Teamwork Measures Research Articles

Observational Assessment of Surgical Teamwork: A Feasibility Study

Teamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings. We observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS (Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co-operation, co-ordination, shared-leadership and monitoring. Ratings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one-eighth of the cases and delays or changes occurred in over two-thirds of the cases. This study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However, for these measures to be used for formal assessment, more research is needed to make them robust and standardized.

Why do Health Professionals Work in a Community Mental Health Service?

The aim of this pilot study was to determine the reasons why mental health professionals work in a community mental health service. A survey of psychiatrists and trainees (n = 13) and other mental health professionals (n = 67) was conducted in an Australian community mental health service with a socioeconomically deprived catchment population. Respondents were asked to list their main reasons for working and to complete measures of job design, well-being, social support, role clarity, teamwork and job satisfaction. The qualitative results were validated using focus groups. The response rate was 53.7% (43/80). Income (31/43), belonging (21/43), self-esteem (30/43) and self-actualization (9/43) were the main reasons given for working. Mental health professionals, who reported self-actualization as a reason for work, had significantly higher well-being and job satisfaction than other subjects. Mental health professionals who cited self-actualization as a reason for work perceived that their work was more significant and had higher task identity compared with other subjects. This study is limited by a small sample size and the inability to exclude confounding variables. Maslow's hierarchy of needs was a useful framework for categorizing reasons for work. Some practical approaches to meet the needs of the mental health workforce are discussed.

Why do health professionals work in a community mental health service?

Objective: The aim of this pilot study was to determine the reasons why mental health professionals work in a community mental health service.Methods: A survey of psychiatrists and trainees (n = 13) and other mental health professionals (n = 67) was conducted in an Australian community mental health service with a socioeconomically deprived catchment population. Respondents were asked to list their main reasons for working and to complete measures of job design, well-being, social support, role clarity, teamwork and job satisfaction. The qualitative results were validated using focus groups.Results: The response rate was 53.7% (43/80). Income (31/43), belonging (21/43), self-esteem (30/43) and self-actualization (9/43) were the main reasons given for working. Mental health professionals, who reported self-actualization as a reason for work, had significantly higher well-being and job satisfaction than other subjects. Mental health professionals who cited self-actualization as a reason for work perceived that their work was more significant and had higher task identity compared with other subjects.Conclusions: This study is limited by a small sample size and the inability to exclude confounding variables. Maslow's hierarchy of needs was a useful framework for categorizing reasons for work. Some practical approaches to meet the needs of the mental health workforce are discussed.

The complexity of measuring interprofessional teamwork in the operating theatre

Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance. However, measurement and assessment of interprofessional teamwork is lacking and interprofessional team training is scarce in the surgical domain. This paper addresses the complexity of measuring interprofessional teamwork in the operating theatre. It focuses mainly on the design and properties of observational assessment tools. The report and analysis serves to inform the researcher or clinician of the issues to consider when designing or choosing from alternative measures of team performance for training or assessment.

Assessing performance in final year medical students. Can a postgraduate measure be used in an undergraduate setting?

The transition between medical school and graduate performance should be a continuum. This study aimed to evaluate an assessment tool developed for practising doctors when applied to undergraduates. A 12-item rating form was developed from that used for practising doctors by the Royal Australasian College of Physicians. Over a 2-year period, senior doctors, junior doctors and nurses completed the rating form on final year medical students. Some students completed self-assessments. We performed factor analysis and correlated scores between raters and attachments. Correlating ratings with concurrent traditional assessment results across the year tested construct validity. Ten forms per student were distributed for all 123 students and 856 were returned (70%). Internal consistency was very high. In all, 71.1% of the variance was accounted for by two factors (clinical skills and humanistic). This factor structure is unchanged when restricted to different raters and is the same as that noted previously when rating practising doctors. There were good correlations between raters (including self) and between attachments. Nurse ratings were reliable but nurses rated students significantly lower on humanistic qualities. Correlations with traditional assessments were high when all traditional assessments were combined. Women scored more favourably than men on humanistic qualities. A rating instrument for doctors in practice retains the same factor structure and a high degree of reliability and validity for senior medical students. Reliable ratings by nurses have implications for measures of collegiality and teamwork. We believe the instrument could be a useful outcome measure for medical programmes and employers.

Enhancing patient safety through teamwork training.

The effective reduction of medical errors depends on an environment of safety for patients in both clinically-based and systems-oriented arenas. Formal teamwork training is proposed as a systems approach that will achieve these ends. In a study conducted by Dynamics Research Corporation, weaknesses and error patterns in Emergency Department teamwork were assessed, and a prospective evaluation of a formal teamwork training intervention was conducted. Improvements were obtained in five key teamwork measures, and most importantly, clinical errors were significantly reduced.

Teamwork Quality and the Success of Innovative Projects: A Theoretical Concept and Empirical Evidence

An extensive body of literature indicates the importance of teamwork to the success of innovative projects. This growing awareness, that “good teamwork” increases the success of innovative projects, raises new questions: What is teamwork, and how can it be measured? Why and how is teamwork related to the success of innovative projects? How strong is the relationship between teamwork and various measures of project success such as performance or team member satisfaction? This article develops a comprehensive concept of the collaboration in teams, called Teamwork Quality (TWQ). The six facets of the TWQ construct, i.e., communication, coordination, balance of member contributions, mutual support, effort, and cohesion, are specified. Hypotheses regarding the relationship between TWQ and project success are tested using data from 575 team members, team leaders, and managers of 145 German software teams. The results of the structural equation models estimated show that TWQ (as rated by team members) is significantly associated with team performance as rated by team members, team leaders, and team-external managers. However, the magnitude of the relationship between TWQ and team performance varies by the perspective of the performance rater, i.e., manager vs. team leader vs. team members. Furthermore, TWQ shows a strong association with team members' personal success (i.e., work satisfaction and learning).

Relationship between team assists and win-loss record in The National Basketball Association.

Using research methodology for analysis of secondary data, statistical data for five National Basketball Association (NBA) seasons (1993-1994 to 1997-1998) were examined to test for a relationship between team assists (a behavioral measure of teamwork) and win-loss record. Rank-difference correlation indicated a significant relationship between the two variables, the coefficients ranging from .42 to .71. Team assist totals produced higher correlations with win-loss record than assist totals for the five players receiving the most playing time ("the starters"). A comparison of "assisted team points" and "unassisted team points" in relationship to win-loss record favored the former and strongly suggested that how a basketball team scores points is more important than the number of points it scores. These findings provide circumstantial support for the popular dictum in competitive team sports that "Teamwork Means Success-Work Together, Win Together."

RELATIONSHIP BETWEEN TEAM ASSISTS AND WIN-LOSS RECORD IN THE NATIONAL BASKETBALL ASSOCIATION

Using research methodology for analysis of secondary data, statistical data for five National Basketball Association (NBA) seasons (1993–1994 to 1997–1998) were examined to test for a relationship between team assists (a behavioral measure of teamwork) and win-loss record. Rank-difference correlation indicated a significant relationship between the two variables, the coefficients ranging from .42 to .71. Team assist totals produced higher correlations with win-loss record than assist totals for the five players receiving the most playing time (“the starters”). A comparison of “assisted team points” and “unassisted team points” in relationship to win-loss record favored the former and strongly suggested that how a basketball team scores points is more important than the number of points it scores. These findings provide circumstantial support for the popular dictum in competitive team sports that “Teamwork Means Success—Work Together, Win Together.”

Assessing Team Situation Awareness in Simulated Military Missions

We developed a measure of team situation awareness (SA) to capture team members' shared mental model of the team. The measure assesses the congruence among team members about what actions they were performing at salient events during a simulated mission. We used this measure in a research program investigating adaptive architectures for command and control (A2C2). As hypothesized, the measure of team SA was positively correlated with team performance and process measures in three A2C2 experiments in which it was used. The relationship between team SA and a teamwork measure that is comprised of such underlying team processes as coordination behavior and communication behavior supports the underlying premise of a link between team mental models and team SA. Team SA was negatively correlated with a measure of team workload, suggesting that increased levels of workload adversely affect team SA.

Determinants of Perceived Teamwork: Examination of Team Performance and Social Psychophysiology

Team situation awareness (SA) has not received the same amount of research attention as individual SA. Given a lack of established relationships between objective and perceived measures of teamwork, as well as between team psychophysiology and perceived teamwork, the present study examined these potential relationships during a two-person, continuous tracking task. Seventeen two-person teams of undergraduates performed a computer-based, simulated teleoperation task. This investigation tested for relationships between objective performance measures (task completion time, team tracking error, coordination and collision damage), psychophysiological measures (electrodermal activity, heart inter-beat interval and respiration), and three subjective measures (team coordination, task engagement and task difficulty). The results suggest that objective team performance and some social psychophysiological measures (heart cross-correlation) contribute to team member perceptions of teamwork. Theoretical and practical implications of using all three techniques to assess team SA are discussed.

Improving the quality of service in an emergency room using simulation-animation and total quality management

In this paper, the authors demonstrate how the quality of service in an emergency room can be improved utilizing Total Quality Management (TQM) concepts and simulation-animation as a tool in the generation of feasible alternatives. Specifically, the simulation covers the complete flow of a patient through an emergency room. The processes covered in the simulation are triage, insurance filling, doctor visit, and other supporting resources such as laboratory, x-rays, ct-scan, recovery room, and respiratory therapy. In addition, an animation of the current system was developed to show hospital's management, the areas of opportunity for improvement. As part of the project, the hospital personnel was exposed to TQM concepts such as strategic planning, process improvement using statistical tools, teamwork, and performance measures focusing on quality. This project presents an innovative use of industrial engineering concepts applied to health service operations. As a result of this project, industrial engineering techniques are being utilized in other hospitals in the area.

The Relationship between Herzberg's Two-Factor Theory and Quality Improvement Implementation

ABSTRACTA study was conducted in nine organizations to investigate the relationship between the use of Herzberg's two-factor theory of job satisfaction and the successful implementation of quality improvement management (that is, total quality management, reengineering, quality improvement, etc.). Company respondents rated quality management implementation in their company based on six attributes: organization culture, customer focus, teamwork, problem solving, continuous improvement, and quality measurement. These same respondents were asked to describe a job-related event that was extremely satisfying and one that was dissatisfying. A relationship was found between the presence and use of Herzberg's motivators and quality improvement implementation success. Due to the variety of organizations included in the study, the conclusions would be applicable to most technical organizations.

Does the substitution of a resident for a flight nurse alter scene time?

The purpose of this study was to compare the performance of a nurse resident crew (N/R) to that of the usual nurse/nurse (N/N) crew in a helicopter transport service using scene time as a measure of overall teamwork. It was designed as a retrospective case control study carried out by a university-based helicopter emergency transport service. Emergency Medicine second-year residents who volunteered to be assigned to the helicopter transport service for 1 month rotations flew with an experienced flight nurse. This nurse/resident (N/R) team was compared to the usual nurse/nurse (N/N) team in scene trauma flights. The average ground time for the N/N crew (10.5 minutes, n = 43) was not significantly different from that of the the N/R crew (10.3 minutes, n = 43). This study suggests that an emergency medicine resident can be incorporated into a flight crew without adversely affecting scene time.

The Measurement and Evaluation of Collective Unit Training and Performance

Recent reviews of team training and team performance have drawn at least one common conclusion: Much more research needs to be conducted on the process of and methods for measuring and evaluating teamwork. The current absence of reliable, valid, and robust measures of teamwork hinders not only the development of optimal collective training strategies, but also team-oriented research, human resource management efforts, and organizational and systems development programs. The objectives of this symposium are to (a) present an overview of some key theoretical and methodological issues which confront researchers and practitioners concerned with teamwork, and (b) introduce several innovative concepts, methods, and procedures which can aid in solving some of the problems associated with the measurement and evaluation of teamwork. These objectives will be met, in part, through presentations which describe and discuss (a) a conceptual framework for analyzing and interpreting measures of collective behavior, (b) the application of complexity theory-based measures to team and organizational performance, (c) a measure of teamwork based on the confidence team members have in their individual and collective capabilities, and (d) a system which supports the measurement and evaluation of unit collective performance in a simulation network environment. (The essence of these presentations are captured in the four papers which follow this abstract.) The discussant will provide his summary of the key issues addressed, as well as some that were not addresses. Finally, inputs and active participation of the audience will be solicited. The desired impact of this symposium is a heightened awareness and appreciation of the need for more research on teamwork measurement methods and procedures. The long-term goal of the symposium is to stimulate that research.

A Confident Measure of Teamwork: The Efficacy of Confidence Assessment and Feedback Enhancement for Collective Training

The perceptions that team members have of each other's capabilities and the accuracy of those perceptions are very important in determining how well a team will perform. This paper describes a method for assessing, and the consequences of, team members' confidence in the capabilities of their peers. The mutual judgments of confidence are derived from knowledge each team member has of the capabilities of others to perform their respective tasks and to coordinate their actions with those of other team members. Implications of the accuracy of this knowledge and its impact on collective team training and performance are discussed.

Principles for Measuring Teamwork Skills

Performance measurement research has characteristically focused on the performance of individuals and has not addressed the measurement of teamwork skills. Dyer Suggested that this lack of teamwork measures presents serious problems for conducting team-oriented research because research efforts are often judged by the quality of the measurement device employed. In an effort to assess and advance the science of measuring teamwork, the current review examines the measurement of teamwork skills on theoretical, methodological, and psychometric grounds. Furthermore, we present a series of general principles to guide research in the future. Although some progress has been made, there is still much to be learned about the measurement of teamwork.