Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units

Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews. We found that a combination of the physical environment, traditional work systems and team norms were among the systemic barriers to medicines safety. The layout of wards discouraged teamworking and reinforced professional boundaries. Workspaces were inadequate, and interruptions were uncontrollable. A less experienced workforce undertook prescribing and verification while more experienced nurses undertook administration. Guidelines were inadequate, with actors muddling through together. Formal controls against ADEs included checking (of prescriptions and administration) and barcode administration systems, but these did not integrate into workflows. Families played an important part in the safe administration of medication and provision of information about their children but were isolated from other parts of the system.

Wearable Systems for Unveiling Collective Intelligence in Clinical Settings

Nowadays, there is an ever-growing interest in assessing the collective intelligence (CI) of a team in a wide range of scenarios, thanks to its potential in enhancing teamwork and group performance. Recently, special attention has been devoted on the clinical setting, where breakdowns in teamwork, leadership, and communication can lead to adverse events, compromising patient safety. So far, researchers have mostly relied on surveys to study human behavior and group dynamics; however, this method is ineffective. In contrast, a promising solution to monitor behavioral and individual features that are reflective of CI is represented by wearable technologies. To date, the field of CI assessment still appears unstructured; therefore, the aim of this narrative review is to provide a detailed overview of the main group and individual parameters that can be monitored to evaluate CI in clinical settings, together with the wearables either already used to assess them or that have the potential to be applied in this scenario. The working principles, advantages, and disadvantages of each device are introduced in order to try to bring order in this field and provide a guide for future CI investigations in medical contexts.

Team situational awareness in the context of hospital emergency: A concept analysis

BACKGROUND

Successful management of in-hospital life threatening and emergency conditions require a well working, collaborative team. One of the vital skills that enhance team coordination of information and actions is team situational awareness (TSA). Although the concept of TSA has been long known in military and aviation settings, the concept has not been well investigated in the hospital emergency context.

OBJECTIVE

This analysis was to explore the concept of "TSA" in the context of hospital emergency to explain its meaning for optimum understanding and use in clinical practice and future research.

RESULTS

TSA encompasses two types of situational awareness, each equally important: complementary (individual) and shared situational awareness (SA). The three defining attributes of complementary SA are the perception, comprehension, and projection, meanwhile, the three defining attributes of shared SA include: (1) information is clearly shared; (2) interpreted in the same way; and (3) the same projection of actions formed to guide expectation. Although, TSA is related to other terms in literature, there is increasing acknowledgment that the concept has an impact on team performance. Finally, the two types of TSA should be considered when assessing team performance CONCLUSION: TSA is acknowledged in different fields requiring human control as a significant construct for team performance. Yet it needs to be examined in the emergency hospital context, systematically investigated and agreeably recognized as a fundamental factor in team performance.

In situ bidirectional human-robot value alignment

A prerequisite for social coordination is bidirectional communication between teammates, each playing two roles simultaneously: as receptive listeners and expressive speakers. For robots working with humans in complex situations with multiple goals that differ in importance, failure to fulfill the expectation of either role could undermine group performance due to misalignment of values between humans and robots. Specifically, a robot needs to serve as an effective listener to infer human users’ intents from instructions and feedback and as an expressive speaker to explain its decision processes to users. Here, we investigate how to foster effective bidirectional human-robot communications in the context of value alignment—collaborative robots and users form an aligned understanding of the importance of possible task goals. We propose an explainable artificial intelligence (XAI) system in which a group of robots predicts users’ values by taking in situ feedback into consideration while communicating their decision processes to users through explanations. To learn from human feedback, our XAI system integrates a cooperative communication model for inferring human values associated with multiple desirable goals. To be interpretable to humans, the system simulates human mental dynamics and predicts optimal explanations using graphical models. We conducted psychological experiments to examine the core components of the proposed computational framework. Our results show that real-time human-robot mutual understanding in complex cooperative tasks is achievable with a learning model based on bidirectional communication. We believe that this interaction framework can shed light on bidirectional value alignment in communicative XAI systems and, more broadly, in future human-machine teaming systems.

[Successful knowledge exchange in virtual teams-how important is social presence?]

Effective knowledge sharing is a key process for the success of virtual teams. Several specific challenges like the information technology used, the geographical distribution and the lack of personal contact between team members make it difficult to share knowledge.Current studies on influencing factors of effective knowledge sharing in virtual teams focus either mainly on technical or social factors. In contrast, little attention has been paid to the role of social presence as an interdisciplinary construct. Social presence means the individual or joint experience of a sense of togetherness despite physical distance, which arises in the interaction between the team members while using the existing technology.The present study examines to what extent the experience of social presence influences the success of knowledge sharing in virtual teams.Based on the Critical Incident Technique 26 interviews were conducted with members of virtual teams. The participants described situations in which the virtual knowledge exchange was successful or unsuccessful. The evaluation showed that social presence occurred more frequently in successful situations and emphasized its significance for a successful exchange of knowledge.Practical relevance: Social presence can be positively influenced by media richness and support social processes and relationships in virtual teams. The results can be used to derive implications for virtual collaboration with the aim of optimizing knowledge sharing processes.

Fostering Resilience in New Venture Teams: The Role of Behavioral and Affective Integration

Resilience has begun to receive attention in entrepreneurship research. However, most studies focus on organizational and individual resilience; little is known about team resilience in the entrepreneurship field. To fill the gap, this study explores team resilience and its formation and function in a specific context: new venture teams (NVTs). Conceptualizing team resilience as a second-order emergent state with first-order dimensions being resilience-efficacious beliefs and resilience-adaptive capacity, this study articulates the role of behavioral integration in cultivating team resilience and tests the effect of team resilience on NVT performance. Furthermore, a double-edged sword effect of affective integration is proposed: it strengthens the link between behavioral integration and team resilience but weakens the tie between team resilience and performance. Survey data collected from 488 entrepreneurs in 110 NVTs lend support to our hypotheses. These findings add to the knowledge of team resilience in a unique entrepreneurship setting, expand our understanding of NVT effectiveness, and provide implications to NVTs in terms of resilience building and team climate management.

An evidence-based multilevel framework of talent management: a systematic review

Purpose

Past research provides mixed evidence of the various elements of talent management. This review consolidates that research evidence to present a comprehensive evidence-based multilevel framework to inform practice and outline future research directions.

Design/methodology/approach

A systematic review of 120 empirical studies, focusing on determinants, practices and/or outcomes of talent management practices, was undertaken.

Findings

Our multilevel framework suggests that talent management perspectives determine talent management practices which, in turn, impact organizational, group and employee outcomes. Most studies focused on identifying talent management perspectives or practices within organizations, while few studies investigated how these perspectives influence practices. The inclusive vs exclusive perspective has been the main focus of the research. However, findings indicate that a combination of perspectives generates a hybrid approach which leads to a range of talent management practices. The most studied practices involve talent development and the least studied involve talent engagement. In total, 67 studies focusing on outcomes of talent management identified organizational performance as the most conspicuous outcome of talent management.

Originality/value

This review contributes to the existing knowledge of talent management by consolidating the empirical evidence on determinants and outcomes of talent management practices and provides a comprehensive, integrated and multilevel framework to guide practice and future research.

How teams perform under emergent and dynamic situations: the roles of mental models and backup behaviors

Purpose

The purpose of this study is to evaluate the roles of team mental models (TMMs) and backup behaviors for teams operating under emergent and dynamic situations. Specifically, the authors used a biased-corrected bootstrapping approach to assess the mediation effects of backup behaviors between the similarity of TMMs and team performance.

Design/methodology/approach

TMMs are a representation of the common understanding and beliefs in terms of task requirements or teamwork skills among different team members. It has wide implementations in various teams that are required to adapt quickly to an emergent and dynamic environment. The construct of TMMs has been studied extensively in previous literature, indicating a strong relationship between TMMs and team performance. However, how TMMs affect team performance under emergent and dynamic situations is only partially understood.

Findings

The findings of this study suggest that the similarity of task-focused mental models positively affects team performance through the mediation effects of backup behaviors. In contrast, the similarity of team-focused mental models does not positively affect backup behaviors and team performance.

Originality/value

This study contributes to the TMMs literature by investigating how teams perform in an emergent and dynamic environment. It not only provides theoretical support to the similarity of TMMs–backup behaviors–team performance relationships but has important implications in terms of team training and decision-making for teams operating under such conditions.

Measuring Real-Time Team Cognition During Team Training

OBJECTIVE

A method for detecting real-time changes in team cognition in the form of significant communication reorganizations is described. We demonstrate the method in the context of scenario-based simulation training.

BACKGROUND

We present the dynamical view that individual- and team-level aspects of team cognition are temporally intertwined in a team's real-time response to challenging events. We suggest that this real-time response represents a fundamental team cognitive skill regarding the rapidity and appropriateness of the response, and methods and metrics are needed to track this skill.

METHOD

Communication data from medical teams (Study 1) and submarine crews (Study 2) were analyzed for significant communication reorganization in response to training events. Mutual information between team members informed post hoc filtering to identify which team members contributed to reorganization.

RESULTS

Significant communication reorganizations corresponding to challenging training events were detected for all teams. Less experienced teams tended to show delayed and sometimes ineffective responses that more experienced teams did not. Mutual information and post hoc filtering identified the individual-level inputs driving reorganization and potential mechanisms (e.g., leadership emergence, role restructuring) underlying reorganization.

CONCLUSION

The ability of teams to rapidly and effectively reorganize coordination patterns as the situation demands is a team cognitive skill that can be measured and tracked.

APPLICATION

Potential applications include team monitoring and assessment that would allow for visualization of a team's real-time response and provide individualized feedback based on team member's contributions to the team response.

Team reflections, team mental models and team performance over time

Purpose

Although previous research proved positive impacts of team reflection on team outcomes, especially team performance and innovation, there are only a few insights in to which factors (mediators) account for these positive effects and over what period these effects unfold (temporal effects). To close this gap, this paper aims to investigate the direct effects of team reflection on team performance over time, as well as indirect effects because of the development of similar and accurate team mental models to explain this relationship.

Design/methodology/approach

Within a longitudinal experimental study on 22 student project teams working on a complex problem-solving task, the effects of repeated team reflection interventions on the development of team performance and team mental models over six measuring times were analysed.

Findings

Results show that team reflections caused significant increases in team performance and team mental models over time. Results also provide evidence that team mental models’ quality mediates the effects of team reflections on team performance.

Research limitations/implications

The results are interesting for both research fields, team reflection and team mental models, as the findings indicate the merits of recurrent reflection for improving team mental models’ quality.

Practical implications

For organisational practice, the question of how reflection processes can be deliberately triggered in teams and effectively integrated into the daily routine should be considered.

Originality/value

The findings accentuate the role of team reflections for improving team performance team mental models over time. By continuous reflecting teams increase awareness and insights into effective team processes and strategies (i.e. shared and accurate team mental models), which lead to better performance.

Toward an Organizational Theory of Sustainability Vision

While vision is considered as the starting point for any transformation process toward sustainability, little is known about how such a vision looks. To fill in a fundamental gap in the corporate sustainability literature, the present study advances a theory of organizational vision into a coherent theory of sustainability vision. It adopts the theory-building approaches of covering-law, enlightenment, and process by comparing and contrasting a diverse set of relevant plausible, logical, empirical, and/or epistemological conjectures so that highlighting occurs to form the substance of the refined theory. The resulting theory of sustainability vision asserts that effective sustainability visions are characterized by the seven attributes of brevity, clarity, future orientation, stability, challenge, abstractness, desirability or ability to inspire and one imagery of stakeholder satisfaction. Relevant propositions and a model are introduced for future research, followed by practical implications.

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

PURPOSE

Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination.

MATERIALS AND METHODS

We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders.

RESULTS

Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome.

CONCLUSION

Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.

A Scientific Foundation of Simulation Games for the Analysis and Design of Complex Systems

Background. The use of simulation games for complex systems analysis and design has been acknowledged about 50 years ago. However, articles do not combine all salient factors for successful simulation games, and often stem from a clear view of one particular field of science only. With combining multiple disciplines, connect analysis and design as well as research and practice, we provide deep insights in design and use of simulation games. Aim. This article analyzes the design and evaluation process of a variety of game-based projects and activities, using existing scientific concepts and approaches, in order to establish games as a valid research tool. Our focus lies on the approach towards the use of games as design instrument; using them as an intervention in a larger, complex context, in order to design this context. With our contribution, we aim at providing insights and recommendations on the design and use of games as valid research tools, the limitations of this use, possible pitfalls, but also best practices. Method. We carried out a literature review of related work to identify the most important scientific concepts related to our approach of game design. Further use of combined quantitative and qualitative case study analyses highlights the design process and results of our own game studies. Results. The analyses yielded a consolidated conceptualization of simulation games as research instruments in complex systems analysis and design. The results also include methods for the evaluation of simulation games, additional evaluation methods, and limitations to use simulation games as research instruments. Conclusions. We propose guidelines for using simulation games as research instruments that may be of value to practitioners and scientists alike. Recommendation. We recommend practitioners and scientists to apply the guidelines presented here in their efforts to analyze and design complex systems.

Developing Team Cognition: A Role for Simulation

STATEMENT

Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.

Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations

Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.

Changing Systems Through Effective Teams: A Role for Simulation

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

ICU team composition and its association with ABCDE implementation in a quality collaborative

PURPOSE

Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation.

MATERIALS & METHODS

We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility. We assessed ABCDE implementation using a 5-point Likert ("routine part of every patient's care" - "no plans to implement"). We used ordinal logistic regression to examine team composition and ABCDE implementation, adjusting for confounders and clustering.

RESULTS

From 293 surveys (75% response rate), we found that frequent nurse [OR 6.1 (1.1-34.9)] and physician involvement [OR 4.2 (1.3-13.4)] in SATs, nurse [OR 4.7 (1.6-13.4)] and nursing assistant's involvement [OR 3.9 (1.2-13.5)] in delirium and nurse [OR 2.8 (1.2-6.7)], physician [OR (3.6 (1.2-10.3)], and nursing assistants' involvement [OR 2.3 (1.1-4.8)] in early mobility were significantly associated with higher odds of routine ABCDE implementation.

CONCLUSIONS

ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.

An Integrative Perspective on Interpersonal Coordination in Interactive Team Sports

Interpersonal coordination is a key factor in team performance. In interactive team sports, the limited predictability of a constantly changing context makes coordination challenging. Approaches that highlight the support provided by environmental information and theories of shared mental models provide potential explanations of how interpersonal coordination can nonetheless be established. In this article, we first outline the main assumptions of these approaches and consider criticisms that have been raised with regard to each. The aim of this article is to define a theoretical perspective that integrates the coordination mechanisms of the two approaches. In doing so, we borrow from a theoretical outline of group action. According to this outline, group action based on a priori shared mental models is an example of how interpersonal coordination is established from the top down. Interpersonal coordination in reaction to the perception of affordances represents the bottom-up component of group action. Both components are inextricably involved in the coordination of interactive sports teams. We further elaborate on the theoretical outline to integrate a third, constructivist approach. Integrating this third approach helps to explain interpersonal coordination in game situations for which no shared mental models are established and game situations that remain ambiguous in terms of perceived affordances. The article describes how hierarchical, sequential, and complex dimensions of action organization are important aspects of this constructivist perspective and how mental models may be involved. A basketball example is used to illustrate how top-down, bottom-up and constructivist processes may be simultaneously involved in enabling interpersonal coordination. Finally, we present the implications for research and practice.

Team Resilience as a Second-Order Emergent State: A Theoretical Model and Research Directions

Resilience has been recognized as an important phenomenon for understanding how individuals overcome difficult situations. However, it is not only individuals who face difficulties; it is not uncommon for teams to experience adversity. When they do, they must be able to overcome these challenges without performance decrements.This manuscript represents a theoretical model that might be helpful in conceptualizing this important construct. Specifically, it describes team resilience as a second-order emergent state. We also include research propositions that follow from the model.

Organizational knowledge and capabilities in healthcare: Deconstructing and integrating diverse perspectives

Diverse concepts and bodies of work exist in the academic literature to guide research and practice on organizational knowledge and capabilities. However, these concepts have largely developed in parallel with minimal cross-fertilization, particularly in the healthcare domain. This contributes to confusion regarding conceptual boundaries and relationships, and to a lack of application of potentially useful evidence. The aim of this article is to assess three concepts associated with organizational knowledge content—intellectual capital, organizational core competencies, and dynamic capabilities—and to propose an agenda for future research. We conducted a literature review to identify and synthesize papers that apply the concepts of intellectual capital, organizational core competencies, and dynamic capabilities in healthcare settings. We explore the meaning of these concepts, summarize and critique associated healthcare research, and propose a high-level framework for conceptualizing how the concepts are related to each other. To support application of the concepts in practice, we conducted a case study of a healthcare organization. Through document review and interviews with current and former leaders, we identify and describe the organization’s intellectual capital, organizational core competencies, and dynamic capabilities. The review demonstrates that efforts to identify, understand, and improve organizational knowledge have been limited in health services research. In the literature on healthcare, we identified 38 papers on intellectual capital, 4 on core competencies, and 5 on dynamic capabilities. We link these disparate fields of inquiry by conceptualizing the three concepts as distinct, but overlapping concepts influenced by broader organizational learning and knowledge management processes. To aid healthcare researchers in studying and applying a knowledge-based view of organizational performance, we propose an agenda for future research involving longitudinal comparative case studies.

A Macroergonomic Approach to Distributed Team Performance

With the structure of teams in organizations increasing in complexity to include both co-located and distributed team members, explicit linkages between theory and practice are critically needed to mitigate the negative effects that computer-mediated interaction may have on distributed team performance. Following a macroergonomic approach, this paper focuses on describing how theories from organizational psychology can address some of the challenges faced by this small, but growing, subset of teams. Specifically, theories in motivation, group dynamics, and decision making can be applied to offer practical guidelines to foster the development of positive team attitudes (e.g., cohesion, trust) and behaviors (e.g., goal-setting, self-regulation), and successful decision making performance in distributed teams.

The Role of Planning in Coordinated Team Decision Making: Implications for Training

Critical decisions are made every day by teams of individuals who must coordinate their activities to achieve effectiveness. Recently, researchers have suggested that shared mental models among team members may help them to make successful decisions. Several avenues for training shared mental models in teams exist, one of which is training in planning behaviors. The relationship between team planning, team shared mental models, and coordinated team decision making and performance is explored.

Planning Effects on Communication Strategies: A Shared Mental Model Perspective

Teams play an unquestionably vital role in modern society, yet much is still unknown about how teams coordinate their activities to attain adaptive and effective performance. The current effort attempted to gain insight into how team members are able to anticipate and predict each other's needs, enabling coordinated task accomplishment. It did so by integrating the literature across three broad areas related to teamwork and testing two specific hypotheses of how teams function. Results indicated that planning is a critical skill necessary for teams to understand each other's informational requirements and to communicate in an efficient manner. Implications for training this crucial skill are discussed.

Organizational Learning

The burgeoning literature on organizational learning attests to the considerable interest engendered by `organizational learning' and `learning organizations'. At the same time it indicates considerable confusion surrounding these subjects. We discuss four controversial issues regarding organizational learning: (1) What are the similarities and differences between individual and organizational learning? (2) What are the conditions that promote productive organizational learning? (3) When is organizational learning feasible? (4) How is organizational learning related to learning organizations? We suggest that (1) although individual and organizational learning involve information processing, they require different mechanisms to convert information to actionable knowledge at different (individual vs organizational) systemic levels; (2) productive organizational learning requires a learning culture that consists of commitment to learning, valid knowledge, transparency, issue orientation and accountability; (3) the feasibility of organizational learning is enhanced by high environmental uncertainty, high costs of potential error, high level of members' professionalism, and a strong leadership commitment to learning, (4) learning organizations are organizations that embed institutionalized learning mechanisms within a learning culture.

Organizational Learning Mechanisms

This article presents a two-faceted (structural and cultural) approach to organizational learning. The structural facet focuses on organizational learning mechanisms, which are institutionalized structural and procedural arrangements allowing organizations to systematically collect, analyze, store, disseminate, and use information that is relevant to the performance of the organization. The cultural facet focuses on the shared values, without which these mechanisms are likely to be enacted as rituals rather than as means to detect and correct error. The authors describe how this proposed approach deals with the problem of anthropomorphism in organizational learning and discuss its utility for researching organizational learning and for introducing it into organizations.

Attributions for Poor Group Performance as a Predictor of Perspective-Taking and Subsequent Group Achievement: A Process Model

Several studies on group problem solving have shown that perspective-taking may affect group performance. In this paper, a model is outlined in which the effect of performance attributions on group achievement is assumed to be mediated by the quality of group members' partner spaces (i.e. by their ability to recognize their partners' perspective on a problem). According to the model, the extent to which individuals try to take their partner's perspective is a function of their attributions for poor performance: the more group members attribute negative feedback on performance or disagreement about the correct problem solution to themselves relative to their partners, the more they will try to generate an adequate partner space. Additionally, it is assumed that the quality of the partner spaces has a direct impact on group achievement. These basic assumptions were confirmed by a study in which participants were asked to solve Tower of Hanoi problems in dyads, although attributions themselves did not directly predict achievement.

Naturalistic Decision Making and Organizational Learning in Nuclear Power Plants: Negotiating Meaning Between Managers and Problem Investigation Teams

We explore the linkages between naturalistic decision making, which examines decisions in context, and team and organizational learning, which examines how feedback from decisions affects context. We study 27 problem investigation teams in three nuclear power plants, a setting that combines complex team decisions with organizational learning. Further, managers who commission the teams and receive team reports are a key aspect of context for the teams and a critical conduit for organizational learning and change. Questionnaires were given to both team members and manager recipients of written team reports, and team reports were coded for qualities of their analyses and recommendations. We find that team members value reports in which the team discovered causes or lessons that could be used in other contexts, whereas managers appreciate reports with logical corrective actions from teams with investigation experience. Teams with managers or supervisors as team members are better able to reach shared understanding with their manager customers. Teams with more diverse departmental backgrounds produce deeper and more creative analyses. Teams need access to information and analytical skills in order to learn effectively, but they also need management support and boundary-spanning skills in order to diffuse their learning.

The Measurement of Team Mental Models: We Have No Shared Schema

This article seeks to promote the advancement of empirical research on team mental models by (a) highlighting the conceptual work that must precede the selection of any measurement tool, (b) delineating measurement standards for group-level cognitions, and (c) evaluating a set of techniques for measuring team mental models. Pathfinder, multidimensional scaling, interactively elicited cognitive mapping, and text-based cognitive mapping are critiqued and compared according to their treatment of content and structure, as well as their psychometric properties. We conclude that these four techniques hold promise for measuring team mental models and illustrate the variability in measurement options. However, careful attention to the research question and research context must precede the selection of any measurement tool.

Revealing structures in narratives: A mixed-methods approach to studying interdisciplinary handoff in critical care

OBJECTIVE

To examine a novel mixed-methods approach for studying patterns of clinical communication that could inform future informatics solutions, with a specific focus on handoff within interdisciplinary teams.

MATERIALS AND METHODS

Researchers observed, recorded, and transcribed verbal handoff discussions of different members of critical care teams. The transcripts were coded qualitatively, and then analyzed quantitatively for emerging structural patterns using categorical cluster analysis, and for degree of shared mental models (SMM) using the modified Pyramid method.

RESULTS

An empirical study using the proposed mixed-methods approach suggested emerging patterns of communication among clinicians. For example, the temporal focus of handoff was often determined by the role of the clinician giving the handoff; the clinical content of handoff was consistent between clinicians, but varied between patients. The SMM index ranged from 0.065 (with the maximum possible overlap score of 1) to 0.007 with a median of 0.026; the overlap was higher in statements concerned with patient presentation (23.6% of these had overlap) and referring to the past (24% overlapped). This calculated SMM index was correlated with the assessment of coherence within the participating teams by independent physicians (r=0.63, p=0.038).

CONCLUSIONS

The proposed novel mixed-methods approach helped to reveal emerging patterns in content and structure of handoff communication and highlight differences due to the clinical context, and to the different priorities of clinicians on interdisciplinary patient care teams. The approach for calculating SMM is more ecologically sensitive as it relies on naturally occurring discourse and less intrusive than traditional ways of assessing SMM, and takes initial steps toward establishing empirical foundation for the design of electronic tools to support handoff in interdisciplinary teams.

Faculty reflections on the process of building an integrated preclerkship curriculum: a new school perspective

This is a reflective essay based on the experience of developing a structure and function module within a new integrated medical curriculum. Our hope is that the insights we gained during a 4-yr journey in a new medical school will be transferable to others engaged with curriculum development. Here, we present an interpretive analysis of our personal experiences together with some original research data and a synthesis of the literature. We will argue that a focus on teaching faculty is the key to successful curriculum integration and suggest an agenda for faculty development. Our essay begins by exploring what curriculum integration really means and what its purpose might be. Our case study explores the challenges of building a shared understanding among stakeholders and of negotiating learning outcomes and methods of teaching as well as the process of developing content and assessment. We feel that many of our experiences in the new medical school are applicable in other settings, such as curriculum reform in established schools and for developers of competency-based premedical curricula. We conclude with recommendations to assist other curriculum planners and teachers by offering some benefits of hindsight.

Surgical swab counting: a qualitative analysis from the perspective of the scrub nurse

The aim of the study was to conduct a qualitative exploration of the sociotechnical processes underlying retained surgical swabs, and to explore the fundamental reasons why the swab count procedure and related protocols fail in practice. Data was collected through a set of 27 semistructured qualitative interviews with scrub nurses from a large, multi-site teaching hospital. Interview transcripts were analysed using established constant comparative methods, moving between inductive and deductive reasoning. Key findings were associated with interprofessional perspectives, team processes and climate and responsibility for the swab count. The analysis of risk factors revealed that perceived social and interprofessional issues played a significant role in the reliability of measures to prevent retained swabs. This work highlights the human, psychological and organisational factors that impact upon the reliability of the process and gives rise to recommendations to address contextual factors and improve perioperative practice and training.

HR strategy: optimizing risks, optimizing rewards

Purpose

– The purpose of this paper is to suggest that in the arena of human capital, risk-mitigation may overshadow risk-optimized decisions, and show how a more balanced approach can be achieved by understanding and applying frameworks from behavioral decision theory, as well as framing human capital risk using tools and frameworks that have a long history in other management arenas, such as finance.

Design/methodology/approach

– Review risk-optimization frameworks in human resource and general management, distill key connections, suggest ways to enhance risk optimization for human capital, and offer suggestions for future research and practice.

Findings

– For human capital, risk-mitigation may overshadow risk-optimization, a balanced approach can be achieved by applying behavioral decision theory and by using frameworks from other management arenas, such as finance.

Practical implications

– Organizations must acknowledge and skillfully manage the connections between human capital and competitive strategy in this emerging arena of human capital risk, or they will miss key strategic opportunities.

Originality/value

– Attention to human capital risk has largely emphasized minimizing or controlling unwanted outcomes, but the paper proposes that risk-optimization requires balanced attention to risk-taking as well.

The cognitive underpinnings of adaptive team performance in ill-defined task situations

As the nature of work changes due to technology, organizational restructuring, and globalization, complex tasks have emerged that necessitate the use of teams. Oftentimes, teams complete tasks that have more than one plausible solution or engage in performance episodes under uncertain circumstances. Therefore, teams are called upon to be highly adaptable to these ill-defined tasks by responding to continuous changes in the task environment. We propose that dimensions of team cognition (i.e., shared mental models and transactive memory systems) help drive adaptation. In recognition of the additional cognitive demands placed upon teams who must be highly adaptable, we believe much can be gained from taking a closer look at the facets of team-level cognitive variables. The current effort aims to provide a more comprehensive explanation of emergent cognitive states, and how they interact to drive adaptive team performance, especially within the context of ill-defined problems.

Antecedents and Consequences of User Coproduction in Information System Development Projects

Based on a coproduction concept highlighted by service-dominant logic, this study attempts to understand the antecedents and consequences of user coproduction in information system development projects. As a key contribution, we posit that user coproduction is influenced by social capital between users and developers; we then postulate that user coproduction determines the project outcomes. Paired data collected from both user representatives and developers by using a survey approach was used to test proposed hypotheses. The results showed that user coproduction has a positively significant influence on project outcomes, and social capital between user representatives and developers is also associated with user coproduction.

A review of human factors challenges of complex adaptive systems: discovering and understanding chaos in human performance

OBJECTIVE

In this paper, the author explores a need for a greater understanding of the true nature of human-system interactions from the perspective of the theory of complex adaptive systems, including the essence of complexity, emergent properties of system behavior, nonlinear systems dynamics, and deterministic chaos.

BACKGROUND

Human performance, more often than not, constitutes complex adaptive phenomena with emergent properties that exhibit nonlinear dynamical (chaotic) behaviors.

METHOD

The complexity challenges in the design and management of contemporary work systems, including service systems, are explored. Examples of selected applications of the concepts of nonlinear dynamics to the study of human physical performance are provided.

RESULTS

Understanding and applications of the concepts of theory of complex adaptive and dynamical systems should significantly improve the effectiveness of human-centered design efforts of a large system of systems.

CONCLUSION

Performance of many contemporary work systems and environments may be sensitive to the initial conditions and may exhibit dynamic nonlinear properties and chaotic system behaviors. Human-centered design of emergent human-system interactions requires application of the theories of nonlinear dynamics and complex adaptive system.

APPLICATION

The success of future human-systems integration efforts requires the fusion of paradigms, knowledge, design principles, and methodologies of human factors and ergonomics with those of the science of complex adaptive systems as well as modern systems engineering.

Healthcare system intervention for prevention of birth injuries - process evaluation of self-assessment, peer review, feedback and agreement for change

BACKGROUND

Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased.

METHODS

Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change.

RESULTS

The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change.

CONCLUSIONS

Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.