Sustainable and replicable clinical and financial outcomes in an interprofessional education and collaborative practice nexus

Our Interprofessional Education and Collaborative Practice (IPECP) Nexus previously reported significant reductions in Emergency Department (ED) visits, hospitalizations, hemoglobin A1c levels, and patient charges. This study examines sustainability of these results over two additional years and replication in two subsequent independent patient cohorts. Participants in the sustainability cohort (N = 276) met ≥1 of the following criteria: (a) ≥3 ED visits in first or second half of the year, (b) hemoglobin A1c level ≥ 9, or (c) Length of Stay, Acuity, Comorbidities, and ER (Emergency Room) Visits (LACE) score ≥ 10. Participants in two replicability cohorts (N = 255) and (N = 160) met the same criteria, but the LACE criterion was changed to ≥3 hospitalizations in baseline years. The Nexus, housed in a family medicine (FM) residency clinic, included professionals and students from multiple disciplines. IPECP skills and interventions included communication, team building, and conflict engagement skills training, daily huddles and pre-visit planning, immediate consultations, small teamlet IPECP interactions, and weekly IPECP case conferences for complex patients. Original health improvements and charge reductions were sustained for two additional years for ED visits, hospitalizations, A1c, and patient charges, and replicated in two additional patient cohorts. The IPECP Nexus interventions were associated with Quadruple Aim outcomes while training the next generation of health care professionals.

The paramedic-general practitioner relationship: a scoping review

BACKGROUND

Health services internationally are implementing programs that increase working ties between paramedics and general practitioners (GPs) to reduce unnecessary transport to emergency departments (EDs) and improve access to primary health care. As paramedic involvement in primary health care develops, there is increasing focus on the GP-paramedic collaborative relationship. Resulting issues regarding professional boundaries may occur, as paramedics practice in fields that were previously solely in the GP scope. An effective paramedic-GP working relationship will be an essential foundation to the success of future strategies.

METHODS

A search of three electronic databases was completed (Ovid MEDLINE, Embase Classic+ Embase and CINAHL Plus). Eligibility for inclusion required analysis of the relationship between paramedics and GPs. All processes were completed by two independent reviewers.

RESULTS

After removal of duplicates, 4995 titles were screened by title and/or abstract. After full-text review, 15 studies were included. Five themes were identified that contribute significantly to the strengths and weaknesses of the relationship - the importance of communication, understanding scope of practice, leadership roles, responsibility for patient care and interdisciplinary training. Issues identified included significant variation in the structure of different emergency medical services and varying standards of education requirements for paramedics worldwide.

CONCLUSIONS

There were no published Australian studies that had the primary aim of examining the paramedic-GP relationship. The depth of research on this topic is lacking, despite increased interest over the past decade. The relevance of the international literature to the Australian setting is questionable.

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.

Handoffs and the challenges to implementing teamwork training in the perioperative environment

Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.

Opioid Use Disorder Curricular Content in US-Based Doctor of Pharmacy Programs

OBJECTIVES

To characterize the instructional settings, delivery methods, and assessment methods of opioid use disorder (OUD) content in Doctor of Pharmacy (PharmD) programs; assess faculty perceptions of OUD content; and assess faculty perceptions of a shared OUD curriculum.

METHODS

This national, cross-sectional, descriptive survey study was designed to characterize OUD content, faculty perceptions, and faculty and institutional demographics. A contact list was developed for accredited, US-based PharmD programs with publicly-accessible online faculty directories (n = 137). Recruitment and telephone survey administration occurred between August and December 2021. Descriptive statistics were computed for all items. Open-ended items were reviewed to identify common themes.

RESULTS

A faculty member from 67 (48.9%) of 137 institutions contacted completed the survey. All programs incorporated OUD content into required coursework. Didactic lectures were the most common delivery method (98.5%). Programs delivered a median of 7.0 h (range, 1.5-33.0) of OUD content in required coursework, with 85.1% achieving the 4-hour minimum for substance use disorder-related content recommended by the American Association of Colleges of Pharmacy. Just over half (56.8%) of faculty agreed or strongly agreed that their students were adequately prepared to provide opioid interventions; however, 50.0% or fewer perceived topics such as prescription interventions, screening and assessment interventions, resource referral interventions, and stigma to be covered adequately. Almost all (97.0%) indicated moderate, high, or extremely high interest in a shared OUD curriculum.

CONCLUSION

Enhanced OUD education is needed in PharmD programs. A shared OUD curriculum was of interest to faculty and should be explored as a potentially viable solution for addressing this need.

Occupational adaptation as a social process for dementia care teams

BACKGROUND

Few studies have examined a group's collective experience of occupation using occupational therapy theoretical models. Dementia caregiving requires a diverse team of caregivers who learn and work together to resolve shared challenges. An Occupational Adaptation (OA) theory-based training program for dementia care teams was developed to better understand the team's adaptive process inherent in cooperative caregiving.

AIM/OBJECTIVES

Describe how the team learned together and how the training impacted their teamwork.

MATERIALS/METHODS

Fourteen employees at one continuing care retirement community underwent OA-based training. During the program, the team analysed and resolved challenging dementia care cases. Participant observations, participant journals, open-ended surveys, and follow-up semi-structured interviews were analysed.

RESULTS

The thematic framework included five steps: unite around a shared challenge, tap the collective adaptive repertoire, collaborate on case-specific plans, implement with teamwork, and return for ongoing problem solving and integration. The program enhanced appreciation for teammates' knowledge, skills, and experiences, learning from each other, and integration of team-centered OA process.

CONCLUSION/SIGNIFICANCE

The OA-based program appears to have facilitated adaptation that was complex, social, and generalisable. OA theory is enriched with a social view of occupational adaptation opening new opportunities for therapists and researchers to understand and facilitate adaptation among teams.

Mapping knowledge-sharing behavior through emotional intelligence and team culture toward optimized team performance

Purpose

Research unveiled that interdisciplinary health-care teams are often found to be ineffective because of deprived team mechanisms. Considering effective team functioning, a leader’s non-cognitive abilities, knowledge-sharing behavior and the role of culture remain central concerns of health-care teams. This study aims to investigate how a leader’s emotional intelligence (EI) in a prevailing team culture can nurture the sharing of knowledge and enhance team EI that influences team performance.

Design/methodology/approach

The authors used multisource data representing a sample of 195 teams (735 respondents) to examine the hypothesized relationships by using the analytic strategy of partial least squares-structural equation modeling. This study bridged the methodological gap by using the repeated indicator approach that includes the reflective-formative second-order hierarchical latent variable model.

Findings

The results revealed a standpoint that leaders practicing the ability of EI influences team performance by understanding each other emotions in the leader–member relationship. Further, culture adds value and maps knowledge-sharing behavior which is tailored and beneficial for effective team outcomes.

Practical implications

This study provides valuable inputs by articulating uniquely modeled variables for health-care teams confronting high work demands. This study highlights that leaders' EI can enhance understanding of the emotions of the team and can exchange information by harnessing knowledge-sharing behavior amongst professionals.

Originality/value

This study provides a novel contribution by integrating leaders’ EI, knowledge-sharing behavior, the role of culture and team performance in a single framework. The integrated theoretical model sheds light on team working in the health-care setting and advances the understanding of a leader’s EI and team culture through mapping knowledge sharing particularly being central to enhancing team performance.

Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion

Purpose: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a “psychological safety climate” at the group level and “perceived workgroup inclusion” at the individual level within professionally diverse workgroups of healthcare professionals. Material and Methods: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. Results: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. Conclusion: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.

Importance of Interprofessional Education for Occupational Therapy

The purpose of this position statement is to provide recommendations for educators on best practices to embed interprofessional education (IPE) into today's occupational therapy curricula, whether entry level or postprofessional, to bridge academic and clinical learning environments.

Relevance of Deployment Experience and Clinical Practice Characteristics on Military Critical Care Air Transport Team Readiness: A Study of Simulation Construct Validity

INTRODUCTION

The Critical Care Air Transport Team (CCATT) Advanced course utilizes fully immersive high-fidelity simulations to train CCATT personnel and assess their readiness for deployment. This study aims to (1) determine whether these simulations correctly discriminate between students with previous deployment experience ("experienced") and no deployment experience ("novices") and (2) examine the effects of students' clinical practice environment on their performance during training simulations.

MATERIALS AND METHODS

Critical Care Air Transport Team Advanced student survey data and course status (pass/no pass) between March 2006 and April 2020 were analyzed. The data included students' specialty, previous exposure to the CCATT Advanced course, previous CCATT deployment experience, years in clinical practice (<5, 5-15, and >15 years), and daily practice of critical care (yes/no), as well as a description of the students' hospital to include the total number of hospital (<100, 100-200, 201-400, and >400) and intensive care unit (0, 1-10, 11-20, and >20) beds. Following descriptive analysis and comparative tests, multivariable regression was used to identify the predictors of passing the CCATT Advanced course.

RESULTS

A total of 2,723 surveys were analyzed: 841 (31%) were physicians (MDs), 1,035 (38%) were registered nurses, and 847 (31%) were respiratory therapists (RTs); 641 (24%) of the students were repeating the course for sustainment training and 664 (24%) had previous deployment experience. Grouped by student specialty, the MDs', registered nurses', and RTs' pass rates were 92.7%, 90.6%, and 85.6%, respectively. Multivariable regression results demonstrated that deployment experience was a robust predictor of passing. In addition, the >15 years in practice group had a 47% decrease in the odds of passing as compared to the 5 to 15 years in practice group. Finally, using MDs as the reference, the RTs had a 61% decrease in their odds of passing. The daily practice of critical care provided a borderline but nonsignificant passing advantage, whereas previous CCATT course exposure had no effect.

CONCLUSION

Our primary result was that the CCATT Advanced simulations that are used to evaluate whether the students are mission ready successfully differentiated "novice" from "experienced" students; this is consistent with valid simulation constructs. Finally, novice CCATT students do not sustain their readiness skills during the period between mandated refresher training.

Perceptions of Teamwork in Schools of Nursing

BACKGROUND

Characteristics of high-performing teams include shared purpose, clear vision, strong leadership, and the ability to use conflict management when needed. While many individuals who teach in schools of nursing come from the clinical setting where teamwork is normative, that same expectation of teamwork may not be present for the faculty as a whole.

PURPOSE

This study assessed perceptions of teamwork among faculty members in schools of nursing in 4 states in the Midwestern region of the United States.

METHODS

Perception of teamwork, related to communication, leadership, team structure, situation monitoring, and mutual support, was examined using a modified TeamSTEPPS Teamwork Perceptions Questionnaire.

RESULTS

Perceptions of teamwork were highest for team structure and leadership, whereas communication, situation monitoring, and mutual support were lower. In addition, teamwork dimension scores were higher for those who previously participated in teamwork training.

CONCLUSIONS

There are opportunities to improve teamwork in all domains. Teamwork skills are transferrable to different roles and across various situations; therefore once learned and fostered, these can impact the individual as well as improve the organizational climate.

Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study

Background

Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings.

Methods

The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory.

Results

Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies.

Conclusions

Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.

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

This state of the science review brings together the disparate literature of effective strategies for enhancing and accelerating team performance. The review evaluates and synthesises models and proposes recommended avenues for future research. The two major models of the Input-Mediator-Output-Input (IMOI) framework and the Big Five dimensions of teamwork were reviewed and both will need significant development for application to future teams comprising non-human agents. Research suggests that a multi-method approach is appropriate for team measurements, such as the integration of methods from self-report, observer ratings, event-based measurement and automated recordings. Simulations are recommended as the most effective team-based training interventions. The impact of new technology and autonomous agents is discussed with respect to the changing nature of teamwork. In particular, whether existing teamwork models and measures are suitable to support the design, operation and evaluation of human-nonhuman teams of the future. Practitioner summary: This review recommends a multi-method approach to the measurement and evaluation of teamwork. Team models will need to be adapted to describe interaction with non-human agents, which is what the future is most likely to hold. The most effective team training interventions use simulation-based approaches.

The influence of personal attitude on instructor intent to integrate online collaborative activities

Collaborative activities are a method used in higher education to develop the higher-order skills that students need to succeed in today's workforce. However, instructors have continued to make the integration of online collaborative activities a low priority. The purpose of this study was to explore the influence of personal attitude on instructor intent to integrate collaborative activities. The principal results determined that participant behavioral beliefs determining personal attitude had a negative influence on instructor intent. The primary areas of influence were lack of real value, the increased difficulty with managing the activity, instructor challenges, and online student expectations. Major conclusions include providing instructors with expertise in instructional design and the tools needed to assess group performance, integrating a method for peer assessment, and implementing student contracts may have a positive impact on personal attitude. Future research should explore whether these strategies alter the intent to integrate online collaborative activities.

A team mental model approach to understanding team effectiveness in an emergency department: A qualitative study

OBJECTIVES

To demonstrate how the team mental model concept can broaden our understanding of team effectiveness in health care by exploring the knowledge that underpins it, and the workplace conditions that sustain it in a metropolitan emergency department (ED) in Sydney, Australia.

METHODS

This study draws on accounts of 19 ED clinicians (registered nurses, doctors and nurse practitioners) of their teamwork practice and perceptions of their team's effectiveness through semi-structured interviews. Analysis was conducted in two stages. A thematic analysis was followed by a template analysis using the a priori themes of task, team, team process and goal knowledge to specify the content of the team's mental model.

RESULTS

The content of the ED team's mental model revealed that the knowledge the team employed to coordinate their work was deeply embedded in the team's tasks and the workplace context. Team effectiveness not only relied on how well team members coordinate, but also their ability to perform their own role effectively and efficiently. Three workplace conditions were identified as enablers to individuals acquiring the knowledge needed to work effectively in the team: stability in team membership; workplace experience; and the spatial-temporal conditions of emergency work where permanent emergency doctors and nurses executed their tasks concurrently, regularly interacted and shared a common goal.

CONCLUSIONS

Getting health care teams 'on the same page' is a long-standing challenge. This study suggests that solutions may lay in the organisation of health care work, creating team stability and opportunities for team members to interact that allows a team mental model to emerge.

The role of gender, profession and informational role self-efficacy in physician-nurse knowledge sharing and decision-making

While gender and professional status influence how decisions are made, the role played by health care professionals' informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-efficacy in sharing expertise and decision-making. Validated questionnaires were answered by a cross-sectional sample of 108 physicians and nurses working in mental health care teams. A moderated mediation analysis was performed. Results reveal that the impact of sharing knowledge on informational role self-efficacy is negative for nurses. Being a nurse negatively affects the relation between informational role self-efficacy and participating in decision-making. Informational role self-efficacy is also a strong positive predictor of participation in decision-making for male physicians but less so for female physicians.

Advancing team cohesion: Using an escape room as a novel approach

Objective

An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams.

Methods

This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M.

Results

Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline.

Conclusions

This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

Interprofessional team-based geriatric education and training: A review of interventions in Canada

Given world-wide rises in the number of older adults, interprofessional education and training in geriatrics must be promoted across the learning spectrum, both for students and for health care professionals. This review examined interprofessional team-based education and training interventions in Canada focusing on the team component. A total of 10 studies (1997-2017) were eligible for analyzes. Studies offered health care providers opportunities to enhance their knowledge of geriatric competencies, as well as their ability to work in interprofessional geriatric teams. Although several interventions did not include team-based learning content explicitly, team-building opportunities, as well as assignments related to working on teams yielded positive impacts on learners. Results showed improved geriatric competencies as well as team functioning. Geriatric health care teams add significant value to the Canadian health care system. Consequently, opportunities to improve health care providers' geriatric knowledge and their ability to work in teams should be encouraged.

[Teamwork and stress in routine interventions: an observational study of multiprofessional OR teams]

Hintergrund

Effektive interprofessionelle Teamarbeit im Operationssaal (OP) und intraoperativer Stress sind von großer Bedeutung für Patientensicherheit und Versorgungsqualität. Dennoch gibt es nur wenige systematische Studien zum Zusammenhang von Teamarbeit im OP und Arbeitsstress.

Ziele der Arbeit

Untersuchung des Zusammenhangs von Teamarbeit und empfundenem Stress bei Routineeingriffen – für das OP-Team als Gesamtheit sowie für die einzelnen Professionen Chirurgie, Anästhesie und Pflege.

Material und Methoden

Durchgeführt wurde eine Mehrmethodenstudie bestehend aus Expertenbeobachtungen mittels eines standardisierten Beobachtungsinstruments (OTAS-D) und systematischer Selbstberichte des gesamten OP-Teams. Erfasst wurden 64 elektive Routineeingriffe unterschiedlicher chirurgischer Fachbereiche. Die statistischen Zusammenhangsanalysen unter Kontrolle prozeduraler Einflussfaktoren wurden mit „Mixed-effects“-Regressionsmodellen berechnet.

Ergebnisse

Die Güte der intraoperativen Teamarbeit lag auf mittlerem Niveau. Der situative Stress während des Eingriffs wurde durch die Befragten eher auf niedrigerem Niveau berichtet, mit signifikanten Unterschieden zwischen den Professionen Chirurgie, Pflege und Anästhesie. Mitglieder des chirurgischen Teams berichteten im Durchschnitt die höchsten Stressniveaus. Ein genereller Zusammenhang zwischen Teamarbeit und Stresserleben konnte nicht beobachtet werden, allerdings für die einzelnen Professionen: Für das chirurgische Team ergaben sich signifikante, positive Zusammenhänge, sowie für die Teamarbeitsdimensionen Zusammenarbeit und Führung. Signifikante negative Zusammenhänge ergaben sich für das Pflegeteam hinsichtlich der Qualität der interdisziplinären Teamarbeit insgesamt sowie für die Teamarbeitsdimension Team-Monitoring.

Diskussion

Die Effekte interprofessioneller Zusammenarbeit im OP auf subjektives Stressempfinden bei Routineeingriffen hängen von Professionszugehörigkeit, Aufgabe und Tätigkeit ab. Weitere Forschungsarbeit ist notwendig, inwiefern gute Teamarbeit bei Routineeingriffen innerhalb und über die Professionen hinweg intraoperativen Stress beeinflusst.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00113-021-00977-w) enthält eine vollständige Liste mit Kurzbeschreibungen der beobachteten Eingriffe. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de/link/10.1007/s00113-021-00977-w zur Verfügung.

Toward the Development of the Perfect Medical Team: Critical Components for Adaptation

OBJECTIVE

Medical teams play a vital role in the delivery of safe and effective patient care. Toward the goal of becoming a high-reliability health system, the authors posit that the "perfect" medical team is one that develops their attitudes, behaviors, and cognitions (ABCs) to facilitate adaptation.

METHODS

The authors synthesized the literature (frameworks, measures, and conceptual models) on teamwork in healthcare (k = 161) to develop an evidence-based model of ABCs, which current evidence suggests, are requisite for medical team adaptation. Clinical vignettes were garnered from the media and other sources to illustrate how these ABCs-or failure in using these ABCs-can lead to positive or negative events in healthcare.

RESULTS

The resulting model contains the most frequently included ABCs in healthcare teamwork models, measures, and frameworks: psychological safety (41, 25.5%), situation assessment (66, 41.0%), shared mental models (56, 34.8%), team leadership behaviors (78, 48.4%), role awareness (64, 39.7%), team decision-making (61, 37.9%) and planning (41, 25.5%), conflict management (51, 31.7%), task coordination (71, 44.1%), adaptation (46, 28.6%), and backup behavior (54, 33.5%). The authors posit that communication and organizational conditions-other highly cited components-(141, 87.6%, and 90, 55.9%, respectively) serve as moderators of these relationships.

CONCLUSIONS

The authors argue that each of these ABCs is critical for enhancing team adaptation and subsequently increasing patient safety. A list of practical tools and educational strategies that teams and organizations can use to improve their performance on each of these ABCs is provided.

Teamwork in the time of COVID-19

Strong and effective clinical teamwork has been shown to improve medical outcomes and reduce medical errors. Incorporating didactic and clinical activities into undergraduate medical education in which students work in teams will develop skills to prepare them to work in clinical teams as they advance through their education and careers. At the Yale School of Medicine, we foster the development of team skills in the classroom through team-based learning (TBL) and in clinical settings with the Interprofessional Longitudinal Clinical Experience (ILCE). Both TBL and ILCE require students work in close physical proximity. The COVID-19 pandemic forced us to immediately adapt our in-person activities to an online format and then develop clinical and interprofessional experiences that adhere to social distancing guidelines. Here we describe our approaches to solving these problems and the experiences of our students and faculty.

Reliability and structural validity of the Norwegian version of the TeamSTEPPS Teamwork Attitudes Questionnaire: A cross-sectional study among Bachelor of Nursing students

AIM

To test the reliability and structural validity of the Norwegian version of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ) among Bachelor of Nursing students.

DESIGN

Cross-sectional study.

METHODS

Bachelor of Nursing students (N = 1,624) at three campuses in different regions of Norway were invited to complete the survey. The data were analysed with descriptive statistics, Cronbach's alpha and confirmatory factor analysis (CFA). Three models were tested. Model 3 was a post hoc modification with a correlation between four negatively worded items. The data was collected in September 2018 and May-June 2019.

RESULTS

A total of 509 students were included in the study. Cronbach's alpha ranged from 0.44-0.70 for the dimensions and was 0.79 for the total questionnaire. The fit indexes of model 3 were as follows: RMSEA = 0.043, chi-square = 724.3 (p < .000), normed chi-square = 1.862, TLI = 0.812 and CFI = 0.832. The questionnaire shows some potential to display attitudes towards teamwork in health care among Bachelor of Nursing students. Low Cronbach's alpha in the dimensions might indicate that the questionnaire should be considered used as a unidimensional questionnaire.

The Impact of Teammates' Online Reputations on Physicians' Online Appointment Numbers: A Social Interdependency Perspective

Online medical team is an emerging online medical model in which patients can choose a doctor to register and consult. A doctor’s reputation cannot be ignored. It is worth studying how that online reputation affects the focal doctor’s appointment numbers on the online medical team. Based on the online reputation mechanism and social interdependence theory, this study empirically studied the impact of the focal doctor’s own reputation and other teammates’ reputation on his/her appointment numbers. Our data include 31,143 doctors from 6103 online expert teams of Guahao.com. The results indicate that for a leader doctor, his/her appointment numbers are not related to his/her own reputation, and there was an inverted U-shaped relationship with the ordinary doctors’ reputations on the team. For an ordinary doctor, his/her appointment numbers were positively correlated with his/her own reputation and positively correlated with his/her leader’s reputation and there was an inverted U-shaped relationship with the other ordinary doctors’ reputations. The research showed that there is a positive spillover effect on the team leader’s reputation. There are two relationships between team doctors: competition and cooperation. This study provides guidance for the leader to select team members and the ordinary doctor to select a team.

High and low functioning team-based pre-licensure interprofessional learning: an observational evaluation

Interprofessional education (IPE) is embedded in many health professional training programs, often with a focus on collaborative teamwork. Most studies into whether IPE delivers the desired collaborative teamwork capabilities has tended to rely on short term, self-assessed changes in learners' attitudes, knowledge and skills. This study adopted overt ethnographic observation to understand how a convenience sample of students behave in groups during interprofessional team-based clinical placements. Interprofessional student teams were observed by two independent observers on eight occasions (a total of 720 hours) across three sites. Thematic analysis of the observational data indicates that student teams fell into two categories: higher and lower functioning. Higher functioning teams were observed using humor to build rapport, reduce tension and express humility, and evidenced a greater emphasis on shared client goals. In contrast, lower functioning teams were more formal, with no evidence of humor and less interaction. The higher functioning teams, therefore, not only demonstrated greater interprofessional collaboration they also appeared to have higher levels of psychological safety. Participants in the higher functioning teams also demonstrated mutual trust and confidence and took more risks, often speaking up to provide suggestions, share knowledge and skills, and seek or offer feedback. The results suggest that further explicit training in, and assessment of, psychological safety in IPE needs to be undertaken.

Application of an adapted relationship scale for assessing the occurrence of six different relationships as perceived by seven health care professions in Northern Italy

Interprofessional working relationships can influence the quality of collaborative practices, with consequences for patient safety outcomes. This article reports findings of an adapted relationship scale comprising six different relationship types, ranging from hostile to collegial, between seven health-care professions: physicians, nurses, dieticians, occupational therapists, physiotherapists, speech therapists, and psychologists. Survey data were gathered within amixed-method study aiming to explore the current status quo of interprofessional collaboration in aHealth Trust, located in Northern Italy. An online questionnaire was completed by 2,238 health professionals achieving aresponse rate of 44%. The working relationship element was answered by 1,897 respondents. The results of the survey are used as abasis for recommending strategies for advancing interprofessional collaboration in the Trust. Descriptive statistics were used to examine relationship-types, with frequency of occurrence considered. The non-parametric Mann Whitney and Kruskal Wallis tests were used to explore relationship differences among groups defined by sociodemographic variables. Participants reported overall positive relationships with other health professions. We noted variability in the occurrence of different relationship-types amongst the health professions. In particular, the six professions viewed their relationships with doctors more negatively than physicians who reported amore positive perception of their relationships with the six professions.

Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study

Background

Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals’ needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP.

Methods

Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital’s OT.

Results

10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs.

Conclusions

Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.

The Association of Nurse-Physician Teamwork and Mortality in Surgical Patients

In this study we describe nurse-physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse-physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse-physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce.

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

BACKGROUND

The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.

METHODS

The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically.

RESULTS

The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses.

CONCLUSION

Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review

Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

Towards a safer culture: implementing multidisciplinary simulation-based team training in New Zealand operating theatres - a framework analysis

AIM

NetworkZ is a simulation-based multidisciplinary team-training programme designed to enhance patient safety by improving communication and teamwork in operating theatres (OTs). In partnership with the Accident Compensation Corporation, its implementation across New Zealand (NZ) began in 2017. Our aim was to explore the experiences of staff - including the challenges they faced - in implementing NetworkZ in NZ hospitals, so that we could improve the processes necessary for subsequent implementation.

METHOD

We interviewed staff from five hospitals involved in the initial implementation of NetworkZ, using the Organising for Quality model as the framework for analysis. This model describes embedding successful quality improvement as a process of overcoming six universal challenges: structure, infrastructure, politics, culture, motivation and learning.

RESULTS

Thirty-one people participated. Structural support within the hospital was considered essential to maintain staff enthusiasm, momentum and to embed the programme. The multidisciplinary, simulation-based approach to team training was deemed a fundamental infrastructure for learning, with participants especially valuing the realistic in situ simulations and educational support. Participants reported positive changes to the OT culture as a result of NetworkZ and this realisation motivated its implementation. In sites with good structural support, NetworkZ implementation proceeded quickly and participants reported rapid cultural change towards improved teamwork and communication in their OTs.

CONCLUSION

Implementation challenges exist and strategies to overcome these are informing future implementation of NetworkZ. Embedding the programme as business as usual across a nation requires significant and sustained support at all levels. However, the potential gains in patient safety and workplace culture from widespread multidisciplinary team training are substantial. Trial registration number ACTRN12617000017325.

Treating the "Not-Invented-Here Syndrome" in Medical Leadership: Learning From the Insights of Outside Disciplines

Physicians are being increasingly called upon to engage in leadership at all levels of modern health organizations, leading many to call for greater research and training interventions regarding physician leadership development. Yet, within these calls to action, the authors note a troubling trend toward siloed, medicine-specific approaches to leadership development and a broad failure to learn from the evidence and insight of other relevant disciplines, such as the organizational sciences. The authors describe how this trend reflects what has been called the "not-invented-here syndrome" (NIHS)-a commonly observed reluctance to adopt and integrate insights from outside disciplines-and highlight the pitfalls of NIHS for effective physician leadership development. Failing to learn from research and interventions in the organizational sciences inhibits physician leadership development efforts, leading to redundant rediscoveries of known insights and reinventions of existing best practices. The authors call for physician leaders to embrace ideas that are "proudly developed elsewhere" and work with colleagues in outside disciplines to conduct collaborative research and develop integrated training interventions to best develop physician leaders who are prepared for the complex, dynamic challenges of modern health care.

Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care

As health care delivery moves toward more complex, team-based systems, the topic of medical teamwork has gained considerable attention and study across disciplines. This systematic review integrates empirical research on teamwork and health care to identify broad trends. We identified and coded 1,818 relevant, English, and peer-reviewed journal articles using a teamwork processes rubric. Several themes emerged. The health care teamwork literature has grown substantially over the past 20 years. Approximately half of the studies were descriptive (rather than interventional or psychometric); the majority relied on quantitative methods. Health care teamwork was also studied in thematically distinct manners. Interpersonal processes were most commonly studied across fields. Of all disciplines, medicine focused most on transition processes, whereas those from team science centered more highly on action processes. There were also finer grained disciplinary differences in content areas of communication and collaboration. Interprofessional journals represent a potential area for interdisciplinary efforts. Implications and future directions are discussed.

Interprofessional Teams: Current Trends and Future Directions

This article addresses the current and desired future state of interprofessional practice in pediatric hospital medicine. It focuses on identifying optimal team composition and work patterns, describing the value of parent involvement on both the patient's care team and on operational teams, describing the need for interprofessional education, and identifying outcomes associated with interprofessional teamwork. The article also identifies challenges and opportunities for growth as interprofessional teamwork increasingly becomes a standard practice within healthcare settings.

A novel tool for evaluating non-cognitive traits of doctor of physical therapy learners in the United States

PURPOSE

The primary aim of this study was to develop a survey addressing an individual's non-cognitive traits, such as emotional intelligence, interpersonal skills, social intelligence, psychological flexibility, and grit. Such a tool would provide beneficial information for the continued development of admissions standards and would help better capture the full breadth of experience and capabilities of applicants applying to doctor of physical therapy (DPT) programs.

METHODS

This was a cross-sectional survey study involving learners in DPT programs at 3 academic institutions in the United States. A survey was developed based on established non-proprietary, non-cognitive measures affiliated with success and resilience. The survey was assessed for face validity, and exploratory factor analysis (EFA) was used to identify subgroups of factors based on responses to the items.

RESULTS

A total of 298 participants (90.3%) completed all elements of the survey. EFA yielded 39 items for dimensional assessment with regression coefficients < 0.4. Within the 39 items, 3 latent constructs were identified: adaptability (16 items), intuitiveness (12 items), and engagement (11 items).

CONCLUSION

This preliminary non-cognitive assessment survey will be able to play a valuable role in DPT admissions decisions following further examination and refinement.