Teamwork Behaviors Research Articles

Leaders’ and followers’ individual experiences during the early phase of simulation-based team training: an exploratory study

BackgroundA growing body of evidence shows that team training can develop essential team skills and contribute to better patient outcomes. Current simulation-based team training (SBTT) programmes most often include targets...

Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department

BackgroundCincinnati Children's Hospital is one of the busiest paediatric emergency departments (ED) in the USA; high volume, high acuity and frequent interruptions contribute to an increased risk for error.ObjectiveTo improve...

Speaking up and sharing information improves trainee neonatal resuscitations.

To identify teamwork behaviors associated with improving efficiency and quality of simulated resuscitation training. Secondary analysis of a randomized controlled trial of trainees undergoing neonatal resuscitation training was performed. Trainees at a large academic center (n = 100) were randomized to receive standard curriculum (n = 36) versus supplemental team training curriculum (n = 62). A 2-hour team training session focused on communication skills, and team behaviors served as the intervention. Outcomes of interest included resuscitation duration, time required to complete a simulated newborn resuscitation, and performance score, determined by evaluation of each of the team's steps during simulated resuscitation scenarios. The teamwork behaviors assertion and sharing information were associated with shorter resuscitation duration and higher performance scores. Each additional use of assertion (per minute) was associated with a duration reduction of 41 s (95% confidence interval [CI], -71.5 to -10.2) and an increase in performance score of 1.6% (95% CI, 0.4-2.7). Each additional use of sharing information (per minute) was associated with a 14-second reduction in duration (95% CI, -30.4 to 2.9) and a 0.8% increase in performance score (95% CI, 0.05-1.5). Teamwork behaviors of assertion and sharing information are 2 important mediators of efficiency and quality of resuscitations.

A patient safety course for preclinical medical students

We developed a course to introduce incoming third-year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient-safe practices that will positively impact their performance as clinicians. The course, held prior to the start of clinical rotations, consisted of lectures, web-based didactic materials, small group activities and simulation exercises, with an emphasis on experiential learning. First, students inspected a 'room of horrors', which is a simulated clinical environment riddled with errors. Second, we used lenticular puzzles in small groups to elicit teamwork behaviours that parallel real-life interactions in health care. Each team was given 8 minutes to complete a 48-piece puzzle, with five pieces removed at random and given to other teams. The salient teaching point of this exercise is that for a team to complete the task, team members must communicate with members of their own team as well as with other teams. Last, simulation scenarios provided a clinical context to reinforce the skills introduced through the puzzle exercise and lectures. The students were split into groups of six or seven members and challenged with two scenarios. Both scenarios focused on a 56-year-old man in respiratory distress. The teams were debriefed on both clinical management and teamwork. The vast majority of the students (93%) agreed that the course improved their patient safety knowledge and skills. The positive response from students to the introductory course is an important step in fostering a culture of patient safety.

Putting the “We” Into Teamwork

The study was designed to investigate the effectiveness of a manipulation derived from social categorization and social identity theory to promote greater cabin crew willingness to engage in intergroup communication and teamwork in airline operations. Failures of communication and teamwork between airline crew have been implicated in a number of airline crashes. Flight attendants based domestically (n = 254) or overseas (n = 230) received a manipulation designed to prime either their social identity or personal identity and then read a brief outline of an in-flight event before completing a teamwork questionnaire. Flight attendants who received a social identity prime indicated increased willingness to engage in coordinated team action compared with those who received a personal identity prime. Priming social identity can enhance attitudes toward teamwork and communication, potentially leading to increased willingness to engage in intergroup cooperation. Social categorization and social identity theories can be used to inform joint training program development for flight attendants and pilots to create increased willingness for group members to participate in effective communication and teamwork behaviors.

Effectiveness of teamwork and communication education using an interprofessional high- fidelity human patient simulation critical care code

Background: Effective teamwork and communication among healthcare professionals are essential to ensure quality patient care and safety. The use of high-fidelity human patient simulation scenarios enhances learning and has been used in various health professions education. The purpose of this study was to evaluate the efficacy and retention of teaching team-based competencies to interprofessional student teams using high-fidelity simulation. Methods: Quasi-experimental, pre/post-test design was used. The study was a teaching intervention using high-fidelity human patient simulation with crisis resource management techniques to teach team based competencies. A convenience sample of students from medicine, nurse anesthesia, undergraduate nursing, and physical therapy participated. There were pre/post data collected for fall and spring simulations from both participants and observers. Key variables were the various teamwork competencies. Participants and trained observers rated teamwork behaviors, each using two measures. Mean scores on participant and observer rated tools were compared using paired samples t -tests. Results: A total of 35 students underwent training in the fall of 2009 and 25 of the students returned in the spring of 2010 for repeat training. Participant paired samples t -tests showed a significant increase from simulation scenario one to two ( p < .05) in both the fall and spring. Observer data showed significant improvements in mean scores on one measure. Conclusions: High-fidelity simulation appears to improve both perceived and actual team-based competencies with retention over time. Findings support the benefit to students of repeat training in a six month period and provide some validation for faculty time and effort in repeated simulations.

How do leadership motives affect informal and formal leadership emergence?

SummaryTo what extent and in what ways do leadership motives of potential leaders predict their informal and formal leadership assignments? To address these questions, we conducted two studies in a military setting. In the first study (n = 215), we examined a mediated‐moderation model in which we hypothesized that the motivation to lead (MTL) of candidates to an elite unit would predict their teamwork behaviors and their tendency to emerge as leaders of their peers. We further hypothesized that cognitive ability would interact with MTL to predict teamwork behaviors and that teamwork behaviors would mediate the relationship between this interaction and leadership emergence. In Study 2, we followed up 60 candidates who were selected to the unit and examined whether MTL would predict the extent to which they achieved formal leadership roles. The findings of Study 1 supported the hypotheses included in the moderated mediation model. In Study 2, as expected, MTL predicted formal leadership emergence. We discuss several theoretical implications of these findings. Copyright © 2012 John Wiley &amp; Sons, Ltd.

A Leadership Challenge

The purpose of this study was to measure RNs' perceptions of teamwork skills and behaviors in their work environment during a multiphase multisite nursing organizational teamwork development initiative. Teamwork is essential for patient safety in healthcare organizations and nursing teams. Organizational development supporting effective teamwork should include a just culture, engaged leadership, and teamwork training. A cross-sectional survey study of bedside RNs was conducted in one 5-hospital healthcare system after a TeamSTEPPS teamwork training initiative. TeamSTEPPS teamwork training related to improved RN perceptions of leadership. Initiatives to align the perspectives and teamwork efforts of leaders and bedside nurses are indicated and should involve charge nurses in the design.

Development of an event-based teamwork behavior rating system for cardiopulmonary resuscitationStatus: PendingCategory: CPR Systems

Development of an event-based teamwork behavior rating system for cardiopulmonary resuscitationStatus: PendingCategory: CPR Systems

Strengths and Weaknesses of Specific Interview Methods and Qualitative Data Analysis Strategies in Identifying Team Performance Requirements

Interviews are a widely accepted method for determining team performance requirements in complex work environments. Using examples from two studies in acute patient care settings, this paper discusses the strengths and weaknesses of specific interview methods and qualitative data analysis strategies in identifying performance requirements and in establishing categories for observational research or skills assessment. Interview study 1 was carried out in cardiac anesthesia deductively applying a conceptual framework of cooperation and coordination in analyzing the data. In study 2 interviews were analyzed applying an inductive data analysis approach to establish a basic list of non-technical skills that are important to scrub practitioner performance. Both studies provide valuable insights with regards to performance requirements of the various team members and specific teamwork behaviors. Implications for the interpretation of results and the design of interview studies in the research area are discussed.

Using Video Review for Assessment and Improvement of Team Performance in a Dynamic Medical Domain

Trauma resuscitation, the initial management and treatment of injured patients in the emergency department, is an example of a dynamic medical domain in which coordinated team activity is essential for achieving optimal patient outcome. Identifying individual and teamwork behaviors associated with optimal performance is essential for developing effective training interventions and assessing the impact of new technologies in this setting. Although observational techniques can be used for this purpose, these techniques have limitations because the work in this domain is executed sequentially, concurrently, or in parallel by different providers. In this paper, we will describe how we have used video analysis to track the work during trauma resuscitation and used it to identify factors associated with team performance.

Intentions and potential intentions revisited

The importance of potential intentions has been demonstrated both in the construction of agent systems and in the formalisation of teamwork behaviour. However, there still lacks an adequate semantics for the notion of potential intentions as introduced by Grosz and Kraus in their SharedPlans framework. In this paper, we give a formal semantics to intentions and potential intentions, drawing upon both the representationalist approach and the accessibility-based approach. The model captures the dynamic relationship among intentions and potential intentions by providing semantic rules and conditions. Also, the model treats norms as a special class of intentional context, and it is shown that norms play a critical role in the dynamics of intentions in multiagent systems. The formal semantics allows us to validate some properties that are widely-accepted for intention attitudes.

Leadership, Motivation, and Teamwork Behaviors of Principal Investigator’s in Interdisciplinary Teams: A Synthesis of Research

Increased demand, limited resources, knowledge gaps, and seemingly less time to produce results are the challenges facing researchers and others in higher education today. Working together across disciplines is almost a requirement to stay afloat in the competitive arena most principal investigators are finding themselves in. This study sought to synthesize existing research on leadership behaviors of these investigators in the agricultural discipline. The sections specifically addressed include team science, discipline structure, boundary work, challenges of interdisciplinary research, the direction of research, and leadership in interdisciplinary teams. After analyzing 32 articles, researchers determined that research should continue to investigate the role of leadership behaviors in primary investigators to continue to improve effectiveness.

Playing with Dolls: Effective Utilization of Simulation for Staff Training and Quality Improvement Outcomes

Implications for Nursing Practice This is a safer way for staff to practice their assessment and technical skills and teamwork behaviors. We hope that by practicing in this safe environment, our care will be safer for the patient, and the staff will feel more competent and confident in their skills. We also identified gaps in knowledge regarding some systems that the leadership team will address in the coming months (e.g., how to get certain infrequently used items from the main operating room).

Utilization of Simulation Based Training for Annual Competency Day for Labor and Delivery RNs

To provide opportunities to safely practice specialized care and behaviors for infrequent but potentially catastrophic obstetric problems requiring emergency attention. By using simulated scenarios as part of our annual competencies our goal was to provoke each learner to demonstrate nursing assessment, medical knowledge, technical skill, and teamwork behavior.

Observational Teamwork Assessment for Surgery

To assess the feasibility of training clinical and nonclinical novice assessors to rate teamwork behavior in the operating room with short-term structured training using the observational teamwork assessment for surgery (OTAS) tool. Effective teamwork is fundamental to the delivery of optimal patient care in the operating room (OR). OTAS provides a comprehensive and robust measure of teamwork in surgery. To date, assessors with a background in psychology/human factors have been shown to be able to use OTAS reliably after training. However, the feasibility of observer training over a short timescale and accessibility to the wider clinical community (ie, OTAS use by clinicians) are yet to be empirically demonstrated. Ten general surgery cases were observed and assessed using OTAS in real-time by an expert in rating OTAS behaviors (100+ cases rated) and 4 novices: 2 psychologists and 2 surgeons. Assessors were blinded to each other's scores during observations. After each observation, scores were compared and discussed between expert and novice assessors in a debriefing session. All novices were reliable with the expert to a acceptable degree at rating all OTAS behaviors by the end of training (intraclass correlation coefficients ≥0.68). For 3 of the 5 behaviors (communication, cooperation, and leadership), calibration improved most rapidly across the first 7 observed cases. For monitoring/situational awareness, calibration improved steadily across the 10 observed cases. For coordination, no significant improvement in calibration over time was observed because of high interrater reliability from the outset (ie, a ceiling effect). There was no significant difference between surgeons and psychologists in their calibration with the expert. It is feasible to train both clinicians and nonclinicians to use OTAS to assess teamwork behaviors in ORs over a short structured training period. OTAS is an accessible tool that can be used robustly (ie, reliably) by assessors from both clinical and nonclinical backgrounds.

Dealing with aggressive methadone patients in community pharmacy: A critical incident study

BackgroundCommunity pharmacists are an important link between methadone patients and the health service in the United Kingdom. However, many pharmacists feel ill prepared to deal with methadone patients, with aggressive behavior a particular concern. ObjectiveTo assess the perceived impact of methadone patient aggression on pharmacy practice. MethodsSixteen registered pharmacists with a minimum of 3 years’ work experience were recruited from within 3 Scottish health boards. Critical incident interviews were conducted to assess pharmacist behavior during an interaction with an aggressive methadone patient. ResultsFactors considered by pharmacists to have a negative impact on an interaction with an aggressive methadone patient included intoxication of the patient, the presence of a new or an inexperienced pharmacist, and a restricted time frame for dispensing methadone. Positive factors when dealing with aggressive patients were authoritative behavior by the pharmacist, a separate dispensing area for methadone patients, or a solid counter and a positive relationship between pharmacist and patient. ConclusionAggression from methadone patients is a risk when dispensing methadone. However, action can be taken by the pharmacist to minimize the impact of that aggression on pharmacy practice. The provision of further training and support, particularly to inexperienced pharmacists, could further reduce the negative impact of patient aggression. The present study indicates that such training could be based on nontechnical skills to strengthen current leadership and teamwork behaviors.

Theoretically-Driven Infrastructure for Supporting Health Care Teams Training at a Military Treatment Facility

Designated a Department of Defense Team Resource Center (TRC) in 2008, Naval Medical Center Portsmouth (NMCP) currently hosts three tri-service health care teams training courses annually. Each consists of didactic learning coupled with simulation-based training exercises to provide an interactive educational experience for health care professionals. Simulated cases are developed to reinforce specific teamwork skills and behaviors, and to incorporate a variety of technologies including standardized patients, manikins, and virtual reality. The course is also the foundation of a research program designed to explore applications of modeling and simulation for enhanced team training in health care. The TRC has adopted two theoretical frameworks for evaluating training efficacy and outcomes, and has used these frameworks to guide a systematic reconfiguration of the infrastructure supporting health care teams training at NMCP.

Job Satisfaction Among the Expatriates in the UAE

The aim of the present study was to identify the specific factors associated with Job Satisfaction among the expatriates in the UAE. For this purpose employees at a leading global remittance and foreign exchange organization having partners across the world, representing over 40 nationalities and having over 7000 employees were chosen. The study focuses on revealing the influence of various demographic characteristics that these employees exhibited, which affect their satisfaction level. The questionnaires were distributed among 1202 employees (972 males and 230 females) working in the 4 regions of the UAE. The Factor Analysis (KMO Test) was done to identify the critical factors associated with job satisfaction vis-a-vis their Tenure, Age, Gender and Nationality. A total of 14 factors explained 56.273 % of the total variance. Overall the employees were moderately satisfied with the jobs but more satisfied with the following aspects of their current work situation: Future prospects, Team Work, Work Environment and Supervisor Behaviour and Training Programmes (being the Top 5 Satisfiers) and least satisfied with: Incentives, Social Recognition Programmes and Compensation (being the bottom 3 i.e. dissatisfiers). The data also revealed the influence of the demographic factors chosen for the study on the over-all impact on job-satisfaction. The analysis revealed that a total of 14 factors were important for the males whereas the responses from females indicated that a total of 20 factors were important for females. The dominant factors: Customer satisfaction, Ethics, Events, etc. came out to be as important factors for females over and above the 14 factors which were important for males.

Validity and Reliability of the Brief TeamSTEPPS Teamwork Perceptions Questionnaire

Teamwork is an essential component of hospital nursing quality and safety. The purpose of this study is to test the validity and reliability of the Brief TeamSTEPPS Teamwork Perception Questionnaire (Brief T-TPQ). The 20-item questionnaire was completed electronically by a sample (N = 456) of hospital bedside nurses and tested for reliability and validity. The survey demonstrated internal consistency reliability of .83-.94 with a total survey reliability of .93. A hierarchical relationship three factor subscale structure was confirmed, explaining 64% of the variance and acceptable factor loadings. A secondary five-factor structure revealed statistically and conceptually coherent skills and behaviors sub-subscales. Discriminant validity was demonstrated with self-esteem and control over practice. The 20-item Brief T-TPQ is a valid and reliable survey to measure hierarchical teamwork relationships as well as teamwork skills and behaviors.