Team Judgments Research Articles

Mitigating Information Ambiguity through TSM and Reflexivity for Team Judgment Performance

Part of the work of hierarchical temporary teams found in Professional Service Firms (PSF), is to form judgments based on ambiguous information. In this study, we propose that teams that hold a similar understanding of their client’s situation, in other words, have similar team situation models (TSM), achieve stronger team judgment performance. In addition, we investigate whether a reflexivity intervention helps teams cope with information ambiguity. To test our hypotheses, we collected data from 94 ad-hoc, hierarchical teams of financial auditors from a Big 4 firm, participating in a 2x2 experiment of a judgment task, varying information ambiguity and participation in the reflexivity intervention. We examined two types of TSMs relevant to the context. On the one hand, we looked at the teams’ similarity of perception of the relevant information (TSMinfo) and on the other, the similarity of perception of the judgment complexity (TSMjdm). Our results show that (1) information ambiguity is not directly related to team performance, (2) teams facing high information ambiguity have stronger TSMinfo, (3) teams achieve higher judgment performance with more similar TSMinfo and more dissimilar TSMjdm and (4) reflexivity helps the formation of TSMinfo when information ambiguity is moderate but hurts when it is high.

Early Rooming Triage: Accuracy and Demographic Factors Associated with Clinical Acuity.

IntroductionEarly rooming triage increases patient throughput and satisfaction by rapidly assigning patients to a definitive care area, without using vital signs or detailed chart review. Despite these operational benefits, the clinical accuracy of early rooming triage is not well known. We sought to measure the accuracy of early rooming triage and uncover additional patient characteristics that can assist triage.MethodsWe conducted a single-center, retrospective population study of walk-in emergency department (ED) patients presenting to the ED via an early rooming triage system, examining triage accuracy and demographic factor correlation with higher acuity ED outcomes.ResultsAmong all patients included from the three-year study period (N = 238,457), early rooming triage was highly sensitive (0.89) and less specific (0.61) for predicting which patients would have a severe outcome in the ED. Patients triaged to the lowest acuity area of the ED experienced severe outcomes in 4.39% of cases, while patients triaged to the highest acuity area of the ED experienced severe outcomes in 65.9% of cases. An age of greater than 43 years (odds ratio [OR] 3.48, 95% confidence interval: 3.40, 3.57) or patient’s home address farther from the ED ([OR] 2.23 to 3.08) were highly correlated with severe outcomes. Multivariable models incorporating triage team judgment were robust for predicting severe outcomes at triage, with an area under the receiver operating characteristic of 0.82.ConclusionEarly rooming workflows are appropriately sensitive for ED triage. Consideration of demographic factors, automated or otherwise, can augment ED processes to provide optimal triage.

Fraud Brainstorming Group Composition in Auditing: The Persuasive Power of a Skeptical Minority

ABSTRACT We experimentally examine the effects of trait professional skepticism on fraud brainstorming performance. We find that groups with a minority, but not a majority, of high trait skeptics develop more fraud ideas than control groups with no high trait skeptics. Mediation analyses indicate that minority high trait skeptic groups also assess higher fraud risk, in part because they consider more fraud ideas. Low trait skeptics who brainstorm in groups with a minority of high trait skeptics tend to view the minority high trait skeptic as the best member of the group because of that member's unique insights. Their individual, post-brainstorming fraud risk assessments remain high, indicating conversion to the minority (skeptical) viewpoint. Our study contributes to the brainstorming literature by highlighting the importance of group composition. It suggests that firms can promote skeptical team judgments by leveraging individuals' high trait skepticism in thoughtfully composed interacting groups.

Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome.

Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome. Observational multicenter prospective study. Eight Italian PICUs belonging to the national PICU network Italian PICU network. One hundred thirteen patients, less than 18 years old, mechanically ventilated and treated with analgesic and sedative therapy for five or more days. They were admitted in PICU from November 2012 to May 2014. Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale. The occurrence rate of withdrawal syndrome was 64.6%. The following variables were significantly different between the patients who developed withdrawal syndrome and those who did not: type, duration, and cumulative dose of analgesic therapy; duration and cumulative dose of sedative therapy; clinical team judgment about analgesia and sedation's difficulty; and duration of analgesic weaning, mechanical ventilation, and PICU stay. Multivariate logistic regression analysis revealed that patients receiving morphine as their primary analgesic were 83% less likely to develop withdrawal syndrome than those receiving fentanyl or remifentanil. Withdrawal syndrome was frequent in PICU patients, and patients with withdrawal syndrome had prolonged hospital treatment. We suggest adopting the lowest effective dose of analgesic and sedative drugs and frequent reevaluation of the need for continued use. Further studies are necessary to define common preventive and therapeutic strategies.

Team Entrepreneurial Alertness: Initial Testing of an Emergent Model

Entrepreneurial activities are frequently undertaken by a team rather than by individuals acting alone. Building on the entrepreneurial alertness and entrepreneurial teams literatures, this study seeks to a) provide empirical evidence for the construct validation and measurement of entrepreneurial alertness at the team level, and b) examine the relationship of two specific team processes - team reflexivity and team monitoring - with team entrepreneurial alertness dimensions. The empirical work is done using a sample of 25 entrepreneurial teams. The values of the aggregation indexes, Rwg(j), ICC(1) and ICC(2), support the aggregation of the individual answers at the team level for the entrepreneurial alertness construct. Initial results indicate that team reflexivity is more associated with team alertness scanning and search, and team alertness association and connection; and team monitoring is more associated with team evaluation and judgment. These results are preliminary but open important research aven...

Venous-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: a clinical challenge.

Guidelines stated that extracorporeal membrane oxygenation (ECMO) may improve outcomes after refractory cardiac arrest (CA) in cases of cardiogenic shock and witnessed arrest, where there is an underlying circulatory disease amenable to immediate corrective intervention. Due to the lack of randomized trials, available data are supported by small series and observational studies, being therefore characterized by heterogeneity and controversial results. In clinical practice, using ECMO involves quite a challenging medical decision in a setting where the patient is extremely vulnerable and completely dependent on the medical team's judgment. The present review focuses on examining existing evidence concerning inclusion and exclusion criteria, and outcomes (in-hospital and long-term mortality rates and neurological recovery) in studies performed in patients with refractory CA treated with ECMO. Discrepancies can be related to heterogeneity in study population, to differences in local health system organization in respect of the management of patients with CA, as well as to the fact that most investigations are retrospective. In the real world, patient selection occurs individually within each center based on their previous experience and expertise with a specific patient population and disease spectrum. Available evidence strongly suggests that in CA patients, ECMO is a highly costly intervention and optimal utilization requires a dedicated local health-care organization and expertise in the field (both for the technical implementation of the device and for the intensive care management of these patients). A careful selection of patients guarantees optimal utilization of resources and a better outcome.

The Effects of a Supervisor’s Active Intervention in Subordinates’ Judgments, Directional Goals, and Perceived Technical Knowledge Advantage on Audit Team Judgments

ABSTRACT: Prior research shows that an audit supervisor’s active intervention in a subordinate’s judgment distorts that judgment. However, subordinates’ judgments are only one input into audit team judgments. How do supervisors finalize audit team judgments after actively intervening in their subordinates’ judgments? In an experiment using audit teams, supervisors with weaker or stronger goals to reach a client-preferred conclusion either were or were not asked to first actively coach a subordinate’s judgment (i.e., active intervention) before reviewing it and finalizing the audit team’s judgment. Supervisors’ intervention influenced subordinates’ inputs, which, in turn, supervisors incorporated into their final judgments. More interestingly, intervention biased supervisors’ final judgments, controlling for supervisor directional goal strength and for concurrent effects on subordinates’ inputs. However, supervisors distorted their judgments less as they perceived a larger technical knowledge advantage over subordinates. In a second experiment, auditors appear aware of the bias-reducing knowledge advantage effects but unaware of the bias-increasing active intervention effects. We discuss implications for audit team judgments and audit quality control.

The Effects of Audit Review Format on Review Team Judgments

SUMMARY: The promulgation of standards (e.g., PCAOB 2004b; IFAC 2008b) highlights the importance of workpaper documentation quality and its influence on audit quality. Our study matches audit workpaper preparers with reviewers to examine how alternative workpaper review methods affect sequential audit review team judgments through their impact on preparer workpaper documentation. While reviewers maintain the option of reviewing workpapers on site (“face-to-face review”), they can now also perform their reviews electronically from remote locations (“electronic review”) because of technological advancements such as email and electronic workpapers. Recent research has found that review mode can affect the judgments of auditors preparing the workpapers. Our study extends the literature by examining the extent to which review mode (electronic versus face-to-face) affects the quality of documentation in the workpapers and whether reviewers are able to discern and compensate for these documentation quality issues. Our results indicate that reviewers' judgments are ultimately affected by the form of review expected by their preparer. We test two alternative mediation models to provide insight into why the review format affects reviewer judgment quality. Mediation analyses suggest that the effect of review mode on reviewer judgments is mediated by a documentation quality assessment gap. Specifically, with electronic review, reviewers' burden to recognize and compensate for lower-quality documentation was generally greater, often resulting in lower-quality reviewer judgments than when the mode of review was face-to-face. These results suggest that the effect of review mode can persist to the reviewer's judgment through its influence on preparer workpaper documentation and the resulting documentation quality assessment gap.

Identifying and Evaluating Audit Issues: The Case of VITALOGISTICS

This case invites you to identify audit issues and evaluate an audit team's judgments and decisions on a new engagement (VITALOGISTICS). You will consider a variety of issues in the client acceptance, planning, execution, and reporting phases of an Integrated Audit. Identifying the audit issues and evaluating the audit team's decisions will enhance your: (1) appreciation of the role of research in audit practice; (2) recognition of the conflicting pressures faced by auditors and the potential for these pressures to compromise audit work; and (3) understanding of the requirements of the Integrated Audit and how it differs from the requirements of an audit of financial statements.

COMMENTARY: Balancing Sedation and Analgesia in the Critically Ill

The authors have presented a template for a systematic approach to comforting critically ill patients that can be modified to suit institutional preferences. In this algorithm, the cause of patient discomfort is sought with the priority given to pain and then to anxiety. Special attention is directed to the identification of correctable causes of pain and anxiety with application of nonpharmacologic techniques or medications to control patient discomfort. This step is followed by subsequent reassessment of the need for sedation or anxiolysis and titration or discontinuation of therapy as able. The benefits of protocol-driven care are becoming increasingly evident, and the authors believe the algorithm outlined here provides a rational and practical approach to patient management. It also prompts the caregiver to reevaluate patients' needs and to keep to patients at target sedation levels. Doing so can promote cost effectiveness, reduce side effects caused by drugs, and decrease morbidity and ICU stay. Any treatment protocol or algorithm is simply a guide to therapy and cannot address every clinical situation. The importance of individualized care and physician or care team judgment must be emphasized.

Judgment-Based Assessment

Clinical judgment is an important part of the professional repertoire of any diagnostician or treatment specialist. Collection of multisource data should be an essential feature of clinical work in order to substantiate judgments, prevent diagnostic or treatment errors, and protect clients. This is particularly important in the field of early intervention where many professionals work with the same child and family. Because these professionals represent various disciplines in the field and bring with them diverse skills and points of view, it is essential that these be examined and integrated to provide consistency. This article will (a) define areas in infant and preschool evaluation where clinical judgment is typically used, (b) argue that judgment-based assessment is only as good as the objectivity, reliability, and validity of its collection and use, (c) illustrate the necessity of operationalizing all aspects of clinical functioning, and (d) offer examples of procedures and clinical methods that have been designed to increase the probability of diagnostic accuracy. Examples of sources of error in individual and team judgments are provided to highlight the importance of protecting children and families by preventing clinical errors.

Developing a system for assigning individuals into an appropriate residential setting.

With the goal of maximizing the most suitable placement of elderly persons into different types of residential settings, a mathematical system is being developed, using discriminant function analysis, for replicating interdisciplinary clinical team judgments concerning case specific appropriateness for (1) an institutional setting; (2) an apartment in sheltered housing (providing at least the major meal of the day plus housekeeping services); and (3) an apartment in more traditional housing for the elderly. Two discriminant function systems are being developed--the first for separating elderly persons into those needing institutionalization and those requiring a less supervised setting and the second for separting persons judged not to be in need of institutionalization into those requiring either sheltered housing or some other more independent residency situation. While the first function is considered more fully developed at this time, the second is nevertheless useful in that is suggests forces (variables) predictive of such judgments.

One-to-One Process Analysis of Learning Disability Tutorial Sessions

The major aim of this project was to develop a research technique in order to observe, study, and process analyze children with learning disabilities in one-to-one teacher-child tutorial situations. The purpose was to isolate those effective elements (and the non-effective elements) in the teaching process which help (or hinder) learning of the presented subject matter. These objectives were achieved by devising and/or adopting an array of observational procedures, team judgment categories and standards, single person statistical techniques, and pretesting and posttesting. For brevity, the overall research technique is called the One-to-One Process Analysis Sytem. In Part I, published in September, a description and discussion of the system is presented. Part II is a case report for one child in this project. The results of pretests and posttests are included, with correlations and conclusions for the observations recorded. Part III, to appear in the November issue, will present the coding manual, the card layout, and the observation record form.

One to One process analysis of Learning Disability Tutorial Sessions

The major aim of this project was to develop a research technique in order to observe, study, and process analyze the behavior of children with learning disabilities in one-to-one teacher-child tutorial situations. The purpose was to isolate those effective elements (and the non-effective elements) in the teaching process which help (or hinder) learning of the presented subject matter. These objectives were achieved by devising or adopting an array of observational procedures, team judgment categories and standards, single person statistical techniques, and pretesting and posttesting. For brevity, the overall research technique is called the “One-to-One Process Analysis System.” This is Part I of the final report o f the research project. Part II will appear in October; Part III will appear in the November issue of this publication.