Teamwork Processes Research Articles

Team trust and performance in pediatric trauma

Pediatric trauma cases involve multiple healthcare workers and a complicated coordination of care. The differing roles and changing hospital schedules means that trauma teams are constantly changing and each trauma case may involve a new team. Trust in these dynamic, high stakes environment is important for team performance. A survey on team trust, psychological safety, and team learning behavior was circulated by email to all roles that respond to the highest level trauma at a large, Midatlantic, level 1 pediatric trauma center. Seventy-seven participants responded and represented the emergency department, pediatric intensive care unit, surgery, respiratory therapy, pharmacy, technician, child life, social work, and spiritual care. The respondents generally scored high on measures of psychological safety; however, the majority (69%) did not agree that it was safe to take a risk on the team. Similarly, the respondents scored high on measures of team trust. Measures of team learning varied with the majority responding neither agree nor disagree on “In this team, someone always makes sure that we stop to reflect on the team's work process,” “People in this team often speak up to test assumptions about issues under discussion,” and “We invite people from outside the team to present information or have discussions with us”. The results show that these responses also vary by role and home department, but these differences were not statistically significant. Understanding current perceptions of team trust and learning will allow for targeted interventions to improve team communication and performance in pediatric trauma.

Nurses' production of meaning about National Program for Access and Quality Improvement Primary Care

Abstract Introduction The Brazil's Family Health Strategy (ESF) is one of the initiatives for the strengthening of primary health care (PHC) in Brazil. The ESF is composed of a team of professionals, with the nurse usually adding care and administrative functions. In regard to the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), the nurses have played a prominent role, especially in the external evaluation phase. Aim Analyze the meanings produced by nurses about the PMAQ-AB in a state in the northeastern of Brazil. Methods A qualitative research was carried out with twenty-five nurses from the health macro-regions of the State of Piauí. Data were collected from four focus groups, with one group in each macro-region, containing at least six and at most seven participants. The meetings were held from September to October 2018, in which semi-structured interview script was used. For the analysis of information, the maps of association of ideas proposed by Spink and Gimenes (1994) were used. Conclusions Despite the difficulties and conflicts felt by nurses with the implementation of PMAQ-AB, the program was understood as an agent for transforming in the work process of family health teams. In addition, the realization of this study allowed another space for reflection to the nurses about the program, qualification and financing of PHC, which can contribute to the institutionalization of the culture of monitoring and evaluation and also the consequent strengthening of these services. Key messages Based on the expected impacts, we seek collaborate with reflection on the experience and generate consistent and useful information to contribute to the decision-making processes of health policies. The PMAQ-AB was considered a program that was able to induce substantial changes in work processes because it was a way to finance the workforce.

Pembelajaran Berbasis Masalah sebagai Salah Satu Upaya Meningkatkan Kemampuan Analisis dan Penalaran Peserta Didik

Education aims to develop the potential of students to become quality human resources. The implementation of education takes place in a learning activity. Through the learning process there will be changes, development, progress, both in terms of physical, motoric, intellectual, social emotional and attitudes and values. One of the abilities that must be developed is the analytical and reasoning skills of students, because it will be used in solving problems in everyday life. This article aims to analyze an effective learning model to improve the analytical and reasoning skills of students. This research is a literature study. Analysis of effective learning models to improve the analytical and reasoning power of students is drawn from various references and research results. It was found that one of the learning models that can improve analytical and reasoning skills is the problem-based learning model. Problem-based learning uses a variety of intelligences needed to confront the real world. Problem-based learning is an innovation in learning because in PBL the thinking ability of students is really optimized through a systematic group or team work process so that students can empower, hone, test and develop their thinking skills on an ongoing basis.

RELATO DE EXPERIÊNCIA SOBRE AÇÕES DE PREVENÇÃO AO NOVO CORONAVÍRUS (COVID-19) POR UMA EQUIPE DE SAÚDE DA FAMÍLIA NO RIO GRANDE DO NORTE

Em janeiro de 2020, o novo coronavirus se espalhou para outros países da Ásia e Europa, onde a Organização Mundial da Saúde (OMS) declarou emergência em saúde pública de interesse internacional. Em março de 2020, a OMS classificou a doença causada pelo novo coronavirus como pandemia. O presente trabalho tem como objetivo relatar experiência vivenciada por parte de uma equipe de saúde da família do município de Equador no Estado do Rio Grande do Norte em ações de prevenção e combate a COVID-19. O processo de trabalho da equipe, observando o comportamento do novo coronavírus, fez pensar em estratégias que evitassem a contaminação tanto pelos profissionais quanto pela população. Além do mais, está gerando um novo modelo de atendimento e comportamento dos usuários na atenção básica.

The Teamwork Process Antecedents (TPA) questionnaire: developing and validating a comprehensive measure for assessing antecedents of teamwork process quality

Most models of teamwork describe team behavior and effectiveness using an Input-Process-Output approach. In software engineering, the use of such models has focused on understanding and operationalizing the Process-Output components while less research effort has been applied to define and measure the Input-Process component. To develop and validate a measure of teamwork process antecedents (inputs) that addresses specific characteristics of software teams in industrial practice. First, we reviewed the group work literature, identified and integrated previously described antecedents of work group process, and developed a measure to tap those antecedents. This measure is operationalized in the Teamwork Process Antecedents (TPA) questionnaire, which we then validated with 375 Brazilian software engineers from 100 companies, using exploratory and confirmatory factor analysis. We created a survey to operationalize two multidimensional antecedents of teamwork process, Team Structure and Team Composition, based on well-established models from the literature on work teams. We tailored the response items to the software engineering context to increase construct face validity. We reached a parsimonious set of five dimensions for Team Composition (16 response items) and four dimensions for Team Structure (11 response items). Our results show that our measure of TPA has excellent internal reliability and convergent and discriminant validity. We created a novel measure of antecedents of teamwork process tailored to software teams, that captures the perception of team members about the adequacy of team composition and structure to achieve team goals. Further, we present the development of the TPA measure in the form of a guideline that may be used in the construction of other measurement instruments in empirical software engineering research. We believe both results are important contributions of this work.

Service transitions, interventions and care pathways following remittal to prison from medium secure psychiatric services in England and Wales: national cohort study.

Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes. To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development. Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons. Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team. Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals' legal rights to ongoing aftercare are upheld.

Patient and Physician Perspectives on Training to Improve Communication Through Secure Messaging

Purpose To incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal, as well as identify management strategies that support patient engagement. Methodology Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern Academic Medical Center using Epic MyChart. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework adapted to patient portal implementation. Results Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multi-modal materials addressing how to navigate portal features and direction on when, what and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal, and communicate clear management expectations of physician portal management. Conclusion As communication via secure clinic-level management and training strategies to enhance patient portal use. Practice Implications Health system administrators and outpatient clinic management could implemented these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use. Key Words: patient portals, patient engagement, patient training, provider training, electronic health records

See with Your Eyes, Hear with Your Ears and Listen to Your Heart: Moving from Dyadic Teamwork Interaction towards a More Effective Team Cohesion and Collaboration in Long-Term Spaceflights under Stressful Conditions

The scientific study of teamwork in the context of long-term spaceflight has uncovered a considerable amount of knowledge over the past 20 years. Although much is known about the underlying factors and processes of teamwork, much is left to be discovered for teams who operate in extreme isolation conditions during spaceflights. Thus, special considerations must be made to enhance teamwork and team well-being for long-term missions during which the team will live and work together. Being affected by both mental and physical stress during interactional context conversations might have a direct or indirect impact on team members’ speech acoustics, facial expressions, lexical choices and their physiological responses. The purpose of this article is (a) to illustrate the relationship between the modalities of vocal-acoustic, language and physiological cues during stressful teammate conversations, (b) to delineate promising research paths to help further our insights into understanding the underlying mechanisms of high team cohesion during spaceflights, (c) to build upon our preliminary experimental results that were recently published, using a dyadic team corpus during the demanding operational task of “diffusing a bomb” and (d) to outline a list of parameters that should be considered and examined that would be useful in spaceflights for team-effectiveness research in similarly stressful conditions. Under this view, it is expected to take us one step towards building an extremely non-intrusive and relatively inexpensive set of measures deployed in ground analogs to assess complex and dynamic behavior of individuals.

Fluvial family health: work process of teams in riverside communities of the Brazilian Amazon.

This study aimed to understand and analyze the work process of fluvial family health teams in the context of riverside populations in the Brazilian Amazon. Action research was undertaken, conducting focus groups, individual interviews and participant observation with 27 workers of municipal teams of the state of Pará, in the Brazilian Amazon. The analysis was performed by the content, following the theoretical framework of the work process. The following themes emerged: work object of the teams; work agents (who are the workers?); work technologies (the instruments of the process in fluvial health teams); and challenges for achieving the purpose of the work process. Recognition of the work object centered on the needs of the individual, family and community. The center for permanent education, supply of materials and inputs to the teams were implemented, and improved workflow for referring users was observed.

Crisis checklist (Code Red) for the management of cardiac arrest during minimally invasive thoracic surgery: case report

BackgroundThe management of cardiac arrest during video assisted thoracic surgery is challenging. Checklist use improve the management of operating-room crises.Case presentation: Cardiac arrest (asystole) occurred during anatomical pulmonary resection by minimally invasive surgery. Conversion to thoracotomy was decided (thoracic surgeon and anesthesiologist conjointly) to check for absence of cardiac bleeding and to start cardiac massage (4 min no-flow). After few minutes, ventricular fibrillation occurred and persisted despite shocks. Extracorporeal life support with veno-arterial extracorporeal membrane oxygenation allowed a return of spontaneous circulation (45 min low-flow).ConclusionsThe patient survived without central neurologic deficit due to perfect team work process using a crisis check-list (strengthened by a comprehensive simulation program with crisis resource management).

Driving SMEs Through Nepotism and Individualism: A Cross Cultural Analysis & Implications for Enterprise Success in Sub-Sahara Africa

As we gravitate deeper into the 21st century, work patterns that drive productivity tend towards teamwork, group specialization, hi-tech and hi-touch processes. This study in acknowledging this new paradigm advocates the adoption of the twin practices of nepotism and individualism for African SMEs. The authors argue that given the peculiar cultural inclinations of Africans where socio-economic activities are woven around family subsistence and individualism in optimizing skills and competences, coupled with readily available labour in most African families; it will be economically wise to drive SMEs set-up and start-ups through family. The authors contend that given the weak capacities of African entrepreneurs competitively, they can become effective if they make a strategic retreat and gradually develop their enterprises via deploying family resources cost effectively to increment capacities for productivity. The paper in examining extant literature evidenced the application of nepotism and individual acumen in the growth of enterprises across notable cultures in the world. Theories of entrepreneurship lending credence to arguments canvassed include Cantillon’s theory, the Knightian theory, the individual-opportunity nexus theory and the Mill’s theory of individualism among others. These along with empirical studies outcome cited reveal the immense benefits and successes recoverable in the creation/administration of SMEs along these dimensions. In the light of these benefits, the authors suggest among others that policies of government in sub-Saharan Africa should tilt towards incentives for family-patterned SMEs. It also advocates for a platform were innovative SMEs can receive recognition and sponsorship from government and trade/industrial associations. Finally, the paper suggests that SMEs in Africa link up via the Internet with SMEs abroad with a history of family business to learn success and survival strategies and gradually become global players themselves.

Public oral health services performance in Brazil: Influence of the work process and service structure.

The quality of oral health care might be evaluated based on Donabedian’s structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or ≥ the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or ≥ 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA ≥ 1 and 37.05% presenting FDA ≥ the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA ≥ 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA ≥ the mean. OHTs with better structural and work process conditions had better performance.

O Acesso Avançado como estratégia de organização da agenda e de ampliação do acesso em uma Unidade Básica de Saúde de Estratégia Saúde da Família, município de Diadema, São Paulo

Introdução: Pressionadas pela demanda e por agendas lotadas, equipes de saúde têm discutido estratégias de reorganização da agenda e ampliação do acesso. O Acesso Avançado vem ganhando espaço nesta discussão como uma estratégia desenvolvida nos Estados Unidos, que tem como princípio “Faça hoje o trabalho de hoje!”. Propôs-se descrever a influência da implantação do Acesso Avançado sobre acesso ao atendimento de usuários numa Unidade de Saúde da Família no município de Diadema. Métodos: Tratou-se de um relato de experiência da gerente da unidade no processo de implantação do Acesso Avançado, com a proposta de analisar as agendas e os relatórios de produção dos profissionais de saúde (médicos, enfermeiros e técnicos de enfermagem) no período de janeiro de 2017 a abril de 2018 e apresentar estatística descritiva da influência do Acesso Avançado sobre os atendimentos desses profissionais. O Acesso Avançado foi amplamente discutido com a equipe e com o conselho gestor, num processo de construção conjunta de fluxos e novas agendas. Resultados: Identificou-se aumento de 157% no número de usuários atendidos em consultas, passando de 1.048 em janeiro de 2017 para 2.694 atendimentos em abril de 2018, e queda de 13% para 2% na taxa de faltas dos usuários às consultas. Conclusão: Pôde-se demonstrar que a estratégia foi efetiva na ampliação do acesso ao serviço de saúde, gerando também efeitos positivos na organização da agenda e dos processos de trabalho das equipes. Espera-se contribuir e fomentar discussões acerca da otimização do acesso à Atenção Primária à Saúde (APS), suas complexidades e peculiaridades, e propor análise da influência do Acesso Avançado sobre os demais atributos da APS, particularmente nos atributos de longitudinalidade e integralidade do cuidado.

Patient Perceptions and Real-Time Observations of Bedside Rounding Team Communication: The Interprofessional Teamwork Innovation Model (ITIM)

Interdisciplinary rounds are designed to address barriers to teamwork, communication, and quality patient care. This study used multiple methods (observations, patient surveys) in two hospital sites to examine communication and teamwork in the Interprofessional Teamwork Innovation Model (ITIM). Observations of 68 ITIM teams that completed 685 patient visits were conducted in a 302-bed community-based acute care hospital (CH) and a 569-bed academic medical center (AMC) in one academic health care system. Patients were asked to complete surveys about their experience with their ITIM team. Length of stay (LOS) in the CH was significantly and negatively associated with team structures and communication processes. LOS in the AMC was associated with communication processes. Geographic cohorting was a system factor associated with teamwork and communication processes that affect patient care and quality. A variety of communication processes were operating in ITIM teams, including soliciting questions from patients and staff, politeness, rapport, speaking percentages, and team-oriented communication. Patients were satisfied with their ITIM experience, indicating that their encounters were collaborative and supportive and contributed to their care experience. This multimethod study illustrates the value of system-level approaches to structured patient-centered team care delivery and understanding the complexity of communication in team-based patient care. Findings suggest that when patients feel they are given opportunities to ask questions, speak without being interrupted, and have their questions answered, they tend to be satisfied with their experience of care. Health care leaders may consider ITIM to advance their mission of improving patient experiences and quality of bedside care.

PROGRAMA NACIONAL DE MELHORIA DO ACESSO E DA QUALIDADE DA ATENÇÃO BÁSICA: VISÃO DE ENFERMEIROS

Objetivo: compreender os reflexos da implementação do Programa Nacional de Melhoria doAcesso e da Qualidade da Atenção Básica no processo de trabalho de equipes da Estratégia Saúdeda Família, a partir da visão de enfermeiros.Método: pesquisa qualitativa, descritiva e exploratória, desenvolvida com nove enfermeiros nointerior do Rio Grande do Sul. As entrevistas foram realizadas entre janeiro e abril de 2017 esubmetidas à análise temática.Resultados: os padrões de qualidade requeridos pelo Programa contribuem para a superação daslacunas da organização e assistência dos serviços de saúde. A pactuação de metas e indicadoresincitam a mobilização dos atores envolvidos, intermediando ações, manejos e recursos, suprindoas necessidades das equipes.Conclusão: a implementação do Programa nas equipes trouxe melhorias no acesso e na qualidadeno contexto estrutural, equipamentos e insumos, refletindo diretamente no processo de trabalhodas equipes.

Patient and physician perspectives on training to improve communication through secure messaging: Clarifying the rules of engagement.

The aim of the study was to incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal as well as to identify management strategies that support patient engagement. Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern academic medical center using Epic MyChart were performed. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety 2.0 framework adapted to patient portal implementation. Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multimodal materials addressing how to navigate portal features and direction on when, what, and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal and communicate clear management expectations of physician portal management. As communication via secure messaging has become more common, our study identified patient, physician, portal and health system-level management and training strategies to enhance patient portal use. Health system administrators and outpatient clinic management could implement these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use.

Learning to be an interdisciplinary researcher: incorporating training about dispositional and epistemological differences into graduate student environmental science teams

The interdisciplinary research (IR) that is necessary for the creation of innovative solutions for the many complex environmental challenges facing society requires collaboration and the sharing and integration of knowledge from different disciplines in teams. Higher education programs should deploy effective pedagogical approaches to train students in interdisciplinary, team research collaboration. This paper discusses the design of three learning modules that supported the development of collaboration and teamwork skills among doctoral students during an IR workshop held in 2017 at the University of Texas at El Paso. The module activities were scaffolded to provide multiple opportunities for students to develop knowledge about the impacts that individual dispositional characteristics and differences in epistemological philosophies can have on teamwork processes. The activities and the workshop overall created opportunities for the students to apply this knowledge in a variety of authentic, collaborative contexts. An inquiry approach to pedagogical practice was used to address two key questions: (1) Did the learning modules increase knowledge of the impact of sharing dispositional features of team members on the practice of IR? (2) How confident were workshop participants in their ability to adapt to dispositional and epistemological diversity during future IR team activities? Results from a post-workshop questionnaire data, group reflections, and retrospective pre- and post-assessment showed (1) participants learned and practiced essential collaborative skills in authentic contexts; (2) the modules were valued and helped participants recognize the important role that personal dispositional characteristics have on the development of effective IR teams; (3) participants’ confidence in adapting to differences among team members increased; and (4) participants recognized that effective collaboration is an emergent property of a team that benefits from the overall intentionality of using a defined process and communication strategy.

Practical actions for fostering cross-disciplinary global health research: lessons from a narrative literature review

IntroductionGlobal health research involves disciplines within and beyond the health sciences. A cross-disciplinary collaborative research approach enables an interchange of knowledge and experience and stimulates innovative responses to complex health...

Evaluation of the effect of multidisciplinary simulation-based team training on patients, staff and organisations: protocol for a stepped-wedge cluster-mixed methods study of a national, insurer-funded initiative for surgical teams in New Zealand public hospitals

IntroductionNetworkZ is a national, insurer-funded multidisciplinary simulation-based team-training programme for all New Zealand surgical teams. NetworkZ is delivered in situ, using full-body commercial simulators integrated with bespoke surgical models. Rolled...

IMPACT OF BIM ON BUILDING DESIGN QUALITY

During last decades, the aim of new technologies was to develop new information systems to automate manual processes. Large-scale projects in the field of construction industry need a different approach to organize and analyze data creating a database without any duplication or redundancy. Building Information Modeling (BIM) is a teamwork process using advanced technologies to generate data modeling. Based on a literature review, the present research proposes a set of hypotheses that links BIM implementation with the enhancement of information sharing capability (ISC) and collaborative decision capability (CDC) in the construction sector of the building industry. Consequently, it relates the degree of BIM use to the design quality enhancement using ISC and CDC as mediators. Towards this end, the research adopts three sets of criteria namely, functionality, form and aesthetic values, and building construction quality as indicators to design quality improvement. Finally, the research proposes a new conceptual model to set the potential relations between the different variables included in the study. Hence it offers several implications for practitioners and decision makers concerning the importance of BIM to enhance the design quality.