Objective Communication Patterns Associated With Team Member Effectiveness in Real-World Virtual Teams

OBJECTIVE

We explore the relationships between objective communication patterns displayed during virtual team meetings and established, qualitative measures of team member effectiveness.

BACKGROUND

A key component of teamwork is communication. Automated measures of objective communication patterns are becoming more feasible and offer the ability to measure and monitor communication in a scalable, consistent and continuous manner. However, their validity in reflecting meaningful measures of teamwork processes are not well established, especially in real-world settings.

METHOD

We studied real-world virtual student teams working on semester-long projects. We captured virtual team meetings using the Zoom video conferencing platform throughout the semester and periodic surveys comprising peer ratings of team member effectiveness. Leveraging audio transcripts, we examined relationships between objective measures of speaking time, silence gap duration and vocal turn-taking and peer ratings of team member effectiveness.

RESULTS

Speaking time, speaking turn count, degree centrality and (marginally) speaking turn duration, but not silence gap duration, were positively related to individual-level team member effectiveness. Time in dyadic interactions and interaction count, but not interaction length, were positively related to dyad-level team member effectiveness.

CONCLUSION

Our study highlights the relevance of objective measures of speaking time and vocal turn-taking to team member effectiveness in virtual project-based teams, supporting the validity of these objective measures and their use in future research.

APPLICATION

Our approach offers a scalable, easy-to-use method for measuring communication patterns and team member effectiveness in virtual teams and opens the opportunity to study these patterns in a more continuous and dynamic manner.

Evaluation of an Interprofessional Blended Learning Course Focusing on Communication within Veterinary Teams

Based on the importance of communication and teamwork in veterinary practice, we explored the impact of a blended learning course designed to enhance interprofessional communication skills among veterinary students and apprentice assistants. The blended learning course design included online modules, synchronous (online) seminars, and simulation training sessions. The asynchronous online elements should complement the varied schedules of different professions and meet the individual needs of participants, especially considering the challenges posed by the COVID-19 pandemic. The course structure, evaluations, and outcomes were documented, showing a positive impact on knowledge gain concerning communication and self-assessment in communication skills. In the pretest, the participants scored 43.18% correct answers to a knowledge test, whereas 71.50% correct answers were given in the posttest. Some participants indicated an improvement in the self-assessment of their skills. For example, before the training only 13.64% answered the question "How prepared do you feel regarding your communication skills for entering the profession?" with "Very good" or "Good", versus 50.00% in the posttest. There were also only 22.73% of participants who agreed to having sufficient understanding of the roles of other professional groups, while in the posttest, 81.82% agreed. The evaluations highlighted positive feedback on the organization, learning environment, and overall course structure. However, challenges such as limited resources, especially time and financial constraints, influenced the implementation and ongoing development of the course. Subsequent runs of the course could gather more data to further improve the teaching of veterinary interprofessional communication. This ongoing data collection would allow continuous insights into and adjustments to the teaching methods, ensuring maximum benefit for veterinary students and apprentice assistants.

Communication Strategies in Human-Autonomy Teams During Technological Failures

OBJECTIVE

This study examines low-, medium-, and high-performing Human-Autonomy Teams' (HATs') communication strategies during various technological failures that impact routine communication strategies to adapt to the task environment.

BACKGROUND

Teams must adapt their communication strategies during dynamic tasks, where more successful teams make more substantial adaptations. Adaptations in communication strategies may explain how successful HATs overcome technological failures. Further, technological failures of variable severity may alter communication strategies of HATs at different performance levels in their attempts to overcome each failure.

METHOD

HATs in a Remotely Piloted Aircraft System-Synthetic Task Environment (RPAS-STE), involving three team members, were tasked with photographing targets. Each triad had two randomly assigned participants in navigator and photographer roles, teaming with an experimenter who simulated an AI pilot in a Wizard of Oz paradigm. Teams encountered two different technological failures, automation and autonomy, where autonomy failures were more challenging to overcome.

RESULTS

High-performing HATs calibrated their communication strategy to the complexity of the different failures better than medium- and low-performing teams. Further, HATs adjusted their communication strategies over time. Finally, only the most severe failures required teams to increase the efficiency of their communication.

CONCLUSION

HAT effectiveness under degraded conditions depends on the type of communication strategies enacted by the team. Previous findings from studies of all-human teams apply here; however, novel results suggest information requests are particularly important to HAT success during failures.

APPLICATION

Understanding the communication strategies of HATs under degraded conditions can inform training protocols to help HATs overcome failures.

Meaningful Communication but not Superficial Anthropomorphism Facilitates Human-Automation Trust Calibration: The Human-Automation Trust Expectation Model (HATEM)

OBJECTIVE

The objective was to demonstrate anthropomorphism needs to communicate contextually useful information to increase user confidence and accurately calibrate human trust in automation.

BACKGROUND

Anthropomorphism is believed to improve human-automation trust but supporting evidence remains equivocal. We test the Human-Automation Trust Expectation Model (HATEM) that predicts improvements to trust calibration and confidence in accepted advice arising from anthropomorphism will be weak unless it aids naturalistic communication of contextually useful information to facilitate prediction of automation failures.

METHOD

Ninety-eight undergraduates used a submarine periscope simulator to classify ships, aided by the Ship Automated Modelling (SAM) system that was 50% reliable. A between-subjects 2 × 3 design compared SAM appearance (anthropomorphic avatar vs. camera eye) and voice inflection (monotone vs. meaningless vs. meaningful), with the meaningful inflections communicating contextually useful information about automated advice regarding certainty and uncertainty.

RESULTS

Avatar SAM appearance was rated as more anthropomorphic than camera eye, and meaningless and meaningful inflections were both rated more anthropomorphic than monotone. However, for subjective trust, trust calibration, and confidence in accepting SAM advice, there was no evidence of anthropomorphic appearance having any impact, while there was decisive evidence that meaningful inflections yielded better outcomes on these trust measures than monotone and meaningless inflections.

CONCLUSION

Anthropomorphism had negligible impact on human-automation trust unless its execution enhanced communication of relevant information that allowed participants to better calibrate expectations of automation performance.

APPLICATION

Designers using anthropomorphism to calibrate trust need to consider what contextually useful information will be communicated via anthropomorphic features.

A Lexical Approach to Assessing Stress: Development and Proof-of-Concept

OBJECTIVE

We describe a methodology that provides a nonobtrusive means of detecting stress and related deficits through the assessment of spontaneous verbal output in ongoing communications.

BACKGROUND

In high-demand environments, operational personnel are exposed to an array of environmental, task, and interpersonal stressors that can negatively impact performance as well as jeopardize safety and well-being. In these settings, the requirement exists to assess cognitive and emotional state "at a distance" and without interfering with ongoing performance.

METHOD

We describe a lexical approach to assessing stress effects from ongoing or spontaneous verbal output. This approach is examined in a spaceflight analog setting.

RESULTS

We assess stress effects in terms of five core dimensions and develop lexical indicators of these core stress dimensions and relevant sub-facets. We establish the proof-of-concept of this approach by presenting representative data from a spaceflight analog.

CONCLUSION

This approach provides an unobtrusive means to evaluate ongoing task communications at the individual and team level in order to assess cognitive/emotional states such as workload, negative affect, attentional focus, anxiety, and team orientation.

APPLICATION

There are many high-demand settings in which it is valuable to monitor the potential negative effects of stress on operational personnel. These environments include spaceflight, the military, aviation, law enforcement, and medicine.

Meeting the Challenge of Transmission Delay: Communication Protocols for Space Operations

OBJECTIVE

Several studies were conducted to assess media-specific communication protocols as a countermeasure to challenges of asynchronous space-ground communication.

BACKGROUND

Previous research demonstrated that transmission delay can negatively impact space-ground communication, collaboration, and task performance. We created media-specific protocols designed to mitigate identified problems associated with asynchronous communication and examined their effects on team communication and task performance.

METHODS

The lab study included 24 teams of three who collaborated remotely via voice or text on computer-based tasks simulating failures in a spacecraft's life support system. Training and availability of communication protocols was the between-groups variable. Perceived usability, criticality, and effectiveness of the communication protocols were also assessed in space-analog simulations.

RESULTS

Lab study data revealed that communication protocols facilitated some aspects of team communication; specifically, they reduced threats to common ground and information splitting but not instances of miscommunication. Analog data indicated that protocol compliance was high, participants evaluated most elements as highly important, and protocols maintained perceived communication effectiveness between space crews and mission control during time delay comparably to no-time-delay conditions.

CONCLUSION

Converging data attest to the feasibility, usability, and effectiveness of empirically derived communication protocols as a countermeasure to the negative impacts of transmission delay and also point to technological solutions.

APPLICATION

The communication protocols have been adopted for training in NASA analog simulations involving time-delayed communication. They could also support communication among remote team members in medical operations, command-and-control teams, or disaster response under asynchronous conditions or when time is limited and precise communication is critical.

Assessing the Value of Huddle Implementation in the Perioperative Setting

Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.

Development and validation of a scale to measure team communication behaviors

Introduction

With the COVID-19 pandemic, remote work was increased all over the globe. As a consequence, workers had to adapt their communication behaviors to smoothly coordinate work in their flexible teams (i.e., when team members divide work between the office and their homes). Drawing on relational coordination theory, we constructed and validated a scale to capture the most relevant team communication behaviors.

Methods

We employed interviews and focus groups to construct the scale, refined the scale based on three samples with employees working flexibly and finally validated the scale with 130 teams from diverse organizations.

Results

Our scale comprises three dimensions: focused communication, knowledge sharing and spontaneous communication. All three dimensions showed convergent validity with team planning and discriminant validity with time-spatial flexibility. Also, predictive validity with collective efficacy and team viability was achieved for focused communication and knowledge sharing. Spontaneous communication only predicted collective efficacy, but not team viability.

Discussion

We conclude that the TCS is a reliable and valid measure for assessing team communication and contribute by focusing on behaviors.

Insights From the Virtual Team Science: Rapid Deployment During COVID-19

OBJECTIVE

To provide insights for organizations that must rapidly deploy teams to remote work.

BACKGROUND

Modern situations, such as the COVID-19 pandemic, are rapidly accelerating the need for organizations to move employee teams to virtual environments, sometimes with little to no opportunities to prepare for the transition. It is likely that organizations will continually have to adapt to evolving conditions in the future.

METHOD

This review synthesizes the literature from several sources on best practices, lessons learned, and strategies for virtual teams. Information from each article deemed relevant was then extracted and de-identified. Over 64 best practices were independently and blindly coded for relevancy for the swift deployment of virtual teams.

RESULTS

As a result of this review, tips for virtual teams undergoing rapid transition to remote work were developed. These tips are organized at the organization, team, and individual levels. They are further categorized under six overarching themes: norm setting, performance monitoring, leadership, supportive mechanisms, communication, and flexibility.

CONCLUSION

There is a significant deficit in the literature for best practices for virtual teams for the purposes of rapid deployment, leaving it to organizations to subjectively determine what advice to adhere to. This manuscript synthesizes relevant practices and provides insights into effective virtual team rapid deployment.

Improving Ad Hoc Medical Team Performance with an Innovative "I START-END" Communication Tool

PURPOSE

To study the effect of a communication tool entitled: "I START-END" (I-Identify; S-Story; T-Task; A-Accomplish/Adjust; R-Resources; T-Timely Updates; E-Exit; N-Next; D-Document and Debrief) in simulated urgent scenarios in non-operating room settings (referred to as "Ad Hoc") with anesthesia residents. The "I START-END" tool was created by incorporating Crisis Resource Management (CRM) principles into a practical and user-friendly format.

METHODS

This was a mixed methods pre/post observational study with 47 anesthesia resident volunteers participating from July 2014 to June 2016. Each resident served as their own control, and participated in three simulated Ad Hoc scenarios. The first simulation served as a baseline. The second simulation occurred 1-2 weeks after I START-END training. The third simulation occurred 3-6 months later. Simulation performance was videotaped and reviewed by trained experts using technical skill checklists and Anesthesia Non-Technical Skills (ANTS) score. Residents filled out questionnaires, pre-simulation, 1-2 weeks after I START-END training and 3-6 months later. Concurrently, resident performance at actual Code Blue events was scored by trained observers using the Mayo High Performance Teamwork Scale.

RESULTS

80-90% of residents stated the tool provided an organized approach to Ad Hoc scenarios - specifically, information helpful to care of the patient was obtained more readily and better resource planning occurred as communication with the team improved. Residents stated they would continue to use the tool and apply it to other clinical settings. Resident video performance scores of technical skills showed significant improvement at the "late" session (3-6 months post exposure to the I START-END). ANTS scores were satisfactory and remained unchanged throughout. There was no difference between residents with and without I START-END training as measured by the Mayo High Performance Teamwork Scale, however, debriefing at Code Blues occurred twice as often when residents had I START-END training.

CONCLUSION

Non-operating room settings are fraught with unfamiliarity that create many challenges. The I START-END tool operationalizes key CRM elements. The tool was well received by residents; it enabled them to speak up more readily, obtain vital information and continually update each other by anticipating, planning, and debriefing in an organized and collaborative way.

Improving Patient Safety in General Hospitals Using Structured Handoffs: Outcomes From a National Project

Background

Promoting quality and patient safety is one of the health policy pillars of Israel's Ministry of Health. Communication among healthcare professionals is of utmost importance and can be improved using a standardized, well-known handoff tool such as the Introduction, Situation, Background, Assessment, and Recommendations (ISBAR). This study aims to present implementation process and participants' satisfaction of a national project that used a standardized tool for team communication.

Methods

This national intervention project included process implementation teams from 17 Israeli general hospitals evaluating the ISBAR implementation process for transferring patients from intensive care units to medical/surgical wards. The project, conducted between January 2017 and March 2018, used Fischer's test and logistic regression. The project evaluation was based on the participants' assessment of and satisfaction with the handoff process.

Results

Eighty-seven process implementers completed the questionnaire. A statistically significant increase in satisfaction scores in terms of four variables (p < 0.001) was observed following the implementation of the project. Nurses reported higher satisfaction at the end of the process (0.036). Participants who perceived less missing information during handoffs were more satisfied with the process of information flow between wards (84.9%) than those who perceived more missing information (15.6%). Participants who responded that there was no need to improve information flow were more satisfied with the project information flow (95.6%) compared to the group which responded that it was necessary to improve information flow (58.2%). Three out of four variables predicted satisfaction with the process. Being a nurse also predicted satisfaction with information flow with a point estimate of 2.4. The C value of the total model was 0.87.

Conclusions

Implementation of a safety project at a national level requires careful planning and the close involvement of the participating teams. A standardized instrument, a well-defined process, and external controls to monitor and manage the project are essential for success. Disparities found in the responses of nurses vs. physicians suggest the need for a different approach for each profession in planning and executing a similar project in the future.

From the Patient's Perspective: Orthopedic Virtual Rounds

Interdisciplinary rounding on hospital inpatients is an integral part of providing high-quality, safe patient care. As orthopedic groups have grown and geographic coverage increased, surgeons are challenged to make in-person rounds on their patients every day given time constraints and physical distances. Virtual technology is being used in multiple healthcare settings to provide patients with the opportunity to connect with health care professionals when in-person options are not available. The purpose of this study was to explore the patient experience of virtual inpatient rounding. Using digital communication technology, virtual rounds were conducted by having the surgeon connect via their mobile device or laptop to the nursing unit's communication tablet. Twenty-seven patient interviews were digitally recorded and qualitatively analyzed. Results demonstrated that virtual rounds provided a positive patient experience for many. Most patients felt that virtual rounds were a good alternative when in-person rounds are not possible. Dissatisfaction was related to feeling “rushed” by the surgeon. This feedback can be used to better prepare patients and providers for virtual rounds and to enhance virtual technologies.

Guidelines in Practice: Specimen Management

Specimen management is a complex process that involves multiple steps and numerous health care personnel. Preventable specimen-related errors are common and can occur during any phase of the specimen management process. Perioperative nurses manage specimens during the preanalytical phase before specimens are delivered to the laboratory for analysis. Errors in the preanalytical phase may include mislabeling, miscommunication, loss of a specimen, improper fixation of the specimen, and transport failures. The AORN "Guideline for specimen management" provides guidance for managing specimens collected during surgical and other invasive procedures, including recommendations for handling specific types of specimens. This article discusses the guideline recommendations for intraoperative team communication, transfer from the sterile field, containment, transport, and quality. A scenario describes a facility team's use of a root cause analysis and a failure modes and effects analysis tool to assess the risk and effects of specimen errors and create a process improvement plan.

Leveraging an Ambulatory Patient and Family Advisory Council to Improve Patient Experience Scores

Reports have shown that ambulatory primary care practices that include patients and families in their quality improvement efforts have many benefits including better relationships and interactions with patients. In this paper, we describe our experience of involving our patients, family, and staff who are members of or Patient and Family Advisory Council (PFAC) in our quality improvement efforts related to patient experience. For a year, members of the PFAC suggested creative implementations to our office policies and workflow to improve satisfaction scores on the Clinician and Group Consumer Assessment of Health care Providers and Systems survey in key areas: information about delays, wait times in clinic, and convenience of appointments.

The Influence of Trust on Creativity: A Review

Examining the trust-creativity relationship is important to promote creativity and organizational innovation. The goal of this study is to investigate how trust influences creativity by summarizing existing findings of diverse empirical studies. The impact of trust at different levels on creativity primarily manifests in three ways: (1) individuals' cognition- and affect-based trust has a positive effect on creativity together with the role of trust-derived perspective taking in creativity; (2) interpersonal trust helps enhance the joint creativity of an entire group via mediators such as team communication and commitment together with trust-evoked safety and the motivation to risk proposing, sharing, accepting or adopting uncommon ideas; (3) group trust has a positive, mostly indirect effect on creativity via mediating variables such as collaborative culture/climate and team communication. Potential implications and avenues for future research are also discussed.

Guidelines in Practice: Electrosurgical Safety

Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.

A Scoping Review of Strategies Used to Implement the Surgical Safety Checklist

In 2007, the World Health Organization initiated the Surgical Safety Checklist (SSC) as part of an initiative to improve patient outcomes. After publication of the SSC, perioperative nurses identified challenges with implementing it and questioned its effectiveness. We desired to summarize the state of the science on the effectiveness of strategies that perioperative personnel have used to implement and assess the SSC; therefore, we conducted a scoping review. We searched several databases and identified 28 articles that described the three key stages of SSC implementation (ie, before, during, and after). Half of the identified articles addressed intervention strategies and most articles provided strategies for SSC implementation. The literature also indicated that effective implementation occurred when there was adequate planning. Perioperative leaders should work with nurses when implementing the SSC and monitor its use after implementation to verify compliance and help prevent negative patient outcomes.

Family Perceptions of Palliative Care and Communication in the Surgical Intensive Care Unit

Few data exist on palliative care for trauma and acute care surgery patients. This pilot study evaluated family perceptions and experiences around palliative care in a surgical intensive care unit (SICU) via mixed methods interviews conducted from February 1, 2020, to March 5, 2020, with 5 families of patients in the SICU. Families emphasized the importance of clear, honest communication, and inclusiveness in decision-making. Many interviewees were unable to recall whether goals-of-care discussions had occurred, and most lacked understanding of the patients' illnesses. This study highlights the significance of frequent communication and goals-of-care discussions in the SICU.

"A real eye opener" - development, implementation and evaluation of a seminar on interprofessional teamwork in GP specialty training

Introduction: The successful treatment of a multitude of chronic diseases is largely dependent on effective interprofessional collaboration. In Germany, many healthcare employees feel unprepared for the challenges of interprofessional teamwork. Can a seminar designed by an interprofessional team for an interprofessional target group improve mutual understanding and provide the basis for successful interprofessional collaboration? Methodological approach: For the development of the seminar, Kern's model for curriculum development was used, which includes the following six steps: problem identification, needs analysis, goal definition (learning objectives and learning content), educational strategies, implementation and evaluation. The all-day event brought together physiotherapists, pharmacists, medical assistants and doctors undergoing specialist training in family medicine. Representatives of the various professions were recruited through multiple channels (associations, pharmacist societies, alumni-networks, etc.). Practical examples and role-play were used to develop a better understanding of each other's professions and to support goal-oriented and appreciative communication among them. The seminar belongs to the curriculum provided by the Hesse Competence Center for Specialist Training in General Practice and has so far taken place three times. The evaluation was carried out by means of a detailed, self-designed questionnaire with five open and 20 closed questions. The statistical analysis was mainly descriptive (mean value, minimum, maximum and SD). Results: Overall, 29 persons have participated in the workshops (eleven doctors undergoing specialist training, six physiotherapists, six pharmacists, six medical assistants). Overall, the seminar was rated very highly. Individual aspects of the seminar's design, such as relevance and practice-orientation, as well as an assessment of whether the seminar contributed towards increasing participants' ability to collaborate with other professionals, were rated positively. In addition, a pre-post comparison of self-assessed ability to collaborate interprofessionally showed significant improvement. Discussion: This highly interactive one-day seminar design contributed towards improving understanding for other professions and communication skills. In order to achieve a broad-based improvement in interprofessional collaboration over the long term, this or similar concepts should be employed more extensively. Conclusions: The results suggest that participants in interprofessional seminars consider them to improve interprofessional collaboration.

Team Combat Identification: Effects of Gender, Spatial Visualization, and Disagreement

OBJECTIVE

The combat identification (CID) abilities of same-gender and mixed-gender dyads were experimentally assessed, along with measures of spatial skills and team communication.

BACKGROUND

CID is a high-stakes decision-making task involving discrimination between friendly and enemy forces. Literature on CID is primarily focused on the individual, but the extensive use of teams in the military means that more team-based research is needed in this area.

METHOD

After a set of training sessions, 39 dyads were tasked with identifying 10 armored vehicles in a series of pictures and videos. Team communication was recorded, transcribed, and coded for instances of disagreements.

RESULTS

Analyses indicated that males scored higher on a spatial visualization measure than did females. M-M teams performed significantly better than M-F teams on the CID task, but when spatial ability and team disagreements were added as predictors, the effect of team gender composition became nonsignificant. Spatial ability and team disagreement were significant predictors of team CID performance.

CONCLUSION

Results suggest that spatial skills and team disagreement behaviors are more important for team CID performance than a team's gender composition. To our knowledge, this is the first lab study of team CID.

APPLICATION

This research highlights the importance of understanding both individual differences (e.g., spatial skills) and team processes (e.g., communication) within CID training environments in the military context.

Measuring Patient Experiences of Integration in Health Care Delivery: Psychometric Validation of IntegRATE Under Controlled Conditions

The objective of this study was to assess the psychometric properties of IntegRATE—a 4-item patient-reported measure of integration in health care delivery—under controlled conditions. Adults who reported having received health care in the previous year were exposed to a fictional health care scenario featuring good, mixed, or poor integration on 1 or 2 occasions. They were then asked to imagine themselves as a patient in the scenario and complete IntegRATE and other measures. The data collected were analyzed to assess the discriminative, concurrent, and divergent validity of IntegRATE and its test–retest reliability and responsiveness using both “sum score” and “top score” scoring approaches. Six-hundred people participated in the study with 190 taking part on 2 occasions. The IntegRATE sum score demonstrated discriminative validity, concurrent validity, divergent validity, and responsiveness and partially demonstrated test–retest reliability. The IntegRATE top score demonstrated concurrent validity, divergent validity, and responsiveness and partially demonstrated discriminative validity and test–retest reliability. We conclude that the IntegRATE sum score exhibits encouraging psychometric properties and performs more optimally than the IntegRATE top score.

Analysis of Communication, Team Situational Awareness, and Feedback in a Three-Person Intelligent Team Tutoring System

This research assessed how the performance and team skills of three-person teams working with an Intelligent Team Tutoring System (ITTS) on a virtual military surveillance task were affected by feedback privacy, participant role, task experience, prior team experience, and teammate familiarity. Previous work in Intelligent Tutoring Systems (ITSs) has focused on outcomes for task skill training for individual learners. As research extends into intelligent tutoring for teams, both task skills and team skills are necessary for good team performance. This work includes a brief review of previous research on ITTSs, feedback, teams, and teamwork, including the recounting of two categories of a framework of teamwork performance, Communication and Cognition, which are relevant to the present study. This research examines the effects of an intelligent agent, as well as features of the team, its members, and the task being undertaken, on team communication (measured by relevant key-presses) and team situation awareness (as measured by scores on a quiz). Thirty-seven teams of three participants, each at their own computer running a multiplayer surveillance simulation, were given just-in-time private (individually delivered) or public (team-delivered) performance feedback during four 5-min trials. In the fourth trial, two of the three participants switched roles. Feedback type, teamwork experience, and teammate familiarity had no statistically significant effect on communication or team situation awareness. However, higher levels of role experience and task experience showed significant and medium-sized effects on communication performance. Results, based on performance data and structured interview responses, also revealed areas of improvement in future feedback design and a potential benchmark for feedback frequency in an action-oriented serious game-based ITTS. Among the conclusions are six design objectives for future ITTSs, establishing a foundation for future research on designing effective ITTSs that train interpersonal skills to nascent teams.

Virtual Teaming: Leveraging Team Science Sense-Making During COVID-19

Individuals with cancer anorexia cachexia syndrome (CACS) experience multifaceted distress. To address CACS patient concerns regarding their experience of care, our cancer center established a specialized CACS clinic in 2016. We applied the team science principle of the team mental model (TMM) to support development of an effective interprofessional collaborative CACS care team. In 2020, cessation of CACS clinic in-person visits during coronavirus disease 2019 (COVID-19) threatened the viability of the entrenched TMM and once again jeopardized the patient experience of care. We present a case-based vignette as a representative composite of patient experiences to illustrate the challenges. A 48-year-old female was referred to our CACS clinic for pancreatic cancer-associated appetite and weight loss during COVID-19. To reduce risk of infection, in-person clinic visits were curtailed. When informed about the resulting need to defer the CACS assessment, the patient and her spouse expressed concern that postponement would adversely affect her ability to undergo anticancer treatments or achieve beneficial outcomes. To minimize delays in CACS treatment and optimize the patient experience of care, we applied the team science principle of sense-making to help the team rapidly reformulate the TMM to provide interprofessional collaborative CACS care via telemedicine. The sense-making initiative highlights opportunities to examine sense-making within health care teams more broadly during and after the pandemic. The application of sense-making within interprofessional cancer care teams has not been described previously.

"Hear me!"

I am respectfully submitting a narrative essay to this journal. As a faculty member at a residency program, I got interested in contributing this essay after my experience caring for a disabled patient. I presumed we tend to imperfectly decipher what our patients' needs are and my experience highlighted the need to be more sensitive and less dismissive to patients with disabilities. I started with the assumption that there were minimal teaching points to the house staff since this was an overt outpatient placement case. I was wrong and learnt much more than I expected. As faculty physicians, we tend to highlight pertinent clinical data to the learners and inadvertently gloss over vital nonclinical details that ultimately are as important. This patient was very succinct with her demands and understandably upset with our blatant conjectures with our daily mundane clinical rounds and consults. Taking time to listen to her, having a team meeting in her room and coordinating her care with nursing and medical colleagues was not only a learning experience but made me a better physician and teacher. She was the focus and her needs were met, not ours. I have no financial conflict of interest, and the patient was aware I intended to share my experience with my peers. I will appreciate any feedback and opportunity to learn and improve this narrative with expected revisions.

Using Simulation-Based Education to Improve Team Communication During a Massive Transfusion Protocol in the OR

Hemorrhaging during operative and other invasive procedures can result in devastating outcomes for surgical patients. An effective plan of action in the form of a massive transfusion protocol (MTP), along with teamwork and clear communication among OR personnel, is critical during a hemorrhagic crisis to improve patient outcomes. However, perioperative personnel may be unprepared to manage a hemorrhagic crisis because they lack experiential knowledge of these uncommon, high-risk scenarios. Perioperative leaders at a 500-bed acute-care hospital in the Midwest developed an educational activity involving a video-recorded simulated MTP scenario, learning modules, and debriefing sessions to educate more than 150 employees. Perioperative personnel received pre-education and watched the video-recorded MTP simulation together, and then participated in team debriefings after watching the video. Based on team debriefings and evaluation feedback, most staff members believed that the activity improved team communication.

The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre

BACKGROUND

Speaking up is important for patient safety, but only if the concern raised is acknowledged and responded to appropriately. While the power to change the course of events rests with those in charge, research has focussed on supporting those in subordinate positions to speak up. We propose responsibility also rests with senior clinical staff to respond appropriately. We explored the perceptions of senior staff on being spoken up to in the operating theatre (OT), and factors moderating their response.

METHODS

We undertook interviews and focus groups of fully qualified surgeons, anaesthetists, nurses, and anaesthetic technicians working in OTs across New Zealand. We used grounded theory to analyse and interpret the data.

RESULTS

With data from 79 participants, we conceptualise three phases in the speaking up interaction: 1) the content of the speaker's message and the tone of delivery; 2) the message interpreted through the receiver's filters, including beliefs on personal fallibility and leadership, respect for the speaker, understanding the challenges of speaking up, and personal cultural and professional norms around communication; and 3) the receiver's subsequent response and its effects on the speaker, the observing OT staff, and patient care.

CONCLUSIONS

The speaking up interaction can be high stakes for the whole OT team. The receiver response can strengthen team cohesion and function, or cause distress and tension. Our grounded theory uncovers multiple influences on this interaction, with potential for re-framing and optimising the speaker/receiver interaction to improve team function and patient safety.

Challenges of Patient Engagement in an HIV Clinical Research Program: A Qualitative Analysis of Stakeholder Accounts

Patient engagement (PE) promotes collaboration between stakeholders (researchers, patients, clinicians, etc). It often faces challenges due to tensions between its ethical/political and scientific underpinnings. This article explores how stakeholders applied the guiding principles of a PE project (“co-build,” “support and mutual respect,” and “inclusiveness”) for an HIV clinical research program initiated in January 2016. Three researchers/clinicians, a PE agent, and 2 patients held 3 meetings (June-October 2018) to discuss challenges faced and how these impacted their approach to PE. Regular stakeholder discussions about PE in clinical research could be documented and help guide PE to better meet stakeholder needs.

Using Communication to Modulate Neural Synchronization in Teams

Throughout training and team performance, teams may be assessed based on their communication patterns to identify which behaviors contributed to the team’s performance; however, this process of establishing meaning in communication is burdensome and time consuming despite the low monetary cost. A current topic in team research is developing covert measures, which are easier to analyze in real-time, to identify team processes as they occur during team performance; however, little is known about how overt and covert measures of team process relate to one another. In this study, we investigated the relationship between overt (communication) and covert (neural) measures of team process by manipulating the interaction partner (participant or experimenter) team members worked with and the type of task (decision-making or action-based) teams performed to assess their effects on team neural synchronization (measured as neurodynamic entropy) and communication (measured as both flow and content). The results indicated that the type of task affected how the teams structured their communication but had unpredictable effects on the neural synchronization of the team when averaged across the task session. The interaction partner did not affect team neural synchronization when averaged. However, there were significant relationships when communication and neural processes were examined over time between the neurodynamic entropy and the communication flow time series due to both the type of task and the interaction partner. Specifically, significant relationships across time were observed when participants were interacting with the other participant, during the second task trial, and across different regions of the cortex depending on the type of task being performed. The findings from the time series analyses suggest that factors that are previously known to affect communication (interaction partner and task type) also structure the relationship between team communication and neural synchronization—cross-level effects—but only when examined across time. Future research should consider these factors when developing new conceptualizations of team process measurement for measuring team performance over time.

Development of a Communications Program to Support Care of Critically Ill Coronavirus Disease 2019 (COVID-19) Patients

A significant role of intensive care unit (ICU) workforce is ongoing communication with and support for families of critically ill patients. The COVID-19 pandemic has created unanticipated challenges to this essential function. Restrictions on visitors to hospitals and unprecedented clinical demands hamper traditional communication between ICU staff and patient families. In response to this challenge, we created a dedicated communications service to provide comprehensive support to families of COVID-19 patients, and to create capacity for our ICU teams to focus on patient care. In this brief report, we describe the development, implementation, and preliminary experience with the service.

Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis

Background

In Ethiopia, health extension workers (HEWs) are deployed across the country by the government to meet public health needs. Team communication is important for effective teamwork, but community health workers in low-resource settings like Ethiopia may face challenges in carrying out team meetings to compile service statistics. This is due to the nature of their outreach activities, which requires extensive travel.

Objective

This study aimed to identify gaps in team communication about service statistics among HEWs in Ethiopia. Considering mobile communication and data collection as tools for bridging these gaps, we examined disparities in access to electricity, which has been identified as one of the major barriers to this approach.

Methods

Data from the most recent Performance Monitoring and Accountability 2020 service delivery point survey were used for our analysis. Logistic regression analysis was performed to identify disparities in team communication on service statistics for family planning, which is a major component of the HEW’s job. Disparities were examined across health facilities with different levels of HEW integration in their staffing structure (ie, no HEWs, at least one HEW, or only HEWs). Additionally, a chi-square test was conducted to examine disparities in access to electricity to explore the potential of mobile communication and data collection integration.

Results

In total, 427 health facilities of four different types (ie, hospitals, health centers, health posts, and health clinics) were included in our analysis. At most health posts (84/95, 88%), only HEWs were employed; none of the health clinics integrated the HEW model into their staffing structure. Among the 84 health posts, the odds of having team meetings on family planning service statistics in the past 12 months were 0.48 times the odds of those without HEWs (P=.02). No statistically significant differences were found between HEW-only facilities and facilities with at least one HEW. Most health facilities (69/83, 83.13%) with HEWs as the only staff had no electricity at the time of the survey while 71.25% (57/80) had intermittent access (ie, service disruption lasting 2 or more hours that day). There were statistically significant differences in electricity access among health facilities with different levels of HEW integration (P<.001).

Conclusions

Facilities employing only HEWs were less likely to have regular team meetings to discuss service statistics. Since their responsibilities involve extensive outreach activities, travel, and paper-based recordkeeping, empowering HEWs with mobile communication and data collection can be a workable solution. The empirical evidence regarding disparities in electricity access also supports the need for and the feasibility of this approach.

Concerns About Verbal Communication in the Operating Room: A Field Study

OBJECTIVE

To assess verbal communication patterns which could contribute to poor performance among surgical team members in an operating room.

BACKGROUND

There exist certain challenges in communication in health care settings. Poor communication can have negative effects on the performance of a surgical team and patient safety. A communication pattern may be associated with poor performance when the process of sending and receiving information is interrupted or the content of conversation is not useful.

METHOD

This cross-sectional field study was conducted with 54 surgical teams working in two Iranian hospitals during 2015. Two observers recorded all verbal communications in an operating room. An in-depth assessment of various annotated transcripts by an expert panel was used to assess verbal communication patterns in the operating room.

RESULTS

Verbal communication patterns which could contribute to poor performance were observed in 63% of the surgeries, categorized as communication failures (17 events), protests (23 events), and irrelevant conversations (164 events). The anesthesiologists and the circulating nurses had the most concerning communication patterns. The failure of devices and poor planning were important factors that contributed to concerning patterns.

CONCLUSION

Concerning patterns of verbal communication are not rare in operating rooms. Analyzing the annotated transcripts of surgeries can conduce to identifying all these patterns, and their causes. Concerning communication patterns can be reduced in the operating room by providing interventions, properly planning for surgeries, and fixing defective devices.

APPLICATION

The method used in this study can be followed to assess communication problems in operating rooms and to find solutions.

Language and Cultural Discordance: Barriers to Improved Patient Care and Understanding

Providing optimal health care to patients whose first language is not English remains a major challenge. Medical students, residents, and attendings receive limited cultural competency training, but these short sporadic training courses are not nearly enough to give physicians the proper resources or preparation to understand all their patients’ beliefs. Medical interpreters can fill this gap and strengthen health care for these already marginalized communities. It is important to reconceptualize medical interpreters as true collaborators in medicine who can provide valuable insights that extend beyond language interpretation at the bedside. Physicians would benefit from the insights of these professionals who can function as both language and cultural interpreters who know these patient communities well. Improved communication between physicians and interpreters would not violate traditional physician–patient boundaries but would instead strengthen this relationship to provide the best possible care.

NSQIP Impacts Patient Experience

National Quality Improvement Project (NSQIP) semiannual reports (SARs) revealed high observed to expected ratios for venous thromboembolic events (VTEs) on the surgical service. Press Ganey scores identified an area of particular weakness in shared decision-making in patient care. Patients reported little to no participation in shared decision-making. A performance improvement project was developed with a 2-fold objective: decrease the percentages of patients sustaining VTE through adequate screening and prophylaxis (VTEP) and to engage patients in shared decision-making to accept VTEP through enhanced patient-centered discussions and education on the risks and benefits of VTEP. A clinical pathway was developed to implement VTEP using a standardized risk assessment tool. Patient-centered discussion introduced VTEP and impact on perioperative safety. Results included telephone survey, NSQIP SARs, and Press Ganey patient experience survey. Using NSQIP data and a pathway developed for both VTE risk assessment and patient engagement, the authors observe immediate improvements in patient experience and decreased rates of VTE.

Team Role Adoption and Distribution in Engineering Project Meetings

Team communication plays a vital role in engineering management, however, there is a paucity of work that examines how team roles emerge as a response to the communicative processes between participants. This research explored role adoption using qualitative methods comprising observations, questionnaires and semi-structured interviews. Five student teams doing final year projects at a university in New Zealand were observed during the academic year and then interviewed at the final stage of project completion. A number of team roles in the engineering context were identified for students and their supervisors: Explorer; Initiator; Facilitator; Active and Passive Information Provider; Outsider; Active and Passive Connector; Passive Collector; Arbitrator; Gatekeeper and Representative. Personal factors, such as social sensitivity, were correlated with the choice of team behaviour pattern. In addition, the team roles could be arranged in circular order to create a circumplex, the two axes of which were identified as Personal Agency/Communion and Social engagement/Social disengagement.

[Pervasive refusal syndrome: study of a clinical case]

The clinical presentation of pervasive refusal syndrome is marked by a refusal to eat, walk, talk, firm resistance and an aggressive refusal to accept help and care. The management of patients with this syndrome is physically and emotionally draining for caregivers. The quality of the relationship can be quickly affected as it is so unusual and singular. Training, communication and support from the team are essential to be able to continue to provide compassionate care.

Guideline Implementation: Team Communication: 1.8 www.aornjournal.org/content/cme

The perioperative environment is fast paced and complex. Competing responsibilities, noise and distractions, and reluctance of team members to speak up when they are aware of a potential patient safety issue are all barriers to effective communication in the perioperative setting. Communication breakdowns among health care providers can lead to medical errors and patient harm. Accurate and complete communication about the patient and the patient's care can contribute to improved efficiency, better patient outcomes, and fewer adverse events. The new AORN "Guideline for team communication" provides guidance on using standardized processes and tools to improve the quality of team communication. The key points address hand overs between phases of perioperative care; a briefing to share the surgical plan; a time out to verify the correct patient, procedure, site, and side; and a debriefing to discuss what was learned and how to improve. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Objective Measures of Communication Behavior Predict Clinical Performance

OBJECTIVE

Effective teamwork and communication are critical to patient outcomes, and subjective assessment tools have been studied in predicting team performances. However, inherent biases remain while using subjective assessment tools. This study hypothesizes that objective communication features can assess and predict clinical performance.

DESIGN

Forty 3rd-year medical students participated in the Acute Care Trauma Simulation as the role of doctor, teaming up with a nurse confederate and a simulated patient. Participants conducted postoperative patient management, patient care diagnoses, and treatment. Audio from all team members were recorded, speech variables (e.g., speech duration, number of conversations, etc.) were extracted, and statistical analyses were performed to associate communication with clinical performance.

SETTING

This study was performed at the simulation center located at Fairbanks Hall, Indiana University School of Medicine.

PARTICIPANTS

Data from forty 3rd-year medical students were collected and analyzed.

RESULTS

Majority (67%) of the communications were initiated by student. Speech ratio, intensity, and frequency of communications differed when students communicate with nurse than with patient (e.g., student communication to patient had higher intensity than nurse). Increasing frequency of check-backs between student and nurse (p < 0.05) and speech duration from student to patient (p = 0.001) positively associated with student's clinical performance score.

CONCLUSION

Objective communication features can predict medical trainee's clinical performance and provide an objective approach for simulation-based trauma care training.

A Multifaceted Approach to Improve Physician Communication Scores

Improving patient satisfaction scores has become a key focus of health-care organizations nationwide but can be a struggle for community hospitals with constrained resources, and particularly challenging for hospitalist programs due to provider variance and turnover. Using the framework of appreciative inquiry, we implemented a multipronged intervention including a rounding model whereby hospitalist leaders rounded on patients and relayed commentary back to their hospitalist providers. We communicated positive feedback preferentially over negative feedback to the entire hospitalist group through regular communication. Providers were encouraged to employ best practices including sitting with the patient, reviewing recommendations using teach back, and providing business cards. Scores improved in the physician communication category by approximately 1% annually from fiscal year 2015 through 2018, with our percentile rank improving 35 percentile points during that time. These findings indicate that a multifaceted approach including best practices is associated with improved patient experience regarding communication with physicians.

Interprofessional Team Member Communication Patterns, Teamwork, and Collaboration in Pre-family Meeting Huddles in a Pediatric Cardiac Intensive Care Unit

CONTEXT

Interprofessional teams often develop a care plan before engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics but that has not been studied.

OBJECTIVES

To characterize the types of interactions that interprofessional team members have in pre-family meeting huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision making.

METHODS

We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings before care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision making using the Collaboration and Satisfaction About Care Decisions questionnaire.

RESULTS

Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); nonphysicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and nonphysician perceptions of collaboration were found in three of 10 observed meetings.

CONCLUSION

Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings.

Interaction Diagrams: Development of a Method for Observing Group Interactions

Recording of team meeting’s processes with electronic devices can be problematic because of the invasiveness of the process: issues with privacy; interpretation difficulty with noise or quiet speech; and distortion of participants’ behaviour. There is a need for less intrusive methods. We developed the interaction diagram method by extending the directed graph nature of sociograms to capture the time sequence of events, including the identification of the person, communication behaviour, and duration of interactions. The method was tested on engineering team meetings. Data processing by quantitative and qualitative analysis is shown to be feasible. Several team roles were observed in the engineering context: Initiator; Passive collector; Explorer; Information provider; Facilitator; Arbitrator; Representative; Gatekeeper; Connector; and Outsider. The work provides a graphical representation of the record of the interaction flow during meetings. It does this without needing video recording. It is also an efficient method, as it does not require subsequent transcription or coding. It provides a procedure to quickly analyse communication situations, identify group roles, and compare group activity at different meetings.

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

OBJECTIVE

To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs).

BACKGROUND

Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication.

METHOD

Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites.

RESULTS

Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity.

CONCLUSION

Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture "case talk," enable privacy for "comfort talk," and optimize proximity to patients without compromising safety.

Mapping the Patient Journey Across the Continuum: Lessons Learned From One Patient's Experience

Patient-centered care is essential for achieving high-quality and cost-effective health care. This is particularly important for patients with chronic or complex conditions who utilize more health-care services and require comprehensive care coordination. This case report draws on a longitudinal journey map—a valuable tool to capture patient experience and inform the care process—for a patient with multiple chronic conditions who needed a hip replacement. An analysis of the patient journey revealed 3 critical needs for a more patient-centered process: (1) making the patient health goal visible; (2) instigating transparent, shared decision-making; and (3) using a closed-loop communication process. Although key challenges exist, systems can facilitate more patient-centered care enabling health-care organizations to improve the patient experience across the continuum and provide higher quality care.

Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

BACKGROUND

The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date.

OBJECTIVE

We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which characteristics of care mattered most to their experiences.

METHOD

Qualitative interviews were conducted with 32 veterans receiving primary care at 1 of 8 VA clinics in the northwest United States. Interviews were analyzed using an inductive-deductive hybrid approach by an interdisciplinary team that included a veteran patient.

RESULT

Participants noticed recent positive changes, including improved communications and shorter waits in clinic, but rarely were aware of VA's PCMH initiative; a strong relationship with the primary care provider and feeling cared for/respected by everyone involved in care delivery were key components of quality care. The needs of the veteran community as a whole also shaped discussion of care expectations.

CONCLUSION

The PCMH model may provide benefits even when invisible to patients. Veteran awareness of population needs suggests a promising role for veteran involvement in further PCMH transformation efforts.

Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience

Patient experiences with the health-care system are increasingly seen as a vital measure of health-care quality. This study examined whether workplace social capital and employee outcomes are associated with patients’ perceptions of care quality across multiple clinic sites in a diverse, urban safety net care setting. Data from clinic staff were collected using paper and pencil surveys and data from patients were collected via a telephone survey. A total of 8392 adult primary care patients and 265 staff (physicians, nurses, allied health, and support staff) were surveyed at 10 community health clinics. The staff survey included brief measures of workplace social capital, burnout, and job satisfaction. The patient-level outcome was patients’ overall rating of the quality of care. Factor analysis and reliability analysis were conducted to examine measurement properties of the employee data. Data were aggregated and measures were examined at the clinic site level. Workplace social capital had moderate to strong associations with burnout (r = −0.40, P < .01) and job satisfaction (r = 0.59, P < .01). Mean patient quality of care rating was 8.90 (95% confidence interval: 8.86-8.94) ranging from 8.57 to 9.18 across clinic sites. Pearson correlations with patient-rated care quality were high for workplace social capital (r = 0.88, P = .001), employee burnout (r = −0.74, P < .05), and satisfaction (r = 0.69, P < .05). Patient-perceived clinic quality differences were largely explained by differences in workplace social capital, staff burnout, and satisfaction. Investments in workplace social capital to improve employee satisfaction and reduce burnout may be key to better patient experiences in primary care.

Radio Gaga? Intra-team communication of Australian Rules Football umpires - effect of radio communication on content, structure and frequency

Intra-team communication plays an important role in team effectiveness in various domains including sport. As such, it is a key consideration when introducing new tools within systems that utilise teams. The difference in intra-team communication of Australian Rules Football (AFL) umpiring teams was studied when umpiring with or without radio communications technology. A cross-sectional observational study was conducted to analyse the verbal communication of seven umpiring teams (20 participants) grouped according to their experience with radio communication. The results identified that radio communication technology increased the frequency and altered the structure of intra-team communication. Examination of the content of the intra-team communication identified impacts on the 'Big Five' teamwork behaviours and associated coordinating mechanisms. Analysis revealed that the communications utilised did not align with the closed-loop form of communication described in the Big Five model. Implications for teamwork models, coaching and training of AFL umpires are discussed. Practitioner Summary: Assessing the impact of technology on performance is of interest to ergonomics practitioners. The impact of radio communications on teamwork is explored in the highly dynamic domain of AFL umpiring. When given radio technology, intra-team communication increased which supported teamwork behaviours, such as backup behaviour and mutual performance monitoring.

A Communication Training Program to Encourage Speaking-Up Behavior in Surgical Oncology

Patient safety in the OR depends on effective communication. We developed and tested a communication training program for surgical oncology staff members to increase communication about patient safety concerns. In phase one, 34 staff members participated in focus groups to identify and rank factors that affect speaking-up behavior. We compiled ranked items into thematic categories that included role relations and hierarchy, staff rapport, perceived competence, perceived efficacy of speaking up, staff personality, fear of retaliation, institutional regulations, and time pressure. We then developed a communication training program that 42 participants completed during phase two. Participants offered favorable ratings of the usefulness and perceived effect of the training. Participants reported significant improvement in communicating patient safety concerns (t₄₀ = -2.76, P = .009, d = 0.48). Findings offer insight into communication challenges experienced by surgical oncology staff members and suggest that our training demonstrates the potential to improve team communication.

The Role of Social Cue Utilization and Closing-the-Loop Communication in the Performance of Ad Hoc Dyads

OBJECTIVE

To examine whether social cue utilization impacts the performance of ad hoc dyads through its relationship with closing the loop, a communication process whereby team members respond more frequently to initiating statements made by others.

BACKGROUND

There lacks unequivocal experimental evidence for any single cognitive-based process that might predict the performance of ad hoc teams.

METHOD

Using a quasi-experimental design, 80 participants were classified into 40 dyads based on their levels of social cue utilization and attempted a team problem-solving task. A serial mediation model revealed an indirect effect of social cue utilization on the performance of ad hoc dyads through closing the loop.

RESULTS

Analyses indicated that social cue utilization impacts on the performance of ad hoc dyads independently of nonverbal reasoning ability and emotional intelligence. Further, the level of social cue utilization within dyads exhibits a positive indirect impact on the performance of ad hoc dyads through closing the loop.

CONCLUSION

Ad hoc dyads with higher levels of social cue utilization engaged in a greater frequency of closing-the-loop statements and showed better subsequent performance on a problem-solving task in comparison to dyads with lower levels of social cue utilization.

APPLICATION

Potential applications include the optimization of ad hoc team composition within high reliability environments like aviation and power control as well as improving training interventions with a specific mechanism for improving the performance of ad hoc teams.

Primary care emergency team training in situ means learning in real context

OBJECTIVE

The purpose of our study was to explore the local learning processes and to improve in situ team training in the primary care emergency teams with a focus on interaction.

DESIGN, SETTING AND SUBJECTS

As participating observers, we investigated locally organised trainings of teams constituted ad hoc, involving nurses, paramedics and general practitioners, in rural Norway. Subsequently, we facilitated focus discussions with local participants. We investigated what kinds of issues the participants chose to elaborate in these learning situations, why they did so, and whether and how local conditions improved during the course of three and a half years. In addition, we applied learning theories to explore and challenge our own and the local participants' understanding of team training.

RESULTS

In situ team training was experienced as challenging, engaging, and enabling. In the training sessions and later focus groups, the participants discussed a wide range of topics constitutive for learning in a sociocultural perspective, and topics constitutive for patient safety culture. The participants expanded the types of training sites, themes and the structures for participation, improved their understanding of communication and developed local procedures. The flexible structure of the model mirrors the complexity of medicine and provides space for the participants' own sense of responsibility.

CONCLUSION

Challenging, monthly in situ team trainings organised by local health personnel facilitate many types of learning. The flexible training model provides space for the participants' own sense of responsibility and priorities. Outcomes involve social and structural improvements, including a sustainable culture of patient safety. KEY POINTS Challenging, monthly in situ team trainings, organised by local health personnel, facilitate many types of learning. The flexible structure of the training model mirrors the complexity of medicine and the realism of the simulation sessions. Providing room for the participants' own priorities and sense of responsibility allows for improvement on several levels. The participants demonstrated a consistent, long-term motivation to strengthen safety, both for their patients and for themselves.

Haptic Communication in Collaborative Virtual Environments

OBJECTIVE

To understand the interaction between haptic and verbal communication, we quantified the relative effect of verbal, haptic, and haptic-plus-verbal feedback in a collaborative virtual pointing task.

BACKGROUND

Collaborative virtual environments (CVEs) provide a medium for interaction among remote participants. Better understanding of the role of haptic feedback as a supplement to verbalization can improve the design of CVEs.

METHODS

Thirty-six participants were randomly paired into 18 dyads to complete a 2-D pointing task in a CVE. In a mixed experimental design, participants completed the task in three communication conditions: haptic only (H), verbal only (V), and haptic plus verbal (HV). The order of the conditions presented to the participants was counterbalanced.

RESULTS

The time to task completion, path length, overshoot, and root mean square error were analyzed. Overall, performance in the V and HV conditions was significantly better than in the H condition. H was the least efficient communication channel but elicited response with the shortest reaction time. When verbalization was not available, the use of the haptic device was more likely to be exaggerated to ensure information transmission. When verbalization was used, participants converged on the use of a Cartesian coordinate system for communicating spatial information.

CONCLUSION

Haptic communication can be used to complete a collaborative virtual task but is less efficient than verbal communication. A training period may help to improve the efficiency of haptic communication.

APPLICATION

These results can be used to design remote collaboration tasks incorporating haptic components and for improving the design of CVEs that support haptic communication.

Impact of workflow on the use of the Surgical Safety Checklist: a qualitative study

BACKGROUND

Regardless of the benefits associated of the Surgical Safety Checklist, adherence across its three phases remains inconsistent. The aim of this study was to systematically identify issues around workflow that impact on surgical teams' ability to use the Surgical Safety Checklist in a large tertiary facility in Queensland, Australia.

METHOD

Observational audit of 10 surgical teams and 33 semi-structured interviews with 70 participants from nursing, medicine and the community were conducted. Data were collected during 2014-2015. Inductive and deductive approaches were used to analyse field observations and interview transcripts.

RESULTS

The domain, impact of workflow on checklist utilization, was identified. Within this domain, seven categories illustrated the causal conditions which determined the ways in which workflow influenced checklist use. These categories included: 'busy doing the task'; 'clashing task priorities'; 'being pressured, running out of time'; 'adapting processes to work patterns'; 'doubling up on work'; 'a domino effect, leading to delays' and 'reality of the workflow'.

CONCLUSIONS

One of the greatest systemic challenges to checklist use in surgery is workflow. Process changes in the way that surgical safety checklists are used need to incorporate the temporal demands of the workflow. Any changes made must ensure the process is reliable, is easily embedded into existing work routines and is not disruptive.