Understanding adaptive teamwork in health care: Progress and future directions

Effectiveness of group work among the final radiography students of the National Diploma

Background

Group work is employed in higher education institutions to foster communication, collaborative learning, leadership qualities and teamwork skills. The rationale behind group work as a learning strategy is to ensure that graduates are equipped with teamwork skills.

Aim

The aim of this study was to establish whether the final-year radiography students of the National Diploma curriculum in three universities in South Africa were exposed to effective group work.

Setting

The study was conducted in three universities in South Africa, all of which offer diagnostic radiography programmes.

Methods

This study used a non-experimental descriptive design to collect data. A purposive sampling technique was used to select participants. This was an attempt to conduct a census on 167 students, out of which 124 students responded to the questionnaire, giving a response rate of 74.25%.

Results

The findings show that the majority (n = 81; 66.9%) of students did not enjoy group work, as 101 (81.5%) of them preferred less group projects. The results further demonstrated that participants rated factors such as co-operation, leadership, choice, diversity and effectiveness of group work neutral on the Likert scale.

Conclusion

The study results imply that factors that contribute towards the effectiveness of group work should be incorporated into group activities in order for student radiographers to be exposed to effective group work. The gaps identified in this study indicate the need for a follow-up study within the current 4-year bachelor's degree in radiography.

Contribution

Identification of a gap in radiography education, which group work needs to be facilitated effectively.

Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study

OBJECTIVE

Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty.

BACKGROUND

The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, and medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE).

METHODS

Audiovisual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box. Human factors researchers retrospectively coded videos for teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, and leadership) by team role under 2 conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs.

RESULTS

In all, 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behavior skills (5.3× increase; 13.9 instances/hour during an IAE vs 2.2 instances/hour when no IAE) while surgeons and medical trainees expressed more psychological safety skills (surgeons: 3.6× increase; 30.0 instances/hour vs 6.6 instances/hour and trainees: 6.6× increase; 31.2 instances/hour vs 4.1 instances/hour). All roles expressed fewer situation assessment skills during an IAE versus no IAE.

CONCLUSIONS

OR Black Box enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened when dealing with IAEs. The knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.

Decoding healthcare teamwork: a typology of hospital teams

The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.

How to enrich team research in healthcare by considering five theoretical perspectives

The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.

No size fits all - a qualitative study of factors that enable adaptive capacity in diverse hospital teams

Introduction

Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. By examining how performance emerges in everyday work in different healthcare settings, the research seeks to receive knowledge of the enablers for adaptive capacity. Hospitals are defined as complex organizations with a large number of actors collaborating on increasingly complexity tasks. Consequently, most of today's work in hospitals is team based. The study aims to explore and describe what kind of team factors enable adaptive capacity in hospital teams.

Methods

The article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation (115 h) and interviews (30), followed by a combined deductive and inductive analysis of the material.

Results

The study identified four main themes of team related factors for enabling adaptive capacity; (1) technology and tools, (2) roles, procedures, and organization of work, (3) competence, experience, knowledge, and learning, (4) team culture and relations.

Discussion

Investigating adaptive capacity in four different types of teams allowed for consideration of a range of team types within healthcare and how the team factors vary within and across these teams. All of the four identified team factors are of importance in enabling adaptive capacity, the various attributes of the respective team types prompt differences in the significance of the different factors and indicates that different types of teams could need diverse types of training, structural and relational emphasis in team composition, leadership, and non-technical skills in order to optimize everyday functionality and adaptive capacity.

Impact of a Care Task Design Program on Novice Nursing Students' Self-Reflection and Insight, Teamwork Skills, and Holistic Nursing Competency

AIM

The aims of this study were to evaluate the effects of a self-appraisal of clinical simulation care tasks in novice nursing students and assess their self-reflection and insight, teamwork skills, and holistic nursing competence in four different periods.

METHOD

A single group pre- and post-test design was conducted. Data were collected between September 2019 and February 2020. Nursing students who participated in the fundamental nursing laboratory courses in the second year of the nursing department at a medical university were invited to participate in the study. Data were collected at four time points using the Self-Reflection and Insight Scale, Holistic Nursing Competence Scale, and the Teamwork Skills Scale. A generalized estimating equation was used for all statistical analyses.

RESULTS

Across the four measurements, the score of self-reflection and insight ranged from 76.68 to 78.00, teamwork skills from 68.83 to 71.21, and holistic nursing competence from 134.48 to 146.46. Student performance was above average on all research variables. The results confirm the hypotheses that the program improves self-reflection and insight, teamwork skills, and holistic nursing competencies in nursing students.

CONCLUSION

These findings suggest that the program can be used to improve students' self-reflection, and it may also help to enhance their teamwork skills and holistic nursing competence.

Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper

Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.

Suggestions for overcoming the barriers to critical thinking in nursing

Nurses strive to provide the best quality of care to their patients in a stressful and constantly changing environment. Critical thinking (CT) could help nurses provide better quality of care to their patients. However, studies have shown that nurses either have low levels of CT or underutilize it during clinical practice. A possible explanation could be that nurses experience barriers during the development and/or utilization of CT. Since CT can be cultivated during university, nurse educators could utilize methods that improve CT. However, nurse educators do not sufficiently develop the CT of their students, since they usually rely on teacher-centered methods and not active learning methods. On the other hand, during clinical practice nurses cope with several barriers that inhibit their ability to use CT, such as: lack of teamwork, high levels of stress, time constraints, and understaffing. All these barriers decrease the utilization of CT and the quality of care that nurses provide. The present commentary suggests a simple strategy that could be used by educators and assist graduate nurses overcome the barriers to utilize CT during clinical practice. This strategy consists of three distinct components, namely: individual, interdisciplinary, and administrative. Each component could be used individually to improve the CT of nurses depending on the available resources and facilities. Nevertheless, educators by improving the CT of nurses could assist them in providing better quality of care.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

OBJECTIVE

To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.

DESIGN

Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.

STUDY SELECTION

In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.

DATA EXTRACTION AND SYNTHESIS

From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.

RESULTS

The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.

CONCLUSIONS

We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Enhancing leadership training in health services - an evidence-based practice-oriented approach

PURPOSE

Globally, private and public organisations invest ever increasing amounts of money, time and effort to develop leadership capabilities in current and future leaders. Whilst such investment results in benefits for some, the full value of developmental strategies on offer is not always realised. Challenges inhibiting achievement of full value include struggling to identify learning programs that best fit with the organisational structure, culture, mission and vision and difficulties in maximising engagement of personnel at multiple levels of the management structure.

DESIGN/METHODOLOGY/APPROACH

The purpose of this study is to introduce a pathway for health services to develop and embed simulation-based educational strategies that provide targeted learning for leaders and teams. Aligning this approach to leadership development through presentation of case studies in which the model has been applied illustrates the pathway for application in the health-care sector.

FINDINGS

The findings of the approach to leadership development are presented through the presentation of a case study illustrating application of the ADELIS model to simulation-based learning.

PRACTICAL IMPLICATIONS

The ADELIS model, outlined in this study, provides a guide for creating customised and flexible learning designs that apply simulation-based learning, enabling organisations to develop and provide leadership training for individuals, units and teams that is appropriately fit for purpose.

ORIGINALITY/VALUE

The key contribution to health-care leadership development offered in this study is the rationale for using simulation-based learning accompanied by a model and pathway for creating such a pedagogical approach, which embraces the reality of workplace circumstances.

A review of the effects of head-worn displays on teamwork for emergency response

Head-Worn Displays (HWD) can potentially support the mobile work of emergency responders, but it remains unclear whether teamwork is affected when emergency responders use HWDs. We reviewed studies that examined HWDs in emergency response contexts to evaluate the impact of HWDs on team performance and on team processes of situation awareness, communication, and coordination. Sixteen studies were identified through manual and systematic literature searches. HWDs appeared to improve the quality of team performance but they increased time to perform under some conditions; effects on team processes were mixed. We identify five challenges to explain the mixed results. We discuss four theoretical perspectives that might address the challenges and guide research needs-joint cognitive systems, distributed cognition, common ground, and dynamical systems. Researchers and designers should use process-based measures and apply greater theoretical guidance to uncover mechanisms by which HWDs shape team processes, and to understand the impact on team performance. Practitioner Summary: This review examines the effects of head-worn displays on teamwork performance and team processes for emergency response. Results are mixed, but study diversity challenges the search for underlying mechanisms. Guidance from perspectives such as joint cognitive systems, distributed cognition, common ground, and dynamical systems may advance knowledge in the area. Abbreviations: HWD: head-worn display; RC: remote collaboration; DD: data display; ARC: augmented remote collaboration; ACC: augmented collocated collaboration; SA: situation awareness; TSA: team situation awareness; CPR: cardiopulmonary resuscitation; SAGAT: situation awareness global assessment technique; SART: situation awareness rating technique.

BRAVE: A Point of Care Adaptive Leadership Approach to Providing Patient-Centric Care in the Emergency Department

The practice of emergency medicine has reached its cross roads. Emergency physicians (EPs) are managing many more time-dependent conditions, initiating complex treatments in the emergency department (ED), handling ethical and end of life care discussions upfront, and even performing procedures which used to be done only in critical care settings, in the resuscitation room. EPs manage a wide spectrum of patients, 24 h a day, which reflects the community and society they practice in. Besides the medical and “technical” issues to handle, they have to learn how to resolve confounding elements which their patients can present with. These may include social, financial, cultural, ethical, relationship, and even employment matters. EPs cannot overlook these, in order to provide holistic care. More and more emphasis is also now given to the social determinants of health. We, from the emergency medicine fraternity, are proposing a unique “BRAVE model,” as a mnemonic to assist in the provision of point of care, adaptive leadership at the bedside in the ED. This represents another useful tool for use in the current climate of the ED, where patients have higher expectations, need more patient-centric resolution and handling of their issues, looming against the background of a more complex society and world.