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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Broski J, Tarver S, Krase K, Petersen S, Wolverton A, Winchester M, Berbel G, Zabel T, Warren H, Lineberry M. Integrating simulation and interpretive description to explore operating room leadership: critical event continuing education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1211-1244. [PMID: 37022534 DOI: 10.1007/s10459-023-10212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event . The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room.
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Affiliation(s)
- Julie Broski
- The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, KS, USA.
| | - Stephen Tarver
- Department of Anesthesiology, Pain and Perioperative Medicine, The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelli Krase
- Department of Obstetrics and Gynecology, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Shariska Petersen
- Department of Obstetrics and Gynecology, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Amy Wolverton
- The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mae Winchester
- Maternal-Fetal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - German Berbel
- Department of Surgery, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taylor Zabel
- Medical Student, Harvard Medical School, Boston, MA, USA
| | - Hannah Warren
- BSN, RN, Cardiovascular Intensive Care Nurse at Heart Hospital of Austin, Austin, Texas, USA
| | - Matthew Lineberry
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Vauk S, Seelandt JC, Huber K, Grande B, Kolbe M. Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. Br J Anaesth 2022; 129:776-787. [PMID: 36075775 DOI: 10.1016/j.bja.2022.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/27/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. METHODS In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling. RESULTS The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%). CONCLUSION Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
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Affiliation(s)
- Stefanie Vauk
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Katja Huber
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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Silverplats J, Strömsöe A, Äng B, Södersved Källestedt ML. Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors—A survey among in-hospital healthcare professionals. PLoS One 2022; 17:e0271686. [PMID: 35839233 PMCID: PMC9286263 DOI: 10.1371/journal.pone.0271686] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Attitudes towards cardiopulmonary resuscitation (CPR) among in-hospital healthcare professionals (HCPs) are poorly understood. The aim of this study was to evaluate attitudes towards CPR situations among in-hospital HCPs and assess associations with potential influencing factors. Materials and methods A questionnaire was distributed to 3,085 HCPs in 2009 and 2,970 HCPs in 2015–2016. The associations of influencing factors were analyzed using binary logistic regression. Results In the event of a possible cardiac arrest situation, 61% of the HCPs would feel confident in their CPR knowledge, 86% would know what to do, and 60% would be able to take command if necessary. In the latest real-life CPR situation, 30% had been worried about making mistakes or causing complications, 57% had been stressed, and 27% had been anxious. A short time since the latest real-life CPR performance and a high number of previous real-life CPR performances were associated with lower odds of worrying about making mistakes/causing complications, lower odds of feeling stressed or anxious, and higher odds of feeling calm. Regardless of previous real-life CPR experience, there were differences in attitudes between groups of professions, where physicians showed increased odds of worrying about making mistakes/causing complications and nurses showed increased odds of stress. Working on a non-monitored ward meant increased odds of stress and worrying about making mistakes/causing complications. Twelve months or more having passed since the latest CPR training course was associated with increased odds of anxiety. Conclusions Despite HCPs’ generally positive attitudes towards performing CPR in the event of a possible cardiac arrest situation, feelings of stress and anxiety were common in real-life CPR situations. Regular CPR training among all HCPs is a key factor to maintain competence and reduce anxiety. The possible effects of attitudes on performing CPR need to be studied further.
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Affiliation(s)
- Jennie Silverplats
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Anaesthesiology and Intensive Care, Region Dalarna, Mora Hospital, Mora, Sweden
- * E-mail:
| | - Anneli Strömsöe
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Prehospital Care, Region Dalarna, Falun, Sweden
| | - Björn Äng
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Post C, De Smet H, Uitdewilligen S, Schreurs B, Leysen J. Participative or Directive Leadership Behaviors for Decision-Making in Crisis Management Teams? SMALL GROUP RESEARCH 2022. [DOI: 10.1177/10464964221087952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assess the relative value of participative and directive leadership for improving the accuracy and speed of decision-making in crisis management teams, contingent on whether teams face an emergency that is familiar or unfamiliar to them. Testing our theory, using randomized experiments, with 72 teams tasked with managing simulated crises, we found that participative leadership improves decision accuracy in unfamiliar emergencies, whereas directive leadership improves accuracy in familiar crises; directive leadership produces speedier decisions than participative leadership when the team is familiar with the crisis. We discuss implications of our findings for leaders and crisis management experts.
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Affiliation(s)
| | - Hans De Smet
- Belgian Royal Military Academy, Brussels, Belgium
| | | | | | - Jan Leysen
- Belgian Royal Military Academy, Brussels, Belgium
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Hochstrasser SR, Amacher SA, Tschan F, Semmer NK, Becker C, Metzger K, Hunziker S, Marsch S. Gender-focused training improves leadership of female medical students: A randomised trial. MEDICAL EDUCATION 2022; 56:321-330. [PMID: 34473373 PMCID: PMC9291895 DOI: 10.1111/medu.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Recent research suggests that the gender of health care providers may affect their medical performance. This trial investigated (1) the effects of the gender composition of resuscitation teams on leadership behaviour of first responders and (2) the effects of a brief gender-specific instruction on leadership behaviour of female first responders. METHODS This prospective randomised single-blinded trial, carried out between 2008 and 2016, included 364 fourth-year medical students of two Swiss universities. One hundred and eighty-two teams of two students each were confronted with a simulated cardiac arrest, occurring in the presence of a first responder while a second responder is summoned to help. The effect of gender composition was assessed by comparing all possible gender-combinations of first and second responders. The gender-specific instruction focused on the importance of leadership, gender differences in self-esteem and leadership, acknowledgement of unease while leading, professional role, and mission statement to lead was delivered orally for 10 min by a staff physician and tested by randomising female first responders to the intervention group or the control group. The primary outcome, based on ratings of video-recorded performance, was the first responders' percentage contribution to their teams' leadership statements and critical treatment decision making. RESULTS Female first responders contributed significantly less to leadership statements (53% vs. 76%; P = 0.001) and critical decisions (57% vs. 76%; P = 0.018) than male first responders. For critical treatment decisions, this effect was more pronounced (P = 0.007) when the second responder was male. The gender-specific intervention significantly increased female first responder's contribution to leadership statements (P = 0.024) and critical treatment decisions (P = 0.034). CONCLUSIONS Female first responders contributed less to their rescue teams' leadership and critical decision making than their male colleagues. A brief gender-specific leadership instruction was effective in improving female medical students' leadership behaviours.
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Affiliation(s)
- Seraina Rahel Hochstrasser
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Simon Adrian Amacher
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Franziska Tschan
- Department of PsychologyUniversity of NeuchatelNeuchatelSwitzerland
| | | | - Christoph Becker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Kerstin Metzger
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
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Maarseveen OECV, Ham WHW, Huijsmans RLN, Leenen LPH. The pace of a trauma resuscitation: experience matters. Eur J Trauma Emerg Surg 2022; 48:2503-2510. [PMID: 35141771 PMCID: PMC9192480 DOI: 10.1007/s00068-021-01838-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
Purpose Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472–813) vs 852 s (IQR 694–1256); p 0.01 resp. median 1280 s (IQR 979–1494) vs 1535 s (IQR 1247–1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: – 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
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Affiliation(s)
- Oscar E C van Maarseveen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Wietske H W Ham
- Emergency Department, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Nursing Studies, University of Applied Science, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Roel L N Huijsmans
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Janssens S, Simon R, Beckmann M, Marshall S. Shared Leadership in Healthcare Action Teams: A Systematic Review. J Patient Saf 2021; 17:e1441-e1451. [PMID: 29870514 DOI: 10.1097/pts.0000000000000503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.
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Qiao W, Yan Z, Wang X. Join or not: The impact of physicians’ group joining behavior on their online demand and reputation in online health communities. Inf Process Manag 2021. [DOI: 10.1016/j.ipm.2021.102634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pasarakonda S, Grote G, Schmutz JB, Bogdanovic J, Guggenheim M, Manser T. A Strategic Core Role Perspective on Team Coordination: Benefits of Centralized Leadership for Managing Task Complexity in the Operating Room. HUMAN FACTORS 2021; 63:910-925. [PMID: 32119581 DOI: 10.1177/0018720820906041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We examine whether surgical teams can handle changes in task requirements better when their formal leader and strategic core role holder-that is, the main surgeon-is central to team coordination. BACKGROUND Evidence regarding the benefits of shared leadership for managing complex tasks is divided. We tested whether a strategic core role holder's centrality in team coordination helps teams to handle different types of task complexity. METHOD We observed coordination as specific leadership behavior in 30 surgical teams during real-life operations. To assess the strategic core role holder's coordination centrality, we conducted social network analyses. Task complexity (i.e., surgical difficulty and unexpected events) and surgical goal attainment were rated in a questionnaire. RESULTS In the critical operation phase, surgical difficulty impaired goal attainment when the strategic core role holder's coordination centrality was low, while this effect was nonsignificant when his/her coordination centrality was high. Unexpected events had a negative effect on surgical goal attainment. However, coordination centrality of the strategic core role holder could not help manage unexpected events. CONCLUSION The results indicate that shared leadership is not beneficial when teams face surgical difficulty during the critical operation phase. In this situation, team coordination should rather be centralized around the strategic core role holder. Contrarily, when unexpected events occur, centralizing team coordination around a single leader does not seem to be beneficial for goal attainment. APPLICATION Leaders and team members should be aware of the importance of distributing leadership differently when it comes to managing different types of task complexity.
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Affiliation(s)
| | | | | | | | | | - Tanja Manser
- 30805 University of Applied Science and Arts Northwestern Switzerland, Olten, Switzerland
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Leenstra NF, Jung OC, Cnossen F, Jaarsma ADC, Tulleken JE. Development and Evaluation of the Taxonomy of Trauma Leadership Skills-Shortened for Observation and Reflection in Training: A Practical Tool for Observing and Reflecting on Trauma Leadership Performance. Simul Healthc 2021; 16:37-45. [PMID: 32732816 PMCID: PMC7850591 DOI: 10.1097/sih.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Trauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training. METHODS In 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised. RESULTS The resultant "TTLS-Shortened for Observation and Reflection in Training" was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors. CONCLUSIONS The TTLS-Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.
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Burtscher MJ, Nussbeck FW, Sevdalis N, Gisin S, Manser T. Coordination and Communication in Healthcare Action Teams. SWISS JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1024/1421-0185/a000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Communication and coordination represent central processes in healthcare action teams. However, we have a limited understanding of how expertise affects these processes and to what extent these effects are shaped by interprofessional differences. The current study addresses these questions by jointly investigating the influence of different aspects of expertise – individual expertise, team familiarity, and expertise asymmetry – on coordination quality and communication openness. We tested our propositions in two hospitals: one in Switzerland (CH, Sample 1) and one in the United Kingdom (UK, Sample 2). Both samples included two-person anesthesia action teams consisting of a physician and a nurse ( NCH = 47 teams, NUK = 48 teams). We used a correlational design with two measurement points (i.e., pre- and postoperation). To consider potential interprofessional differences, we analyzed our data with actor-partner interdependence models. Moreover, we explored differences in the effects of expertise between both hospitals. Our findings suggest that nurses’ expertise is the most important predictor of coordination quality and communication openness. Overall, differences between the two hospitals were more prevalent than interprofessional differences between physicians and nurses. The current study provides a nuanced picture of the effects of expertise, and thereby extends our understanding of interprofessional teamwork.
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Affiliation(s)
- Michael J. Burtscher
- Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
- University of Zurich, Switzerland
| | | | - Nick Sevdalis
- Health Service and Population Research Department, King’s College London, United Kingdom
| | - Stefan Gisin
- Department of Anesthesiology, University Hospital Basel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland Olten, Switzerland
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Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C, Schuetz P, Marsch S, Hunziker S. Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care 2020; 63:223-230. [PMID: 33046274 DOI: 10.1016/j.jcrc.2020.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary resuscitation represents a major physical and psychological challenge for all involved health care workers because survival of the patients is closely related to the timely and accurate actions of rescuers. Consequently, rescuers may experience high levels of acute mental stress. Stress, in turn, may influence attentional resources and distractibility, which may affect the quality of resuscitation. This narrative review summarizes the current state of research concerning the influence of stress on resuscitation performance. Peer-reviewed studies retrieved in scientific databases were eligible. We found that rescuers experience high levels of stress and some associations of higher levels of stress with lower resuscitation performance. Finally, few interventional studies assessed whether interventions aiming at reducing levels of stress may have a beneficial effect on resuscitation performance, but results are variable. Although the mechanisms linking stress to performance of emergency teams are still not fully understood, factors such as individual experience and self-confidence of rescuers, gender composition and hierarchy within resuscitation teams may play an important role. This review provides a targeted overview of how stress can be defined and measured, how it may influence emergency situations such as a cardiopulmonary resuscitation, and which interventions have the potential to reduce overwhelming stress.
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Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Franziska Tschan
- Department of Psychology, University of Neuchâtel, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Cora Bobst
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Haus 7, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland.
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Hazwani TR, Harder N, Shaheen NA, Al Hassan Z, Antar M, Alshehri A, Alali H, Kazzaz YM. Effect of a Pediatric Mock Code Simulation Program on Resuscitation Skills and Team Performance. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hautz SC, Oberholzer DL, Freytag J, Exadaktylos A, Kämmer JE, Sauter TC, Hautz WE. An observational study of self-monitoring in ad hoc health care teams. BMC MEDICAL EDUCATION 2020; 20:201. [PMID: 32576185 PMCID: PMC7313223 DOI: 10.1186/s12909-020-02115-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. METHODS We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. RESULTS 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders' evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. CONCLUSION Team members seem to have better insight into their team's teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders.
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Affiliation(s)
- Stefanie C Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Daniel L Oberholzer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Julia Freytag
- Simulated Patient Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Max Planck Institute for Human Development, Center for Adaptive Rationality (ARC), Lentzeallee 94, 14195, Berlin, Germany
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland
- Lernzentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital Bern, Freiburgstrasse 16c, 3010, Bern, Switzerland.
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Krenz H, Burtscher MJ, Grande B, Kolbe M. Nurses’ voice: the role of hierarchy and leadership. Leadersh Health Serv (Bradf Engl) 2020. [DOI: 10.1108/lhs-07-2019-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Voicing concerns and suggestions is crucial for preventing medical errors and improving patient safety. Research suggests that hierarchy in health-care teams impair open communication. Hierarchy, however, can vary with changing team composition, particularly during acute care situations where more senior persons join the team later on. The purpose of this study is to investigate how changes in hierarchy and leadership were associated with nurses’ voice frequency and nurses’ time to voice during simulated acute care situations.
Design/methodology/approach
This study’s sample consisted of 78 health-care providers (i.e. nurses, residents and consultants) who worked in 39 teams performing complex clinical scenarios in the context of interprofessional, simulation-based team training. Scenarios were videotaped and communication behaviour was coded using a systematic coding scheme. To test the hypotheses, multilevel regression analyses were conducted.
Findings
Hierarchy and leadership had no significant effect on nurses’ voice frequency. However, there were significant relationships between nurses’ time to voice and both hierarchy (γ = 30.00, p = 0.002; 95 per cent confidence interval [CI] = 12.43; 47.92) as well as leadership (γ = 0.30, p = 0.001; 95 per cent CI = 0.12; 0.47). These findings indicate that when more physicians are present and leadership is more centralised, more time passes until the first nurses’ voice occurred.
Originality/value
This study specifies previous findings on the relationships between hierarchy, leadership and nurses’ voice. Our findings suggest that stronger hierarchy and more centralised leadership delay nurses’ voice but do not affect the overall frequency of voice.
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Keunecke JG, Gall C, Birkholz T, Moritz A, Eiche C, Prottengeier J. Workload and influencing factors in non-emergency medical transfers: a multiple linear regression analysis of a cross-sectional questionnaire study. BMC Health Serv Res 2019; 19:812. [PMID: 31699084 PMCID: PMC6836439 DOI: 10.1186/s12913-019-4638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/14/2019] [Indexed: 11/11/2022] Open
Abstract
Background Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics’ workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number. Methods Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload. Results A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient’s body weight and the transfer of patients with transmittable pathogens. Conclusion The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.
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Affiliation(s)
- Johann Georg Keunecke
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Birkholz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Moritz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Eiche
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Prottengeier
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
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18
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Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019; 9:e028280. [PMID: 31515415 PMCID: PMC6747874 DOI: 10.1136/bmjopen-2018-028280] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
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Affiliation(s)
- Jan B Schmutz
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | - Laurenz L Meier
- Department of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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19
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Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
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20
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Tschan F, Semmer NK, Vetterli M, Hunziker PR, Marsch SC. Predicting team-performance and leadership in emergency situations by observing standardised operational procedures: a prospective single-blind simulator-based trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 5:102-107. [DOI: 10.1136/bmjstel-2018-000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
BackgroundPerformance of interdisciplinary teams and their leaders is crucial in acute medical care and can be monitored by observing specific events. Standardised operational procedures (SOP) are easily observable, whereas the unpredictability of medical emergencies makes performance monitoring in these situations difficult. The aim of this study was therefore to assess whether performance in emergency situations can be predicted by performance observed during an SOP.Methods30 intensive care unit teams composed of one staff physician (leader), one resident and three nurses performed a simulated scenario of an elective electrical cardioversion (SOP) followed by a cardiac arrest (emergency). Video recordings obtained during simulations were used for data analysis. The primary outcome was the correlation between performance scores of electrical cardioversion and performance during cardiopulmonary resuscitation (hands-on time, time to first defibrillation).ResultsNone of the cardioversion performance scores significantly correlated with resuscitation performance. Leadership scores during electrical cardioversion correlated positively with leadership scores during cardiopulmonary resuscitation (r=0.365, p=0.047). Moreover, there was a positive correlation of leaders being hands-off during both electrical cardioversion and cardiopulmonary resuscitation (r=0.645, p<0.0001).ConclusionsTeam performance in SOP carried no predictive value for emergency situations. Observing teams in easily observable SOP is therefore no suitable substitute for monitoring the performance in medical emergencies. There was a between-situation consistency for specific elements of leadership.
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21
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Freytag J, Stroben F, Hautz WE, Schauber SK, Kämmer JE. Rating the quality of teamwork-a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies. Scand J Trauma Resusc Emerg Med 2019; 27:12. [PMID: 30736821 PMCID: PMC6368771 DOI: 10.1186/s13049-019-0591-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. Methods Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources. Results Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores. Conclusions Experts’ and novices’ ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0591-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Freytag
- Simulated Patients Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Stroben
- Lernzentrum, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.,Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Stefan K Schauber
- Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Juliane E Kämmer
- AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
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22
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Gabr AK. The importance of nontechnical skills in leading cardiopulmonary resuscitation teams. J R Coll Physicians Edinb 2019; 49:112-116. [DOI: 10.4997/jrcpe.2019.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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23
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Herre C, Klumb P, Schaffner J. One Best Way? Leader Behavior and Different Aspects of Team Performance. ZEITSCHRIFT FUR ARBEITS-UND ORGANISATIONSPSYCHOLOGIE 2019. [DOI: 10.1026/0932-4089/a000286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. In two experiments, we tested differential effects of transformational, empowering, and task-oriented leader behavior on various aspects of team performance (quantity, quality, independence, subjective group performance) using three different tasks. In Experiment 1, 60 three-person teams completed a rank-order task and in Experiment 2, 54 three-person teams completed a construction and an information-search task. In both experiments, a videotaped team leader displayed transformational, empowering, or task-oriented leadership. Results suggested that leadership effectiveness may be a function of group outcome. Only for the tasks of Experiment 2 did transformational leadership result in superior outcomes, specifically regarding productivity and originality. Empowering leadership, in turn, yielded superior outcomes in terms of leader-independent thinking, while task-oriented leadership resulted in the highest subjective group performance ratings – except for the ranking task in which satisfaction ratings were highest for transformational leadership. Implications for research and practice are discussed.
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Affiliation(s)
| | - Petra Klumb
- Departement of Psychology, University of Fribourg
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24
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Burtscher MJ, Jordi Ritz EM, Kolbe M. Differences in talking-to-the-room behaviour between novice and expert teams during simulated paediatric resuscitation: a quasi-experimental study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:165-170. [PMID: 35519005 PMCID: PMC8936681 DOI: 10.1136/bmjstel-2017-000268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/03/2022]
Abstract
Background Team coordination represents an important factor for clinical performance. Research in this area suggests that not only behaviour frequencies but also patterns of team coordination constitute a central aspect of teamwork. However, little is known about potential differences in coordination patterns between novice teams (ie, teams of inexperienced members) and expert teams (ie, teams of experienced members). The current study addresses this gap by investigating the use of talking-to-the-room-an important implicit coordination behaviour-in novice teams versus expert teams. Aim To illustrate differences in coordination behaviour between novice and expert teams. This will provide important knowledge for simulation-based training. Methods The study was conducted in the context of two resuscitation training courses (introductory course and refresher course) for staff members at a children's hospital. Volunteers from both courses participated in the study. They were randomly assigned to 16 teams each consisting of one physician and two nurses. The study used a quasi-experimental design with two conditions (novice vs expert). Participants of the introductory course were assigned to the novice condition (eight teams), and participants of the refresher course were assigned to the expert condition (eight teams). All teams completed the same standardised paediatric resuscitation scenario. They were videotaped during the simulation, and team coordination behaviour was coded using Co-ACT. Results Lag-sequential analysis of 1902 distinct coordination acts revealed that novice teams and expert teams differed significantly in their coordination behaviour. Expert teams were characterised by patterns in which implicit coordination behaviour (ie, talking to the room) was followed by further implicit coordination behaviour and not followed by explicit coordination behaviour (ie, instructions), whereas the reverse was found for novice teams. Conclusion The current study highlights role of coordination patterns for understanding teamwork in healthcare and provides important insights for team training.
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Affiliation(s)
| | - Eva-Maria Jordi Ritz
- Department of Anaesthesiology, University Children's Hospital Basel, Basel, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
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25
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Hunziker S, O'Connell KJ, Ranniger C, Su L, Hochstrasser S, Becker C, Naef D, Carter E, Stockwell D, Burd RS, Marsch S. Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial. J Crit Care 2018; 48:72-77. [PMID: 30172964 DOI: 10.1016/j.jcrc.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland.
| | | | - Claudia Ranniger
- Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University, Washington, DC, United States
| | - Lillian Su
- Children's National Medical Center, Washington, DC, United States
| | - Seraina Hochstrasser
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Becker
- Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Daryl Naef
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Elizabeth Carter
- Children's National Medical Center, Washington, DC, United States
| | - David Stockwell
- Patient Safety and the Pediatric Intensive Care Unit, Children's National Medical Center, Washington, DC, United States
| | - Randall S Burd
- Children's National Medical Center, Department of Surgery, Washington, DC, United States
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland
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Führen optimierte Teamarbeit und Führungsverhalten zu besseren Reanimationsergebnissen? Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Seelandt JC, Grande B, Kriech S, Kolbe M. DE-CODE: a coding scheme for assessing debriefing interactions. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:51-58. [PMID: 35515884 PMCID: PMC8990183 DOI: 10.1136/bmjstel-2017-000233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/03/2022]
Abstract
Debriefings are crucial for learning during simulation-based training (SBT). Although the quality of debriefings is very important for SBT, few studies have examined actual debriefing conversations. Investigating debriefing conversations is important for identifying typical debriefer-learner interaction patterns, obtaining insights into associations between debriefers' communication and learners' reflection and comparing different debriefing approaches. We aim at contributing to the science of debriefings by developing DE-CODE, a valid and reliable coding scheme for assessing debriefers' and learners' communication in debriefings. It is applicable for both direct, on-site observations and video-based coding. Methods The coding scheme was developed both deductively and inductively from literature on team learning and debriefing and observing debriefings during SBT, respectively. Inter-rater reliability was calculated using Cohen's kappa. DE-CODE was tested for both live and video-based coding. Results DE-CODE consists of 32 codes for debriefers' communication and 15 codes for learners' communication. For live coding, coders achieved good inter-rater reliabilities with the exception of four codes for debriefers' communication and two codes for learners' communication. For video-based coding, coders achieved substantial inter-rater reliabilities with the exception of five codes for debriefers' communication and three codes for learners' communication. Conclusion DE-CODE is designed as micro-level measurement tool for coding debriefing conversations applicable to any debriefing of SBT in any field (except for the code medical input). It is reliable for direct, on-site observations as well as for video-based coding. DE-CODE is intended to allow for obtaining insights into what works and what does not work during debriefings and contribute to the science of debriefing.
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Affiliation(s)
- Julia C Seelandt
- Quality Management and Patient Safety, University Hospital Zurich, Zurich, Switzerland
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Kriech
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- ETH Zurich, Zurich, Switzerland
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The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments. Emerg Med Clin North Am 2017; 36:1-17. [PMID: 29132571 DOI: 10.1016/j.emc.2017.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Resilience is built, not born, and there is no single strategy that reliably manufactures resilient performance in all circumstances. Optimizing team performance in dynamic environments involves the complex interplay of strategies that target individual preparation, team interaction, environmental optimization, and systems-level resilience engineering. To accomplish this, health care can draw influence from human factors research to inform tangible, practical, and measurable improvements in performance and outcomes, modified to suit local and domain-specific needs.
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Buengeler C, Klonek F, Lehmann-Willenbrock N, Morency LP, Poppe R. Killer Apps: Developing Novel Applications That Enhance Team Coordination, Communication, and Effectiveness. SMALL GROUP RESEARCH 2017; 48:591-620. [PMID: 28989264 PMCID: PMC5607933 DOI: 10.1177/1046496417721745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As part of the Lorentz workshop, “Interdisciplinary Insights into Group and Team Dynamics,” held in Leiden, Netherlands, this article describes how Geeks and Groupies (computer and social scientists) may benefit from interdisciplinary collaboration toward the development of killer apps in team contexts that are meaningful and challenging for both. First, we discuss interaction processes during team meetings as a research topic for both Groupies and Geeks. Second, we highlight teamwork in health care settings as an interdisciplinary research challenge. Third, we discuss how an automated solution for optimal team design could benefit team effectiveness and feed into team-based interventions. Fourth, we discuss team collaboration in massive open online courses as a challenge for both Geeks and Groupies. We argue for the necessary integration of social and computational research insights and approaches. In the hope of inspiring future interdisciplinary collaborations, we develop criteria for evaluating killer apps—including the four proposed here—and discuss future research challenges and opportunities that potentially derive from these developments.
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Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study. Crit Care Med 2017. [PMID: 28622215 DOI: 10.1097/ccm.0000000000002375] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance. DESIGN Prospective, randomized simulator study. SETTING High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland). SUBJECTS Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition. CONCLUSIONS We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.
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Su L, Kaplan S, Burd R, Winslow C, Hargrove A, Waller M. Trauma resuscitation: can team behaviours in the prearrival period predict resuscitation performance? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:106-110. [DOI: 10.1136/bmjstel-2016-000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/04/2022]
Abstract
BackgroundOptimising team performance is critical in paediatric trauma resuscitation. Previous studies in aviation and surgery link performance to behaviours in the prearrival period.ObjectiveTo determine if patterns of human behaviour in the prearrival period of a simulated trauma resuscitation is predictive of resuscitation performance.DesignTwelve volunteer trauma teams performed in four simulation scenarios in a paediatric hospital. The scenarios were video recorded, transcribed and analysed in 10-second intervals. Variation in the amount of utterances per team member in the prearrival period was compared with team performance and implicit coordination during the resuscitation.Key resultsCoders analysed 18 962 s of video. They coded 5204 team member utterances into one of eight communication behaviour categories. Inter-rater reliability was excellent (an average of 83.1% across all four scenarios). The average number of communications occurring during the prearrival period was 18.84 utterances, with a range of 2–42 and a SD of 9.55. The average length of this period was almost 2 minutes (mean =117.30 s, SD=39.20). Lower variance in team member communication during the prearrival better was associated with better implicit coordination (p=0.011) but not team performance (p=0.054) during the resuscitation.ConclusionPatterns of communication in the prearrival trauma resuscitation period predicted implicit coordination and a trend towards significance for team performance which suggests further studies in such patterns are warranted.
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Seelandt J, Grande B, Kolbe M. Implizite Führungstheorien in Akutsituationen im Gesundheitswesen. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2017. [DOI: 10.1007/s11612-017-0356-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW The contribution of qualitative methods to evidence-based medicine is growing, with qualitative studies increasingly used to examine patient experience and unsafe organizational cultures. The present review considers qualitative research recently conducted on teamwork and organizational culture in the ICU and also other acute domains. RECENT FINDINGS Qualitative studies have highlighted the importance of interpersonal and social aspects of healthcare on managing and responding to patient care needs. Clear/consistent communication, compassion, and trust underpin successful patient-physician interactions, with improved patient experiences linked to patient safety and clinical effectiveness across a wide range of measures and outcomes. Across multidisciplinary teams, good communication facilitates shared understanding, decision-making and coordinated action, reducing patient risk in the process. SUMMARY Qualitative methods highlight the complex nature of risk management in hospital wards, which is highly contextualized to the demands and resources available, and influenced by multilayered social contexts. In addition to augmenting quantitative research, qualitative investigations enable the investigation of questions on social behaviour that are beyond the scope of quantitative assessment alone. To develop improved patient-centred care, health professionals should therefore consider integrating qualitative procedures into their existing assessments of patient/staff satisfaction.
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Welp A, Manser T. Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review. BMC Health Serv Res 2016; 16:281. [PMID: 27430287 PMCID: PMC4950091 DOI: 10.1186/s12913-016-1535-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review. METHODS We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes. RESULTS The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked. CONCLUSION Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety.
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Affiliation(s)
- Annalena Welp
- Industrial Psychology and Human Factors, Department of Psychology, University of Fribourg, Rue Faucigny 2, 1700, Fribourg, Switzerland
| | - Tanja Manser
- Institute for Patient Safety, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany. .,Department of Management, Technology & Economics, ETH Zurich, Weinbergstrasse 56/58, 8092, Zurich, Switzerland.
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Renna TD, Crooks S, Pigford AA, Clarkin C, Fraser AB, Bunting AC, Bould MD, Boet S. Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study. J Interprof Care 2016; 30:582-90. [PMID: 27294389 DOI: 10.1080/13561820.2016.1179271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the "real life" applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.
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Affiliation(s)
- Tania Di Renna
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | - Simone Crooks
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | - Ashlee-Ann Pigford
- b Department of Anesthesiology , The Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
| | - Chantalle Clarkin
- c The Children's Hospital of Eastern Ontario Research Institute , Ottawa , Ontario , Canada
| | - Amy B Fraser
- a Department of Anesthesiology , The Ottawa Hospital , Ottawa , Ontario , Canada
| | | | - M Dylan Bould
- e Department of Anesthesiology and Department of Innovation in Medical Education , Children's Hospital of Eastern Ontario , Ottawa , Ontario , Canada
| | - Sylvain Boet
- f Department of Anesthesiology and Department of Innovation in Medical Education , The Ottawa Hospital , Ottawa , Ontario , Canada
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Kozlowski SW, Mak S, Chao GT. Team-Centric Leadership: An Integrative Review. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2016. [DOI: 10.1146/annurev-orgpsych-041015-062429] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This integrative review focuses on leadership in the context of work groups and teams: team-centric leadership. Although the process of leadership is largely viewed as one of social influence, most theories of leadership are agnostic about the social units and context within which it occurs. The review examines recent research on mainstream leadership theories—transformational leadership and leader-member exchange—that have contextualized leadership in work teams and also on team-centric leadership theories—shared and functional leadership—that are explicitly team centric. For each theory, we examine its conceptualization and evolution, how well it maps to the input-process-output heuristic of team effectiveness (including moderators indicative of the context, process dynamics, and feedback loops), and the quality of research methods that are employed. The discussion concludes with 14 recommendations designed to advance each type of team-centric leadership and to promote more integration and synergy across the approaches in future research.
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Affiliation(s)
| | | | - Georgia T. Chao
- Department of Management, Michigan State University, East Lansing, Michigan 48824
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Kobras M, Langewand S, Murr C, Neu C, Schmid J. Short lessons in basic life support improve self-assurance in performing cardiopulmonary resuscitation. World J Emerg Med 2016; 7:255-262. [PMID: 27942341 DOI: 10.5847/wjem.j.1920-8642.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are several reasons why resuscitation measures may lead to inferior results: difficulties in team building, delayed realization of the emergency and interruption of chest compression. This study investigated the outcome of a new form of in-hospital cardiopulmonary resuscitation (CPR) training with special focus on changes in self-assurance of potential helpers when faced with emergency situations. METHODS Following a 12-month period of CPR training, questionnaires were distributed to participants and non-participants. Those non-participants who intended to undergo the training at a later date served as control group. RESULTS The study showed that participants experienced a significant improvement in self-assurance, compared with their remembered self-assurance before the training. Their self-assurance also was significantly greater than that of the control group of non-participants. CONCLUSION Short lessons in CPR have an impact on the self-assurance of medical and non-medical personnel.
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Affiliation(s)
- Mario Kobras
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Western Clinical Centre, 20 Suurheid, City of Hamburg 22559, Federal Republic of Germany
| | - Sascha Langewand
- Academy of the Rescue Service Cooperation in Schleswig-Holstein, 50 Esmarch Street, City of Heide 25746, Federal Republic of Germany
| | - Christina Murr
- Academy of the Rescue Service Cooperation in Schleswig-Holstein, 50 Esmarch Street, City of Heide 25746, Federal Republic of Germany
| | - Christiane Neu
- Regio Clinical Center GmbH, Sana Group, 71-75 Ramskamp, Elmshorn 25337, County of Pinneberg, Federal Republic of Germany
| | - Jeannette Schmid
- Executive Committee of the Goethe University, Frankfurt a.M., City of Frankfurt 60323, Federal Republic of Germany
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Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial. Resuscitation 2015; 96:142-7. [PMID: 26234894 DOI: 10.1016/j.resuscitation.2015.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/12/2015] [Accepted: 07/19/2015] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial. METHODS 119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144s in the 2 min teams and 4-6 cycles in the fivex30:2 teams). RESULTS 22/62 (35%) of the "two minutes" teams and 48/57 (84%) of the "five×30:2″ teams provided CPR within a range of ± 20% of their instructed target (P<0.0001). The median time of CPR prior to rhythm check was 91s and 87s, respectively, (P=0.59) with a significant larger variance (P=0.023) in the "two minutes" group. CONCLUSIONS This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable.
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Fernandez Castelao E, Boos M, Ringer C, Eich C, Russo SG. Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study. BMC MEDICAL EDUCATION 2015; 15:116. [PMID: 26205962 PMCID: PMC4526177 DOI: 10.1186/s12909-015-0389-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. METHODS Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). RESULTS CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023). CONCLUSION Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
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Affiliation(s)
- Ezequiel Fernandez Castelao
- Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany.
| | - Margarete Boos
- Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany.
| | - Christiane Ringer
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | - Sebastian G Russo
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
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Cortegiani A, Russotto V, Montalto F, Iozzo P, Palmeri C, Raineri SM, Giarratano A. Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study. PLoS One 2015; 10:e0125685. [PMID: 25955760 PMCID: PMC4425679 DOI: 10.1371/journal.pone.0125685] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 03/21/2015] [Indexed: 11/18/2022] Open
Abstract
High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge) and an objective section (measuring level of knowledge) containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test) with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2) than in group C (mean 65.5, SD 14.3), p = 0.0017, 95% C.I. 3.34 - 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22-5.99) and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13-6.53). Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074). A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079). HFS showed a beneficial effect on knowledge of ALS among medical students, especially for notions of algorithms and team working/early warning scores/communication.
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Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
- * E-mail:
| | - Vincenzo Russotto
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
| | - Francesca Montalto
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
| | - Pasquale Iozzo
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
| | - Cesira Palmeri
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Intensive Care and Emergency, Policlinico “P. Giaccone”, University of Palermo, Palermo, Italy
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Buljac-Samardzic M, van Woerkom M. Can managers coach their teams too much? JOURNAL OF MANAGERIAL PSYCHOLOGY 2015. [DOI: 10.1108/jmp-12-2012-0380] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The relationship between managerial coaching and team performance may be mediated by team reflection because coaching is often thought to lead to reflection, which has been found to lead to improved performance. In contrast, this relationship might be moderated by team reflection, because poorly reflective teams are more likely to depend on coaching than highly reflective teams. The purpose of this paper is to test these rival hypotheses.
Design/methodology/approach
– The authors employed a longitudinal survey method at two points in time in two long-term care organizations. Team members were asked to rate the level of managerial coaching and team reflection. Team managers were asked to evaluate team performance.
Findings
– Team reflection turned out to be a moderator and not a mediator in the relationship between managerial coaching and team performance. Only the performance of poorly reflective teams benefits from managerial coaching.
Practical implications
– Excessive coaching of highly reflective teams may be a waste of the energy and time of both managers and teams and may even harm team efficiency. Therefore, team managers would be wise to estimate the team’s level of reflection in order to adjust their coaching interventions accordingly. Future research should explore how managers can be supported in making a valid assessment of the team’s reflective capabilities and in adjusting their coaching interventions accordingly.
Originality/value
– This paper sheds light on the relationship between managerial coaching and team performance by testing contradicting explanations regarding the role of team reflection.
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Ballangrud R, Persenius M, Hedelin B, Hall-Lord ML. Exploring intensive care nurses' team performance in a simulation-based emergency situation, - expert raters' assessments versus self-assessments: an explorative study. BMC Nurs 2014; 13:47. [PMID: 25606023 PMCID: PMC4299298 DOI: 10.1186/s12912-014-0047-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/09/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual's technical skills and too little on the teams' performance of non-technical skills. The aim of the study was to explore intensive care nurses' team performance in a simulation-based emergency situation by using expert raters' assessments and nurses' self-assessments in relation to different intensive care specialties. METHODS The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams' performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann-Whitney U tests, Spearman's rho and Intraclass Correlation Coefficient Type III. RESULTS The expert raters assessed the teams' performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters' assessments and the registered nurses' self-assessments. CONCLUSIONS Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters' assessments and registered nurses' self-assessments are useful in raising awareness of team performance with regard to patient safety.
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Affiliation(s)
- Randi Ballangrud
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
| | - Mona Persenius
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
| | - Birgitta Hedelin
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
| | - Marie Louise Hall-Lord
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
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Kolehmainen C, Brennan M, Filut A, Isaac C, Carnes M. Afraid of being "witchy with a 'b'": a qualitative study of how gender influences residents' experiences leading cardiopulmonary resuscitation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1276-81. [PMID: 24979289 PMCID: PMC4146658 DOI: 10.1097/acm.0000000000000372] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Ineffective leadership during cardiopulmonary resuscitation ("code") can negatively affect a patient's likelihood of survival. In most teaching hospitals, internal medicine residents lead codes. In this study, the authors explored internal medicine residents' experiences leading codes, with a particular focus on how gender influences the code leadership experience. METHOD The authors conducted individual, semistructured telephone or in-person interviews with 25 residents (May 2012 to February 2013) from 9 U.S. internal medicine residency programs. They audio recorded and transcribed the interviews and then thematically analyzed the transcribed text. RESULTS Participants viewed a successful code as one with effective leadership. They agreed that the ideal code leader was an authoritative presence; spoke with a deep, loud voice; used clear, direct communication; and appeared calm. Although equally able to lead codes as their male colleagues, female participants described feeling stress from having to violate gender behavioral norms in the role of code leader. In response, some female participants adopted rituals to signal the suspension of gender norms while leading a code. Others apologized afterwards for their counternormative behavior. CONCLUSIONS Ideal code leadership embodies highly agentic, stereotypical male behaviors. Female residents employed strategies to better integrate the competing identities of code leader and female gender. In the future, residency training should acknowledge how female gender stereotypes may conflict with the behaviors required to enact code leadership and offer some strategies, such as those used by the female residents in this study, to help women integrate these dual identities.
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Affiliation(s)
- Christine Kolehmainen
- Dr. Kolehmainen is a physician, William S. Middleton Memorial Veteran's Hospital, and clinical adjunct assistant professor, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Dr. Brennan is a women's health fellow, William S. Middleton Memorial Veteran's Hospital, and clinical instructor, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Ms. Filut is research assistant, Center for Women's Health Research, University of Wisconsin, Madison, Wisconsin. Dr. Isaac is assistant professor in research, Mercer University, Atlanta, Georgia. Dr. Carnes is professor of medicine, psychiatry, and industrial and systems engineering and director, Center for Women's Health Research, University of Wisconsin, and director of women veterans health, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Rasmussen MB, Tolsgaard MG, Dieckmann P, Issenberg SB, Ostergaard D, Søreide E, Rosenberg J, Ringsted CV. Factors relating to the perceived management of emergency situations: a survey of former Advanced Life Support course participants' clinical experiences. Resuscitation 2014; 85:1726-31. [PMID: 25151548 DOI: 10.1016/j.resuscitation.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/06/2014] [Accepted: 08/05/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants. METHODS This study was a survey of former ALS course participants' long-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway. RESULTS A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as "managed well". In general, the responders' confidence in being ALS providers was high, mean 4.3 (SD 0.8), scale 1-5. Significant differences between the perceived "well" and "not well" managed situations were found for all questions, p<0.001. The largest differences related to perception of co-workers' ability to apply ALS principles, the team atmosphere and communication. Responders' ratings of quality of management of emergency situations increased with intensity of setting. However, the 'clinical setting' was rated significantly lower as attributor to ability to apply ALS principles compared to 'co-workers familiarity with ALS principles', 'own confidence as ALS-provider' and 'own social/inter-personal skills'. CONCLUSION The results of this survey emphasise that ALS providers' perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers' skills. Team related factors associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management of emergency situations to the same extent as individual and team factors.
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Affiliation(s)
- Maria B Rasmussen
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Martin G Tolsgaard
- Centre for Clinical Education (CEKU), Centre for Human Resources and Rigshospitalet, Capital Region of Denmark and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Juliane Marie Centre, Rigshospitalet, Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Peter Dieckmann
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - S Barry Issenberg
- Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Miami, FL 33136, USA
| | - Doris Ostergaard
- Danish Institute for Medical Simulation (DIMS) and Herlev Hospital, Capital Region of Denmark, and University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Eldar Søreide
- Stavanger Acute Medicine Foundation for Education and Research (Safer), Stavanger University Hospital, 4068 Stavanger, Norway
| | - Jens Rosenberg
- Department of Internal Medicine, Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Charlotte V Ringsted
- Department of Anesthesia and The Wilson Centre, University of Toronto and University Health Network, Toronto, ON, Canada
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Schmutz J, Eppich WJ, Hoffmann F, Heimberg E, Manser T. Five steps to develop checklists for evaluating clinical performance: an integrative approach. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:996-1005. [PMID: 24826862 DOI: 10.1097/acm.0000000000000289] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The process of developing checklists to rate clinical performance is essential for ensuring their quality; thus, the authors applied an integrative approach for designing checklists that evaluate clinical performance. METHOD The approach consisted of five predefined steps (taken 2012-2013). Step 1: On the basis of the relevant literature and their clinical experience, the authors drafted a preliminary checklist. Step 2: The authors sent the draft checklist to five experts who reviewed it using an adapted Delphi technique. Step 3: The authors devised three scoring categories for items after pilot testing. Step 4: To ensure the changes made after pilot testing were valid, the checklist was submitted to an additional Delphi review round. Step 5: To weight items needed for accurate performance assessment, 10 pediatricians rated all checklist items in terms of their importance on a scale from 1 (not important) to 5 (essential). RESULTS The authors have illustrated their approach using the example of a checklist for a simulation scenario of infant septic shock. The five-step approach resulted in a valid, reliable tool and proved to be an effective method to design evaluation checklists. It resulted in 33 items, most consisting of three scoring categories. CONCLUSIONS This approach integrates published evidence and the knowledge of domain experts. A robust development process is a necessary prerequisite of valid performance checklists. Establishing a widely recognized standard for developing evaluation checklists will likely support the design of appropriate measurement tools and move the field of performance assessment in health care forward.
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Affiliation(s)
- Jan Schmutz
- Mr. Schmutz is research associate, Industrial Psychology and Human Factors, Department of Psychology, University of Fribourg, Fribourg, Switzerland. Dr. Eppich is assistant professor of pediatrics and medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Hoffmann is senior pediatrician, Dr. von Hauner University Children's Hospital, Munich, Germany. Dr. Heimberg is pediatrician, University Children's Hospital, Tübingen, Germany. Dr. Manser is associate professor for industrial psychology and human factors, Department of Psychology, University of Fribourg, Fribourg, Switzerland
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Kalaniti K. Do paediatric residents have the skills to 'lead' newborn resuscitations? Acta Paediatr 2014; 103:592-3. [PMID: 24673259 DOI: 10.1111/apa.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/25/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Kaarthigeyan Kalaniti
- Division of Neonatology; Department of Pediatrics; University of Toronto; Toronto ON Canada
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Tsay CJ. The vision heuristic: Judging music ensembles by sight alone. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2014. [DOI: 10.1016/j.obhdp.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bienefeld N, Grote G. Shared leadership in multiteam systems: how cockpit and cabin crews lead each other to safety. HUMAN FACTORS 2014; 56:270-286. [PMID: 24689248 DOI: 10.1177/0018720813488137] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In this study, we aimed to examine the effect of shared leadership within and across teams in multiteam systems (MTS) on team goal attainment and MTS success. BACKGROUND Due to different and sometimes competing goals in MTS, leadership is required within and across teams. Shared leadership, the effectiveness of which has been proven in single teams, may be an effective strategy to cope with these challenges. METHOD We observed leadership in 84 cockpit and cabin crews that collaborated in the form of six-member MTS aircrews (N = 504) during standardized simulations of an in-flight emergency. Leadership was coded by three trained observers using a structured observation system. Team goal attainment was assessed by two subject matter experts using a checklist-based rating tool. MTS goal attainment was measured objectively on the basis of the outcome of the simulated flights. RESULTS In successful MTS aircrews, formal leaders and team members displayed significantly more leadership behaviors, shared leadership by pursers and flight attendants predicted team goal attainment, and pursers' shared leadership across team boundaries predicted cross-team goal attainment. In cockpit crews, leadership was not shared and captains' vertical leadership predicted team goal attainment regardless of MTS success. CONCLUSION The results indicate that in general, shared leadership positively relates to team goal attainment and MTS success,whereby boundary spanners' dual leadership role is key. APPLICATION Leadership training in MTS should address shared rather than merely vertical forms of leadership, and component teams in MTS should be trained together with emphasis on boundary spanners' dual leadership role. Furthermore, team members should be empowered to engage in leadership processes when required.
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Tschan F, Semmer NK, Hunziker S, Kolbe M, Jenni N, Marsch SU. Leadership in different resuscitation situations. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2013.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Roberts NK, Williams RG, Schwind CJ, Sutyak JA, McDowell C, Griffen D, Wall J, Sanfey H, Chestnut A, Meier AH, Wohltmann C, Clark TR, Wetter N. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. Am J Surg 2013; 207:170-8. [PMID: 24468024 DOI: 10.1016/j.amjsurg.2013.06.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. METHODS Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. RESULTS Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. CONCLUSIONS Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams.
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Affiliation(s)
- Nicole K Roberts
- Department of Medical Education, Southern Illinois University School of Medicine, PO Box 19681, Springfield, IL 62794-9681, USA.
| | - Reed G Williams
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Cathy J Schwind
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - John A Sutyak
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Christopher McDowell
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - David Griffen
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jarrod Wall
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Hilary Sanfey
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Andreas H Meier
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Christopher Wohltmann
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ted R Clark
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Nathan Wetter
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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