Team Performance Observation Tool Research Articles

Assessing Team Performance: A Mixed-Methods Analysis Using Interprofessional in situ Simulation.

Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams. This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis. Eighteen team-based simulations took place between January-April 2021. Raters' scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance. Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual's contribution to a team's performance.

The effect of TeamSTEPPS® mobile-based training on perceptions of teamwork and team performance of operating room staff

IntroductionTeamSTEPPS® aims to create an environment where all members feel comfortable to speak about patient safety concerns. The aim of this research was to determine the effect of TeamSTEPPS® mobile-based training on the perceptions of teamwork and team performance of operating room staff. MethodsThis study was a quasi-experimental method with measurements at baseline and after 2 months of intervention. The research samples included 105 OR staff (operating room technologists, anesthesia technologists, and nurses) working in 6 teaching hospitals of Iran University of Medical Sciences in 2022, which were selected by stratified random method and proportional allocation. The research tools included the demographic form, the Persian version of the ‘TeamSTEPPS® Teamwork Perception Questionnaire’ (T-TPQ) and the Persian version of the ‘Team Performance Observation Tool’ (TPOT). The intervention was carried out with sending the link of the TeamSTEPPS® 2.0 course files to participants by mobile messengers so that they could study them during five sessions, with an interval of one week between each session. Data analysis was done by calculating descriptive statistics and paired t-test. ResultsThe results showed that TeamSTEPPS® mobile-based training significantly improved the perception of teamwork (P < 0.011) and team performance of operating room staff (P < 0.001). ConclusionWith the determination of the effect of TeamSTEPPS® mobile-based training on the perception of teamwork and team performance of operating room staff, it is suggested to present this training program to this group.

Translation and psychometric validation of the Thai version of TeamSTEPPS® team performance observation tool

ABSTRACT In healthcare, effective communication and teamwork are pivotal in reducing medical errors. Integrating team training into health professions education is crucial. Accurate measurement of team performance during training requires reliable assessment tools. The TeamSTEPPS® Team Performance Observation Tool (TPOT), recently updated by the Agency for Healthcare Research and Quality, serves this purpose. However, it had not been translated and validated for use in Thailand. We aimed to translate and assess the psychometric properties of the Thai version of TPOT. Employing a back-translation process, TPOT was adapted to the Thai context. The resulting Thai TPOT instrument was administered to 518 healthcare professionals who had undergone TeamSTEPPS® training. Participants were asked to evaluate two prerecorded, 7-minute simulated team emergency scenarios using the Thai TPOT instrument. Results exhibited high internal consistency (Cronbach’s alpha = .96) and inter-rater reliability (ICC = .98). Confirmatory factor analysis affirmed the construct validity of the Thai TPOT. These findings establish the Thai TPOT as useful for evaluating teamwork within healthcare teams.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

IntroductionThe Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course “Simulation Trainer: Improving Teamwork through TeamSTEPPS®”. ObjectivesTo analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course. MethodsA cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires “TeamSTEPPS™ 2.0 Team Performance Observation Tool” to evaluate teamwork performance and “Educational Practices Questionnaire” for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively. ResultsBoth the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®. ConclusionsTeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

Programa de entrenamiento basado en TeamSTEPPS® mediante simulación clínica en profesionales de cuidados intensivos: un estudio con metodología mixta

IntroductionThe Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course «Simulation Trainer: Improving Teamwork through TeamSTEPPS®». ObjectivesTo analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course. MethodsA cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires «TeamSTEPPS™ 2.0 Team Performance Observation Tool» to evaluate teamwork performance and «Educational Practices Questionnaire» for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™, respectively. ResultsBoth the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®. ConclusionsTeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students’ curriculum).

Teaching and evaluating interprofessional teamwork using sequenced instruction and TeamSTEPPS™ Team Performance Observation Tool (TPOT)

Abstract This paper describes a semester-long interprofessional education (IPE) program focused on teaching health care students the knowledge and competencies needed to provide patient-centered collaborative care through a sequence of learning activities. To strengthen and expand IPE efforts at a large Midwestern university, graduate physical therapy, occupational therapy, and nurse practitioner students were enrolled in a one credit hour revised course on interprofessional case management. Students completed five sessions of coursework in which they studied pre-session online modules to acquire knowledge about provider roles and interprofessional communication, practiced conducting patient interviews and peer-teaching through student-led role plays, and worked in interprofessional teams on an unfolding patient case study, facilitated by faculty. At the end of the course, students were asked to self-rate and reflect on their team's performance for leadership, team structure, situation monitoring, mutual support and communication using 16 items from the TeamSTEPPS™ Team Performance Observation Tool (TPOT). Of 98 students enrolled in the course, 63 participated in the study (64.3% response rate). Students assessed all subscales, as well as the overall team performance, very positively with mean values above 4.5 on a scale with values from 1 (strongly disagree) to 5 (strongly agree); however, non-Caucasian students rated two subscales (situation monitoring and mutual support) significantly lower than Caucasian students. Student reflections emphasized patient-centeredness, respect for the other disciplines, and family-centered decision-making. Positive quantitative and qualitative results demonstrate a promising model for teaching the knowledge and skills health profession students need to provide interprofessional health care.

The Effects of Interprofessional Pediatric End-of-Life Simulation on Communication and Role Understanding in Health Professions Students.

The purpose of this study was to analyze the impact of interprofessional pediatric end-of life simulations for health professions students. A quasiexperimental design was used with three TeamSTEPPS® tools. Forty-one students were enrolled (nursing = 20, medicine = 10, pharmacy = 10, public health = 1). TeamSTEPPS 2.0 Teamwork Attitudes Questionnaire and Teamwork Perceptions Questionnaire analysis indicated a significant difference in mean pretest and posttest scores (p = .015 and p = .028, respectively). The Team Performance Observation Tool indicated statistical significance between simulations (p < .001, df = 18, r = .8). Simulations were significantly related to an increase in faculty observation scores, TeamSTEPPS 2.0 Teamwork Attitudes Questionnaire pre-post scores, and TeamSTEPPS 2.0 Teamwork Perceptions Questionnaire pre-post scores.

Interprofessional Simulation: Developing Teamwork Using a Two-Tiered Debriefing Approach

BackgroundEffective interprofessional education (IPE) positively impacts the quality of care. This article evaluates the effectiveness of an IPE simulation model that employed a two-tiered debriefing process with a cohort of medical, physiotherapy, and nursing students. MethodsUsing The TeamSTEPPS, Team Performance Observation Tool as a framework, this mixed methods study used observation, survey, and interview methods to collect data and evaluate the impact of a two-tiered debrief approach on students learning interprofessional communication and teamwork. The two-tiered approach consisted of two separate debriefings. These occurred concurrently after the simulation. The first debrief dealt with the scenario, clinical decision-making, and client outcomes. The second incorporated feedback from the Team Performance Observation Tool and focused learners on teamwork and communication. ResultsPositive changes in practice were demonstrated after debriefing in subsequent simulations, with statistically significant ratings suggesting that items for which students were given feedback for improvement were indeed improved in the next simulation. Furthermore, students reported significant learning, understanding other team member roles, strategies for team communication, and practical experience that substantially increased competencies and confidence in working together as a team. ConclusionsOverall, the IPE experience and design was successful. Further studies using this model with a larger sample would inform development of this model for effective use in health care education.

Alignment of an interprofessional student learning experience with a hospital quality improvement initiative

ABSTRACTAssessment of interprofessional education (IPE) frequently focuses on students’ learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students’ experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

P102: TeamSTEPPS: promoting a culture of safety

Introduction / Innovation Concept: Adverse events due to medical error are a significant source of preventable morbidity and mortality in Canada’s emergency departments. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was introduced in 2006 as a strategy to minimize these errors. Although these strategies have been available and widely implemented in hospitals over the last decade, the optimal method of teaching these tools and strategies has not been elucidated. Methods: We endeavoured to introduce a twelve month longitudinal TeamSTEPPS program to physicians, nurses, and allied health care professionals in a busy tertiary care hospital via a multi-pronged approach consisting of group huddles, props in the department, and several social media strategies. Dedicated observers in the emergency department recorded the use of the strategies by staff members to identify improved and sustained use of TeamSTEPPS behaviours after they were introduced. Curriculum, Tool, or Material: The program that consists of five modules to improve patient safety outcomes: Team structure; Leadership; Situation Monitoring; Mutual support; and Communication. Each module consisted of educational tools including posters in the department explaining the concepts, twice weekly department huddles to discuss the importance of the monthly topic and promote team sharing with real life examples, as well as stimulating and generating discussions around the monthly theme on social media (Facebook, Twitter, and an on-line blog). For several modules, extra prompts, such as I PASS the BATON handover cards were also provided to act as reminder visual cues. The first two modules were rolled out with on-line music videos rewritten to promote the significance of the modules. A team performance observation tool was adopted from the TeamSTEPPS program, and behaviors were evaluated and recorded under the five domains. Conclusion: Although unable to detect a meaningful difference in our pre and post-implementation observations, we present a novel approach to educating a multi-disciplinary team about TeamSTEPPS in a busy emergency department, along with the challenges encountered in this unique area of research, and recommendations for further study to interested parties. The TeamSTEPPS program likely could offer as much to the emergency department as similar programs have to the aviation industry yet it requires extensive investigation within this health care venue.

Teamwork education improves trauma team performance in undergraduate health professional students.

Purpose:Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation.Methods:We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared.Results:We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team’s ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM.Conclusions:Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

Board #206 - Program Innovation Simulations into Pre-clinical Education for Patient Safety and Teamwork Training (Submission #9754)

Objectives Teamwork training and patient safety efforts often focus on culture change.1 Introduction to these topics early in training may contribute to changing an institution’s culture. Of the few examples of undergraduate medical education patient safety courses appear in the literature, curricula involving pre-clinical students were rare2-3 and utilized primarily large lecture and small-group discussion formats.3 In contrast to patient safety for practicing providers, a major challenge in the pre-clinical years is to create the relevance needed to go beyond knowledge and attitudinal changes and achieve higher levels of Kirkpatrick’s framework such as behavioral changes. To achieve this, we describe a comprehensive year-long patient safety course that incorporates adult-learning principles, including “flipped classroom” and team-based learning, as well as technology-enhanced simulations.4 Description The Tulane Interprofessional Patient Safety course (TIPS) uses a combination of teaching methods to cultivate the appropriate degree of relevance to instruct pre-clinical students in patient safety. Students (n=200) work in peer teams composed of 3 medical and 3 nursing students. Pre-session work involves online modules from the Institute for Healthcare Improvement and “flipped classroom” background materials developed specially for the course. As described in the attached table, the curriculum uses a combination of small-group discussion, team-based learning, task-oriented simulations, and mannequin simulations to deliver the patient safety content. Measurements include knowledge, attitudinal, and perception assessments (Team Performance Scale, Value of Teams, and the Readiness for Interprofessional Learning Scale) as well as 360-degree peer evaluations, direct observation checklists using the Team Performance Observation Tool, and narrative descriptions of behaviors in conjunction with facilitated debriefing. Portions of the course (degree of team training) involved randomization. Students showed a significant increase in the attitudinal scores, perception of the value of teams as well as observed team performance during simulations. Conclusion Assess the degree to which the design objectives were achieved, accurate appraisal of limitations, discussion of next steps and future applications. Indicate how outcomes are relevant to potential benefits for healthcare simulation. Describe the contribution of the project to current knowledge, methods or technologies. This curriculum was intended to move patient safety in the pre-clinical years out of theoretical discussions and into hands-on activities more directly related to healthcare delivery. We were able to demonstrate some improvement in perceptions of teamwork and increased awareness of patient safety and clear observations of good teamwork and patient safety behaviors. However, it is not to what extent these improvements are the result of our interventions as control groups were unavailable in the majority of encounters. The extent to which students utilized teamwork training or patient safety material that were not provided by the curriculum (i.e. contamination) is another key limitation. By using various teaching methodologies and designing a curriculum that focuses on simulation scenarios, it is possible for pre-clinical students to demonstrate patient safety behaviors, in addition to increases in knowledge and attitudes.

Evaluation of the team performance observation tool with targeted behavioral markers in simulation-based interprofessional education

The primary aim of this study was to decrease the subjectivity of the Team Performance Observation Tool (TPOT) and determine the psychometric properties of this tool when using scenario-specific targeted behavioral markers (TBMs). We used a convenience sample of 47 physical therapy and 25 nursing students at an academic medical center who were organized in interprofessional teams of three to care for a simulated patient. The TPOT demonstrated satisfactory validity and reliability with the use of TBMs. We demonstrated significant correlations between the TPOT overall rating and two scenario-specific outcomes: (1) a negative correlation between the TPOT overall rating and the number of medical errors committed by the 24 teams (r = −0.531, p = 0.008) and (2) a positive correlation between the TPOT overall rating and a time-based functional outcome (r = 0.803, p < 0.001). We demonstrated substantial test–retest reliability (kappa = 0.707, p < 0.001), inter-rater reliability (kappa = 0.730), and good internal consistency reliability (Cronbach’s α = 0.921). The results of our study support the use of scenario-specific TBMs to enhance the reliability and validity of the TPOT for use in the evaluation of team-based simulation scenarios. Further evaluation of the TPOT with TBMs from other simulation and training contexts is warranted.

Two year cessation of resident teamwork training impacts trauma resuscitation performance and efficiency

METHODS: This prospective, observational study at a Level I trauma center used trained evaluators who scored team performance via the Trauma Team Performance Observation Tool (TPOT). Efficiency (minutes) data were collected for Emergency Department (ED) dwell times and time to FAST and computed tomography (CT) scan during the same time period TPOT scores were collected. Two year post training was compared to pretraining, post training, and one year post ongoing training periods. For each outcomes variable, the data were rank-transformed and analyzed using the analysis of variance. If p < 0.05, a Dunnett’s Multiple Range Test was performed.

Fire in Labor and Delivery: Simulation Case Scenario

Fire in Labor and Delivery: Simulation Case Scenario