Team Functioning Research Articles

Improving communication during damage control surgery: a survey of adult major trauma centres in England.

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. An online survey was devised and distributed via the national programme of care for trauma in November 2020. Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

Enhancing Team Cohesion Through a Custom MOBA Game: Development, Implementation & Impact

The quality of a team in organizations has an impact on the success of the team in achieving their goals. Team building activities are one of the elements which can improve relationships in different kinds of teams. One of those can be playing competitive digital games, whether for teams working remotely or on site. This paper presents a case study that explores the design and development process of an innovative online game that combines elements of third-person action and multiplayer online battle arena (MOBA) games to provide an experience that strengthens team cohesion. The game design and mechanics support distribution of team roles based on Belbin's theory, highlighting the importance of diverse roles for balanced team functionality. By integrating unique character functions, the game encourages players to understand and appreciate the different roles individuals play in a team, enhancing empathy and mutual respect among team members. The game is uniquely designed to be simpler and more accessible than typical MOBAs, making it an ideal tool for educational and organizational settings to boost team cohesion and communication skills among people from various backgrounds. The leveling of the playing field allows individuals with minimal gaming experience to participate fully and effectively. The design principles ensure that the core mechanics of the game encourage teamwork and effective communication over individual skill, emphasizing collective success. The case study delves into the development process, the challenges faced, the solutions implemented, and the outcomes observed as part of a research project conducted between 2022-2023. The findings suggest that game-based learning can significantly transform traditional team-building methods, introducing a new paradigm for fostering high-performance teams in an increasingly digital world.

Nursing Students’ Perceived Ability to Practice Interprofessional Collaboration after the Inclusion of Virtual and Immersion Interprofessional Education Activities: A Quantitative Exploration

BackgroundLittle is known about the influence of interprofessional education (IPE) on interprofessional collaboration (IPC), particularly following the COVID 19 pandemic. AimTo examine nursing students’ perceived ability to practice IPC after exposure to virtual lectures and immersive clinical IPE activities founded on the competencies from the National Interprofessional Competency Framework. DesignA cross-sectional design was used. MethodsThird year nursing students (n=105) enrolled in a pediatric theory and clinical completed surveys including: Demographic items, the revised Interprofessional Collaborative Competency Attainment Survey (ICCAS) and the Interprofessional Education Collaborative Competency Self-Assessment (IPEC) (Version 3). Students completed reflective questions about their IPE experiences. Descriptive statistics, paired t-tests, confidence intervals and odds ratio measured the difference from pre- to post-participation for all items of the ICCAS and IPEC. ResultsParticipants reported improved IPC competence on every item and overall, after the IPE activities. Participants from urban campuses had lower ICCAS scores (OR 0.38, 95% CI, 0.12-0.65) than those from rural campuses (OR 0.45 95% CI 0.18 - 0.72). Students who identified as men had significantly higher team functioning scores before participating in the IPE activities than women (OR 0.50; 95% CI: 0.05 - 0.95). The IPEC Interaction items mean score was 4.03 ±.50 and IPE values items were higher with a mean of 4.62 ± 0.46. ConclusionsThe findings can guide development and implementation of IPE experiences for nursing and allied healthcare students.

Identifying emergent roles and their relationship with learning outcomes and collaborative problem-solving skills

Collaborative problem-solving (CPS) has become essential in today's society because it provides opportunities for deep learning and critical thinking. During CPS, students tend to spontaneously adopt different roles that facilitate the interactive process. Previous studies have focused on the influence of emergent roles on learning outcomes and CPS skills, but have rarely used procedural approaches to analyze the diversity of and changes in emergent roles during CPS. The availability of naturally occurring educational discourse data provides the opportunity to identify emergent roles at a fine-grained level. Therefore, this study identified emergent roles based on fine-grained coding and used hierarchical regression and epistemic network analysis to explore the influence of emergent roles on learning outcomes through CPS activities and their co-occurrence with CPS skills. The identification of emergent roles was based on observations of 54 undergraduates and postgraduates. The results showed that the participants played different, flexible roles during the CPS process. Roles focused on content and performance appeared more frequently, while those related to social emotion and evaluation were relatively less frequent. Furthermore, knowledge seeker and distractor significantly impeded the success of CPS activities, and harmonizer was conducive to high-quality learning outcomes. In addition, information giver always co-occurred with the skills of maintaining team function. Content- and performance-focused roles usually appeared together with negotiation and coordination. These findings highlight the importance of emergent roles during the CPS process, and provide some practical suggestions for improving learning outcomes and CPS skills.

Using System Dynamics for Local Authority Public Health practice in England

A key function of local authority public health teams in England is to undertake a regular health needs assessment of their population. This involves forecasting, among other things, prevalence and incidence of long term conditions and health care service demand. Over the last few years, Kent County Council Public Health has adopted the use of system dynamics modelling (SDM) to not only do this but generate scenarios to simulate the impact of different interventions across different cohorts defined by age groups and diagnosable conditions. These include “no conditions” as well as understand the combined effects of different interventions, demographic changes and wider health determinants. Risk factors, such as smoking, diet and physical activity, were calculated using local linked data for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty. These were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy was significant. SDM heavily influenced local authority commissioning decisions for health improvement services redesign such as smoking cessation, weight management as well as other secondary prevention measures such as hypertension management and cardiovascular disease screening delivered by General Practice and other health service partners.

Enhancing outcomes in IVF laboratories: navigating the human element through leadership and emotional intelligence.

We analyze the psychological and interpersonal aspects of in vitro fertilization (IVF)laboratory operations, highlighting how human factors such as leadership style, emotionalintelligence (EI), and team dynamics influence the effectiveness of IVF treatments. We alsoexamine the role of personality dynamics in team functioning and the adverse effects of toxicbehaviors on laboratory performance and morale. The manuscript comprehensively reviews contemporary literature about leadership styles, EI,and team dynamics. It also includes a detailed analysis of the ramifications of their operationswithin IVF laboratories. The primary emphasis resides in determining how these humanfactors contribute to the overall efficacy of IVF treatments and following patient outcomes. The findings suggest that staff well-being is not just a concern, but a critical factor inenhancing successful IVF outcomes. Leadership styles that promote emotional intelligenceand healthy team dynamics significantly improve laboratory performance. On the other hand,a toxic workplace negatively impacts staff well-being and patient outcomes. The studyhighlights the need for management development and EI training as vital components ofsuccessful IVF laboratory operations, reassuring the audience that these measures can lead toimproved outcomes. This manuscript presents the case for an equitable operational framework that recognizes thevalue of soft skills and technical expertise in IVF laboratories. It underscores the significanceof emphasizing the human element in reproductive medicine, proposing that by prioritizingempathy and delineating the contributions of the human factor, the field can achieve itsmaximum potential and enhance outcomes for staff members and patients. The pivotal role offuture research in empirically substantiating the influence of these human factors in realizingsuccessful IVF laboratories cannot be overstated, and we urge the academic community toparticipate actively in this crucial area of research.

Mitigating Misinformation Toolkit: Addressing COVID-19 Misinformation Through Interprofessional Learning and Collaboration Using a Standardized Patient-Based Educational Module.

Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

O43 - Understanding factors influencing team functionality at operative vaginal birth through multidisciplinary perspectives

O43 - Understanding factors influencing team functionality at operative vaginal birth through multidisciplinary perspectives

Equity in practice: Integrating cross cultural health brokers for culturally safe primary care for immigrants and refugees in British Columbia.

Umbrella Multicultural Health Co-op is a community health centre serving cultural communities of immigrants/refugees in British Columbia. It uses Cross Cultural Health Brokers (CCHBs), multicultural workers bridging patients and the healthcare system, to better meet the primary care needs of immigrant/refugee populations. Through the Team Primary Care initiative, Umbrella Co-op: (1) added new CCHBs alongside allied health practitioners; and (2) implemented team workshops and evaluation for quality improvement. The learning health system framework guided project activities. Comprehensive, culturally responsive primary care for immigrants and refugees benefits from a team-based approach that includes the integration of CCHBs. Team development activities improved team function. Co-developing evaluation with the interprofessional team enabled meaningful participation. Health system design for equity-oriented team-based primary care for immigrants and refugees should include resources for CCHBs and team development infrastructure.

First-year health professions students’ interprofessional identity development following participation in a brief introductory interprofessional activity: a qualitative study

ABSTRACT Healthcare providers need to simultaneously identify with their own profession and the broader interprofessional group to improve interprofessional team functioning and collaboration. The purpose of this study was to explore firstyear healthcare students’ interprofessional identity development following a brief introductory interprofessional activity. The Extended Professional Identity Theory (EPIT) served as the framework for this qualitative study. The sample included 1,047 students from 19 different health professions at one institution in the first semester of their professional program. Deductive content analysis was used to analyze students’ reflections from two reflective questions in a mandatory course evaluation survey. The 24-item version of the Extended Professional Identity Scale was used as a structured categorization matrix for deductive coding of student reflections to the three EPIT constructs: interprofessional belonging, commitment, and beliefs. Participant responses, spanning all three EPIT constructs, support the ability of early health professions learners to demonstrate the development of an emerging interprofessional identity. Future research is needed to assess IPI at various points across the curriculum and to explore between profession differences and the implications for foundational IPE design and learning along the continuum into practice.

Interprofessional Simulation for Nursing and Paramedicine Students: Community Anaphylaxis Management Following Immunization.

Interprofessional simulations are becoming an important aspect of learning for nursing students. Still, the execution of these types of simulations can prove challenging. Educational institutions often struggle to access faculties from different health care fields for interprofessional simulations. There is limited literature on operationalizing and implementing interprofessional simulations related to scenarios in the community, which makes creating these simulations challenging. Nursing and paramedicine educators from a university and a community college collaborated on a simulation centered on the management of immunization anaphylaxis in the community. Feedback from facilitators and students was positive. Both disciplines agreed that collaborative learning significantly enhanced role clarification, team functioning, conflict resolution, collaboration, and communication skills with team members. Challenges included coordinating schedules, space, and training of facilitators. Collaborating with other educational institutions to establish an interprofessional simulation can be complex, but the benefits significantly outweighed the challenges.

Prevalence, Best Practice Use, and Member Engagement on School Mental Health Teams.

School mental health (SMH) teams have been widely recommended to support multi-tiered mental health program implementation in schools. Available research suggests emerging best practices that promote effective SMH teaming and indicates the importance of having team members who are highly engaged (e.g., actively involved, retained on the team). Despite evidence that these factors improve team functioning, there is limited knowledge of SMH team prevalence, best practice use, and factors impacting member engagement among a diverse sample of elementary schools. This study surveyed a cross-sectional sample of elementary principals (n = 314) across the United States whose schools implement multi-tiered SMH programs. Most principals (89%, n = 280) reported using teams to organize these programs. Schools in urban/suburban communities, with 300 or more students, or with specific school funding for SMH activities were more likely to have SMH teams. Only one-third of principals reported that their team members participated in related training. Other SMH team best practices were commonly reported (by two-thirds or more teams). Results of a linear regression model indicate that larger teams (six or more members) and teams with access to resources had significantly higher member engagement scores. The study's findings provide recommendations for practice and future research directions.

Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study

BackgroundLack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.MethodsWe used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.ResultsForty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients’ health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it— “a grey area.” Establishing and maintaining a longitudinal relationship that responded holistically to patients’ needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients’ needs. Participants indicated NPs tried to address all of a patient’s concerns at each visit.ConclusionsNurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.

Barriers and Facilitators to Staff Recruitment and Retention for ACT Teams: Perspectives of Staff and Participants.

The behavioral health workforce has been experiencing deepening problems with recruitment and retention, particularly in publicly funded settings serving individuals with serious mental illnesses. This quality improvement project gathered Assertive Community Treatment (ACT) participant (service user) and provider perspectives on workforce challenges. The authors conducted 8 interviews with ACT participants and 9 focus groups with ACT current staff, team leaders, and former staff. Interviewees discussed barriers to recruitment and retention, including inadequate compensation, work becoming more task-oriented during periods of short staffing, a lack of understanding of what ACT work entails, and elements of the team-based model of care; and facilitators of recruitment and retention, including other aspects of the team-based model of care, connections with colleagues and ACT participants, and flexibility. ACT participants had variable experiences regarding availability of their teams. Recommendations from focus groups and interviews include increasing flexibility, improving awareness of ACT work, optimizing team functioning, addressing staff wellness, and attending to risk. Findings include key insights that may help address the critical workforce shortages in public behavioral health settings.

Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial.

To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES). iHI-FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews. In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval start date for iHI-FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non-CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI-FIVES implementation outcomes. The sample for assessing implementation outcomes included 571 Veterans referred to VA home- and community-based services and their family caregivers eligible for iHI-FIVES. Prior to iHI-FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI-FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm. Fidelity was high overall with 88% of expected iHI-FIVES trainings delivered, and higher among REP only (non-CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non-CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high-reach sites. CONNECT did not influence self-reported team function. A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI-FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI-FIVES reach with national expansion.

When and Why Team Time Urgency Diversity Promotes Team Functioning: The Role of Leader Planning

When and Why Team Time Urgency Diversity Promotes Team Functioning: The Role of Leader Planning

‘You shouldn't ignore it just because it's sensitive’: The perceived needs of healthcare professionals working in culturally diverse teams

AbstractHealthcare is often delivered by teams made up of culturally and demographically diverse members. Group diversity, for example, in terms of age, gender and/or culture, can bring a range of benefits, but also complex challenges for the functioning of healthcare teams. The literature suggests that cultural diversity is the most difficult issue for these teams to manage. Therefore, the aim of this study is to explore the perceived needs of healthcare professionals when working in culturally diverse teams. Data were collected through individual interviews with 23 healthcare professionals working in two hospitals in one municipality in southern Sweden. The data were analysed using an inductive content analysis approach. In the process of the analysis, two main categories of needs emerged: Favourable working conditions and guidance, and Commonalities. The findings highlight the need for the right work and team climate, as well as leadership, for culturally diverse teams to function well. In addition, the implementation and communication of rules and regulations, clarity of roles, and a shared understanding of cultural diversity, language, and the culture of care are important for these teams. By uncovering the needs expressed by healthcare professionals in relation to working in culturally diverse teams, our research provides important insights into the key enablers of the benefits of team diversity in the healthcare context.

Rudeness and team performance: Adverse effects via member social value orientation and coordinative team processes.

A growing body of research shows that rudeness negatively affects individual functioning and performance. Considerably less is known about how rudeness affects team processes and outcomes. In a series of five studies aimed at extending theories of the social-cognitive implications of rudeness to the team level, we show that rudeness is detrimental to team functioning. Using an experimental design, Study 1 shows that teams encountering rudeness perform worse than other teams. Study 2, a medical simulation study, explains this effect by showing that medical teams exposed to rudeness are less likely than other teams to share information and workload and, in turn, execute a variety of medical procedures less well. Studies 3a and 3b highlight the mediating role played by social value orientation (SVO), demonstrating that rudeness elicits these effects by diminishing members' SVO (i.e., making team members less prosocial and more pro-self). In turn, Study 4 shows that rudeness-diminished SVO explains reduced information sharing in teams. Finally, Study 5, a laboratory study, tests a full serial mediation model, demonstrating that rudeness decreases team members' SVO, which in turn reduces team information sharing and, as a result, encumbers team performance. Overall, these findings show that rudeness can have severe implications for team functioning and may even have life-threatening consequences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interprofessional Competency Acquisition in an Interprofessional Training Ward Four-Week Placement: “Teamwork Is What Is Going to Ensure Our Patients Are Happy and Safe”

Demand on education and health authorities to provide workplace based learning opportunities for students to acquire interprofessional collaborative practice competencies is increasing. This article outlines the acquisition of interprofessional competencies by pre-registration health professional students in a four-week interprofessional training ward placement. Four final-year health professional students (medicine, nursing, occupational therapy and physiotherapy), from two tertiary education institutes worked together on an assessment, treatment and rehabilitation ward for older adults based within a local tertiary hospital. Four competency domains were the focus for the placement: role clarification and appreciation; interprofessional communication; team functioning; and interprofessional coordination and shared decision-making. Sequential audio-recorded focus groups were undertaken with the students each week. Using template analysis, student reports on each of the four interprofessional competencies each week over the four-week period were explored. Findings demonstrated all students incrementally and differentially acquired the four competencies over the course of the placement. The period between week-two and week-three was a critical time for competency acquisition as the students encountered real-life clinical problems. The study contributes to a growing body of research demonstrating the potential for interprofessional training wards to enable competency acquisition for undergraduate health professional students, and that competency acquisition may be time sensitive.

Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration.

The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the 'Assisted Early Mobility for Hospitalized Older Veterans' program (STRIDE), an inpatient, supervised walking program. We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. Eight U.S. VAMCs. Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. CONNECT, a complexity-science-based intervention to improve team function. The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.