinical settings: cardiac anesthesia, pediatric sepsis simulation, and trauma resuscitation. Each task analysis identified specific coordination requirements for pertinent tasks. The research team compared these task analyses, identified emerging themes, and agreed on core coordination characteristics common across all three environments by consensus through iterative abductive analysis. Findings across these diverse clinical settings showed that expert action teams (a) continually appraise their dynamic environment, (b) identify and define points of coordination, and (c) respond to the demands of nonroutine events by making coordination highly explicit. Specific examples of adaptive coordination within the health care setting are discussed, and implications for training are articulated. Findings are also pertinent outside of health care and may contribute to the understanding of coordination behaviors within action teams across multiple settings.
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Affiliation(s)
| | | | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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22
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Seelandt JC, Grande B, Kriech S, Kolbe M. DE-CODE: a coding scheme for assessing debriefing interactions. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:51-58. [PMID: 35515884 PMCID: PMC8990183 DOI: 10.1136/bmjstel-2017-000233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/03/2022]
Abstract
Debriefings are crucial for learning during simulation-based training (SBT). Although the quality of debriefings is very important for SBT, few studies have examined actual debriefing conversations. Investigating debriefing conversations is important for identifying typical debriefer-learner interaction patterns, obtaining insights into associations between debriefers' communication and learners' reflection and comparing different debriefing approaches. We aim at contributing to the science of debriefings by developing DE-CODE, a valid and reliable coding scheme for assessing debriefers' and learners' communication in debriefings. It is applicable for both direct, on-site observations and video-based coding. Methods The coding scheme was developed both deductively and inductively from literature on team learning and debriefing and observing debriefings during SBT, respectively. Inter-rater reliability was calculated using Cohen's kappa. DE-CODE was tested for both live and video-based coding. Results DE-CODE consists of 32 codes for debriefers' communication and 15 codes for learners' communication. For live coding, coders achieved good inter-rater reliabilities with the exception of four codes for debriefers' communication and two codes for learners' communication. For video-based coding, coders achieved substantial inter-rater reliabilities with the exception of five codes for debriefers' communication and three codes for learners' communication. Conclusion DE-CODE is designed as micro-level measurement tool for coding debriefing conversations applicable to any debriefing of SBT in any field (except for the code medical input). It is reliable for direct, on-site observations as well as for video-based coding. DE-CODE is intended to allow for obtaining insights into what works and what does not work during debriefings and contribute to the science of debriefing.
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Affiliation(s)
- Julia C Seelandt
- Quality Management and Patient Safety, University Hospital Zurich, Zurich, Switzerland
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Kriech
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- ETH Zurich, Zurich, Switzerland
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Marlow SL, Lacerenza CN, Paoletti J, Burke CS, Salas E. Does team communication represent a one-size-fits-all approach?: A meta-analysis of team communication and performance. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2018. [DOI: 10.1016/j.obhdp.2017.08.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gharaveis A, Hamilton DK, Pati D. The Impact of Environmental Design on Teamwork and Communication in Healthcare Facilities: A Systematic Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 11:119-137. [PMID: 29022368 DOI: 10.1177/1937586717730333] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this systematic review is to investigate the current knowledge about the impact of healthcare facility design on teamwork and communication by exploring the relevant literature. Teamwork and communication are behavioral factors that are impacted by physical design. However, the effects of environmental factors on teamwork and communication have not been investigated extensively in healthcare design literature. There are no published systematic reviews on the current topic. Searches were conducted in PubMed and Google Scholar databases in addition to targeted design journals including Health Environmental Research & Design, Environment and Behavior, Environmental Psychology, and Applied Ergonomics. Inclusion criteria were (a) full-text English language articles related to teamwork and communication and (b) involving any healthcare built environment and space design published in peer-reviewed journals between 1984 and 2017. Studies were extracted using defined inclusion and exclusion criteria. In the first phase, 26 of the 195 articles most relevant to teamwork and 19 studies of the 147 were identified and reviewed to understand the impact of communication in healthcare facilities. The literature regarding the impact of built environment on teamwork and communication were reviewed and explored in detail. Eighteen studies were selected and succinctly summarized as the final product of this review. Environmental design, which involves nurses, support staff, and physicians, is one of the critical factors that promotes the efficiency of teamwork and collaborative communication. Layout design, visibility, and accessibility levels are the most cited aspects of design which can affect the level of communication and teamwork in healthcare facilities.
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Gjeraa K, Mundt AS, Spanager L, Hansen HJ, Konge L, Petersen RH, Østergaard D. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives. Ann Thorac Surg 2017; 104:329-335. [PMID: 28587738 DOI: 10.1016/j.athoracsur.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. RESULTS The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. CONCLUSIONS This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination.
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Affiliation(s)
- Kirsten Gjeraa
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
| | - Anna S Mundt
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Lene Spanager
- Department of General Surgery, Nordsjællands Hospital, Hillerød, Denmark
| | - Henrik J Hansen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - René H Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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SYNSEG – Eine Methode zur syntaxgeleiteten Segmentierung von Kodiereinheiten für die Analyse von Gruppenprozessen. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2016. [DOI: 10.1007/s11612-016-0345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Johnson RH, Macpherson CF, Smith AW, Block RG, Keyton J. Facilitating Teamwork in Adolescent and Young Adult Oncology. J Oncol Pract 2016; 12:1067-1074. [PMID: 27624944 DOI: 10.1200/jop.2016.013870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of a young adult patient in the days immediately after a cancer diagnosis illustrates the critical importance of three interrelated core coordinating mechanisms-closed-loop communication, shared mental models, and mutual trust-of teamwork in an adolescent and young adult multidisciplinary oncology team. The case illustrates both the opportunities to increase team member coordination and the problems that can occur when coordination breaks down. A model for teamwork is presented, which highlights the relationships among these coordinating mechanisms and demonstrates how balance among them works to optimize team function and patient care. Implications for clinical practice and research suggested by the case are presented.
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Affiliation(s)
- Rebecca H Johnson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Catherine Fiona Macpherson
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Ashley W Smith
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Rebecca G Block
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
| | - Joann Keyton
- Mary Bridge Hospital, MultiCare Health System, Tacoma, WA; Children's Hospital Los Angeles, Los Angeles, CA; National Cancer Institute, Bethesda, MD; Critical Mass: The Young Adult Cancer Alliance, Austin, TX; and North Carolina State University Raleigh, NC
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Welp A, Manser T. Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review. BMC Health Serv Res 2016; 16:281. [PMID: 27430287 PMCID: PMC4950091 DOI: 10.1186/s12913-016-1535-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review. METHODS We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes. RESULTS The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked. CONCLUSION Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety.
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Affiliation(s)
- Annalena Welp
- Industrial Psychology and Human Factors, Department of Psychology, University of Fribourg, Rue Faucigny 2, 1700, Fribourg, Switzerland
| | - Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany. .,Department of Management, Technology & Economics, ETH Zurich, Weinbergstrasse 56/58, 8092, Zurich, Switzerland.
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Härgestam M, Hultin M, Brulin C, Jacobsson M. Trauma team leaders' non-verbal communication: video registration during trauma team training. Scand J Trauma Resusc Emerg Med 2016; 24:37. [PMID: 27015914 PMCID: PMC4807541 DOI: 10.1186/s13049-016-0230-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training. METHODS Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time. RESULTS The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks. DISCUSSION In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety. CONCLUSIONS Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.
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Affiliation(s)
- Maria Härgestam
- Department of Nursing, Umeå University, S-90187, Umeå, Sweden. .,Department of Surgical and Perioperative Sciences, Umeå University, S-90185, Umeå, Sweden.
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Umeå University, S-90185, Umeå, Sweden
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Gevers JMP, Uitdewilligen S, Passos AM. Dynamics of team cognition and team adaptation: Introduction to the special issue. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2015. [DOI: 10.1080/1359432x.2015.1065251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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