Team Training Program Research Articles

Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program

BackgroundAchieving a culture of safety is believed to be an important mechanism for improving patient safety. The Safety Attitudes Questionnaire (SAQ) measures provider perceptions of patient safety culture across six...

Teamwork behaviours and errors during neonatal resuscitation

ObjectiveTo describe relationships between teamwork behaviours and errors during neonatal resuscitation.MethodsTrained observers viewed video recordings of neonatal resuscitations (n = 12) for the occurrence of teamwork behaviours and errors. Teamwork...

Simulation-based education for building clinical teams.

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented.

Análisis de las competencias directivas de una red de salud pública

Analysing the effectiveness of training-action methodology in developing and strengthening the skills required by public health network managerial staff. The study evaluated an educational programme (pre- and post- evaluation being applied within the programme's framework and conditions, without controlled conditions) in which 37 managerial staff from the Talcahuano Health Service Network (forming part of the Public Health Assistance Network) participated in the Managerial Team Training programme, 2007 and 2008, run by the Bío-Bío University's Entrepreneurial Science Faculty in Chile. A skill-based self-evaluation instrument was applied on two different occasions. The results revealed a lack of management skills-based training in network managerial teams and the need for it through training-action methodology which stimulates such needed managerial skills. Acquiring these skills will lead to providing users with a quality service through better management practice in public health establishments.

What Are the Critical Success Factors for Team Training in Health Care?

Ineffective communication among medical teams is a leading cause of preventable patient harm throughout the health care system. A growing body of literature indicates that medical teamwork improves the quality, safety, and cost-effectiveness of health care delivery, and expectations for teamwork in health care have increased. Yet few health care professions' curricula include teamwork training, and few medical practices integrate teamwork principles. Because of this knowledge gap, growing numbers of health care systems are requiring staff to participate in formal teamwork training programs. Seven evidence-based, practical, systematic success factors for preparing, implementing, and sustaining a team training and performance improvement initiative were identified. Each success factor is accompanied by tips for deployment and a real-world example of application. (1) Align team training objectives and safety aims with organizational goals, (2) provide organizational support for the team training initiative, (3) get frontline care leaders on board, (4) prepare the environment and trainees for team training, (5) determine required resources and time commitment and ensure their availability, (6) facilitate application of trained teamwork skills on the job; and (7) measure the effectiveness of the team training program. Although decades of research in other high-risk organizations have clearly demonstrated that properly designed team training programs can improve team performance, success is highly dependent on organizational factors such as leadership support, learning climate, and commitment to data-driven change. Before engaging in a teamwork training initiative, health care organizations should have a clear understanding of these factors and the strategies for their establishment.

The active components of effective training in obstetric emergencies

Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric-specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self-directed infrastructural change.

Surgical Team Training

To develop and implement a team-training curriculum. We hypothesized that better interactions between personnel would lead to improved patient safety, increased efficiency, and better staff satisfaction. Prospective assessment of a team-training program. University-affiliated hospital. Operating room physicians, nurses, technicians, and other personnel. Four-hour classroom curriculum, intraoperative coaching on team-related behaviors, and follow-up feedback sessions. Baseline metrics and observational data were collected for 3 months before implementing the team-training program and 6 months after a designated implementation date. A questionnaire regarding perceptions of teamwork was completed at the beginning of and 6 weeks following the team-training classroom session. Six months after implementation of team training, compliance with preoperative briefings was 66%. No changes in hospital metrics were observed. An improved perception of teamwork among the participants was demonstrated in pretraining and posttraining surveys. Perceptions of teamwork and the utility of a preoperative briefing differed among nurses, surgeons, and anesthesiologists. Our team-training program resulted in moderate compliance with behaviors taught in the curriculum. Even with only moderate compliance, we demonstrated improved perceptions of teamwork.

Simulation-Based Crisis Team Training for Multidisciplinary Obstetric Providers

The use of team training programs is promising with regards to their ability to impact knowledge, attitudes, and behavior about team skills. The purpose of this study was to evaluate a simulation-based team training program called Obstetric Crisis Team Training Program (OBCTT) (based on the original training program of Crisis Team Training) framed within a multilevel team theoretical model. We hypothesized that participation in OBCTT would positively impact 10 variables: individual's knowledge (about team process and obstetric emergency care); confidence and competence in handling obstetric emergencies; and participant attitudes (toward the utility of a rapid response team, simulation technology as a teaching methodology, the utility of team skills in the workplace, comfort in assuming team roles; and individual and team performance). Improvement of objectively measured team performance in a simulated environment was also assessed. Twenty-two perinatal health care professionals (attending physicians, nurses, resident, and nurse midwives) volunteered to participate in this pretest-posttest study design. All participants were given an online module to study before attending a 4-hour training session. Training consisted of participation in four standardized, simulated crisis scenarios with a female birthing simulator mannequin. Team simulations were video recorded. Debriefings were conducted after each simulation by having team members review the video and discuss team behaviors and member skills. Self-report measures of perinatal and team knowledge as well as several attitude surveys were given at the beginning and again at the end of the training session. A postsimulation attitude survey was administered immediately after the first and last simulation, and a course reaction survey was administered at the end of the training program. Objective task completion scores were computed after each simulation to assess performance. There were significant (P<0.004) improvements in three of the outcome variables, after controlling for type I error with Bonferroni's correction; attitudes toward competence in handling obstetric emergencies (t=1.6), as well as individual (t=4.2), and team performance (t=4.1). The remaining 6 variables, attitude toward simulation technology, attitude toward the rapid response team; confidence in handling obstetric emergencies; utility of team skills in the workplace; comfort in assuming various team roles; and knowledge, were not statistically significant. Overall task completion from the first to the last simulation (XF, df=3, n=3, 8.2, P=0.042) substantially improved (P<0.05). The crisis team training model is applicable to obstetric emergencies. Trainees exhibit a positive change in attitude; perception of individual and team performance, and overall team performance in a simulated environment. The ability of individuals to accurately assess their performance improved as a result of training.

Does Team Training Work? Principles for Health Care

Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care.

Developing Expert Medical Teams: Toward an Evidence‐based Approach

Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research.

Toward a Definition of Teamwork in Emergency Medicine

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

Assessing the Impact of the Trauma Team Training Program in Tanzania

In sub-Saharan Africa, injury is responsible for more deaths and disability-adjusted life years than AIDS and malaria combined. The trauma team training (TTT) program is a low-cost course designed to teach a multidisciplinary team approach to trauma evaluation and resuscitation. The purpose of this study was to assess the impact of TTT on trauma knowledge and performance of Tanzanian physicians and nurses; and to demonstrate the validity of a questionnaire assessing trauma knowledge. This is a prospective study of physicians and nurses from Dar es Salaam undergoing TTT (n = 20). Subjects received a precourse test and, after the course, an alternate postcourse test. The equivalence and construct validity of these 15-item multiple-choice questionnaires was previously demonstrated. After the course, subjects were divided into four teams and underwent a multiple injuries simulation, which was scored with a trauma resuscitation simulation assessment checklist. A satisfaction questionnaire was then administered. Test data are expressed as median score (interquartile ratio) and were analyzed with the Wilcoxon's signed rank test. After the TTT course, subjects improved their scores from 9 (5-12) to 13 (9-13), p = 0.0004. Team performance scores for the simulation were all >80%. Seventy-five percent of subjects were very satisfied with TTT and 90% would strongly recommend it to others and would agree to teach future courses. After completion of TTT, there was a significant improvement in trauma resuscitation knowledge, based on results from a validated questionnaire. Trauma team performance was excellent when assessed with a novel trauma simulation assessment tool. Participants were very supportive of the course.

209: Implementation of a Team Training Program for Trauma Care: The BETTER (Bringing Enhanced Team Training to the Emergency Room) Initiative

209: Implementation of a Team Training Program for Trauma Care: The BETTER (Bringing Enhanced Team Training to the Emergency Room) Initiative

Research team training: moving beyond job descriptions

Providing appropriate training to research team members is essential to the effective implementation and overall operation of a research project. It is important to identify job requirements beyond those listed in the job description in order to fully assess basic and supplementary training needs. Training needs should be identified prior to and during the conduct of the study. Methods for delivering the training must also be identified. This article describes the identification of training needs and methods in the design of a research team training program using examples from an HIV prevention intervention trial with adolescent girls.

Team Training and Stroke Rehabilitation Outcomes: A Cluster Randomized Trial

Strasser DC, Falconer JA, Stevens AB, Uomoto JM, Herrin J, Bowen SE, Burridge AB. Team training and stroke rehabilitation outcomes: a cluster randomized trial. ObjectiveTo test whether a team training intervention in stroke rehabilitation is associated with improved patient outcomes. DesignA cluster randomized trial of 31 rehabilitation units comparing stroke outcomes between intervention and control groups. SettingThirty-one Veterans Affairs medical centers. ParticipantsA total of 237 clinical staff on 16 control teams and 227 staff on 15 intervention teams. Stroke patients (N=487) treated by these teams before and after the intervention. InterventionThe intervention consisted of a multiphase, staff training program delivered over 6 months, including: an off-site workshop emphasizing team dynamics, problem solving, and the use of performance feedback data; and action plans for process improvement; and telephone and videoconference consultations. Control and intervention teams received site-specific team performance profiles with recommendations to use this information to modify team process. Main Outcome MeasuresThree patient outcomes: functional improvement as measured by the change in motor items of the FIM instrument, community discharge, and length of stay (LOS). ResultsFor both the primary (stroke only) and secondary analyses (all patients), there was a significant difference in improvement of functional outcome between the 2 groups, with the percentage of stroke patients gaining more than a median FIM gain of 23 points increasing significantly more in the intervention group (difference in increase, 13.6%; P=.032). There was no significant difference in LOS or rates of community discharge. ConclusionsStroke patients treated by staff who participated in a team training program were more likely to make functional gains than those treated by staff receiving information only. Team based clinicians are encouraged to examine their own team. (ClinicalTrials.gov identifier NCT00237757).

The Interdisciplinary Team and Polytrauma Rehabilitation: Prescription for Partnership

Strasser DC, Uomoto JM, Smits SJ. The interdisciplinary team and polytrauma rehabilitation: prescription for partnership.Optimal outcomes for polytrauma survivors depend on the integration of complex medical, psychosocial, financial, educational, and vocational resources across diverse specialties and multiple medical centers, programs, and organizations and all in a setting of high public visibility and family involvement. Well-functioning teams are critical to service integration, and teams are more effective in supportive hospital environments. Here, we offer a model of team functioning relevant to polytrauma and outline a team training program to improve services. Furthermore, we propose a partnership among the team, hospital administrators, and national leaders and with patients and their families. Integrated care requires partnerships among the various stakeholders, and those working in polytrauma have a unique opportunity to create an updated paradigm of the team approach responsive to the complexities of contemporary health care.

A Team Training Program Using Human Factors to Enhance Patient Safety

Beginning in 2005, the aorn foundation and Safer Healthcare implemented a human factors program based on Crew Resource Management training in five diverse surgical facilities across the United States. Highly interactive, customized training sessions were designed to help clinicians standardize communication, enhance teamwork, implement preprocedure briefings and postprocedure debriefings, maintain situational awareness, and recognize red flags in the workplace. Pretraining and post-training surveys were used to determine the effectiveness of the program. Brief overviews from the participating facilities detail specific issues encountered in each setting.

Medical Team Training: Applying Crew Resource Management in the Veterans Health Administration

Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room (OR) unit's adoption of "Rules of Conduct" for expected staff behavior, and an ICU team's use of the model for daily administrative briefings. An MTT program based on applied CRM principles was successfully developed and implemented in 43 VA medical centers from September 2003 to May 2007.

Crisis Resource Management: Evaluating Outcomes of a Multidisciplinary Team

Crisis resource management (CRM) is a team-training program that teaches nontechnical skills such as: collaboration, communication, task management, teamwork, and leadership. The purpose of this study was to evaluate improvement in the nontechnical skills of a multidisciplinary team of pediatric residents, anesthesiology residents and pediatric nurses following participation in the CRM educational program. Self-efficacy theory guided the teaching method used in the CRM program. The Collaboration and Satisfaction about Care Decisions instrument and the Anesthetists' Nontechnical Skills System served as outcome measures. Seven multidisciplinary groups were studied with a total of 40 subjects. A significant increase was found in posttest scores for perceived collaboration and satisfaction with care and in numerical ratings of observed team skills following the CRM program. The results suggest multidisciplinary team participation in the CRM program increased perceived team collaboration, satisfaction with care, and observed teamwork skills.

Effects of Basketball Training on Maximal Oxygen Uptake, Muscle Strength, and Joint Mobility in Young Basketball Players

The purpose of this study was to examine the effects of prolonged basketball skills training on maximal aerobic power, isokinetic strength, joint mobility, and body fat percentage, in young basketball players, and controls of the same age. Twenty basketball players and 18 control boys participated in the study. Basketball players participated both in their school's physical education program and in a children's basketball team training program. Controls participated only in their school's physical education program. All subjects were tested every 6 months (18 months total, 11(1/2), 12, 12(1/2), 13 years old) for VO(2)max, peak torque values of the quadriceps and hamstrings at 180 and 300 degrees x s(-1) and range of motion of the knee and hip joints. Body fat percentage was assessed at the beginning and the end of the experimental period. Results showed that the basketball group had lower heart rate values in all ages and higher VO(2) values in the initial test compared with the control in submaximal intensity. The VO(2)max was altered in both groups on the final test, when compared to the initial test. However, the basketball group had a higher VO(2)max on each of the 6-month follow-up measurements, compared to the control group (p < 0.001). At the end of the 18-month follow-up period no significant differences were observed in isokinetic strength and joint mobility of the lower limbs between the 2 groups. On the contrary, the boys of the trained group had significantly lower percentage body fat values, compared to controls. In conclusion, regular basketball training increased aerobic power and decreased body fat percentage of prepubescent boys, while it did not affect muscle strength and joint mobility of the lower limbs. The major implication suggested by the findings of the present study is that, in order to improve the basic physical components, specific training procedures should be incorporated during the basketball training sessions. It is recommended that all children should be involved in some type of cardiovascular and resistance training program.