Teamwork In Health Care Research Articles

Attitudes toward interprofessional practice among healthcare students in a Nigerian University

ABSTRACTThis study assessed attitudes of undergraduate healthcare students in Nigeria toward interprofessional practice. A cross-sectional survey of a convenience sample of 489 dental, medical, medical laboratory science, nursing, physiotherapy, and radiography students from a public university was conducted. The 14-item Attitudes Toward Healthcare Teamwork Scale was used to assess the students’ attitudes. Data were summarized using descriptive statistics while differences in attitudes based on students’ age, gender, year of study, and course of study were identified using inferential statistics. The findings showed that there were more (n= 281; 57.5%) male respondents and mean age was 25 years. Mean attitude score was 53.75 (±7.41) out of 70 depicting an overall positive attitude. Year and course of study resulted in statistically significant (p< .001) differences in attitudes with students in the sixth year of study, and medical students having more positive attitudes than their colleagues in junior years and other courses respectively. Most students agreed that interprofessional practice facilitates optimal patient care but also agreed with statements that portray interprofessional practice as unnecessarily time consuming. Integration of interprofessional education into existing undergraduate healthcare professions curricula in Nigeria could help address misconceptions and reinforce positive attitudes toward interprofessional practice.

Exploring group boundaries and conflicts: a social identity theory perspective.

In the clinical environment, health care professionals self-categorise into different groups towards which they develop positive attitudes, whereas they view other groups less favourably. Social identity theory purports that these attitudes influence group processes and may foster conflicts that impede collaborative practice, although this relationship is poorly understood. This study used concepts from social identity theory to examine the interplay between group processes and conflicts, as well as the consequences of these conflicts, with the goal of identifying educational strategies to favour teamwork. Semi-structured interviews with 82 randomly selected physicians and nursing professionals working at a Swiss academic medical centre explored participants' experiences of conflicts. Data analysis was informed by social identity theory and focused on interviews where group processes were highlighted by participants. The analysis sought to uncover how group processes were intertwined with conflicts and how they affected health care professionals. A total of 42 participants out of the initial pool of 82 interviews shared 52 stories of conflicts involving group processes. Most of these stories were shared by physicians and involved groups of physicians at different hierarchical levels. Conflicts and group processes were linked in two ways: (i) through processes of group membership when individuals struggled to join a relevant group, and (ii) through intergroup boundaries, such as when participants perceived that power differentials disadvantaged their own groups. Conflicts could lead to difficult experiences for clinicians who questioned their abilities, became disillusioned with their professional ideals and developed negative perceptions of other groups. This study suggests that conflicts involving group processes may lead to stronger intergroup boundaries, challenging current educational efforts to favour teamwork in health care. Taking steps to create more inclusive groups and to encourage perspective taking may help manage intergroup conflict.

The Teamwork Model: Proposing a Model for Studying Interprofessional Healthcare Teams.

This article was migrated. The article was marked as recommended. Patient safety is a preeminent healthcare concern in modern medicine. In the years since To Err is Human, researchers have found that the number of preventable deaths far exceeds 98,000; more accurately, 400,000 patients die each year from preventable healthcare errors. To combat the evolving patient safety crisis, a variety of organizations from Institute of Medicine to World Health Organization have called for the development of interprofessional healthcare teams. Interprofessional healthcare teams and teamwork have been a topic of discussion for over 40 years. And while some Interprofessional healthcare teams have been shown to be beneficial in some settings the success of these teams is not universal nor achieved in all healthcare settings. In short, research has found that interprofessional healthcare teams both improve and impede patient care. Building on this contradictions of interprofessional healthcare teams and teamwork, we present a model for the conceptualization of teamwork that could be readily applied to clinical experiences. This model is informed by the interprofessional healthcare team literature and relevant theories, and we believe will enable us to examine authentic interprofessional healthcare team interactions and identify moments when team interactions were breaking down, and reasons why those breakdowns were happening.

Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics.

The levels of teamwork and clinician burnout in healthcare differ depending on demographic and unit characteristics. However, the impact of these characteristics varies between clinical settings. In addition, the impact of objectively measured workload in such settings is largely unknown. The aim of this study was to analyse the predictive role of demographic (e.g., professional experience) and unit (e.g., unit size) characteristics, and workload (e.g., nursing interventions) in explaining teamwork and clinician burnout in Swiss intensive care units (ICUs). This was as cross-sectional multi-source study. Participants were 1148 nurses and 243 physicians working in 55 ICUs. They provided demographic information and answered a questionnaire on teamwork and clinician burnout. In addition, unit characteristics and surrogate measures of workload were extracted from a central database that accumulates patient and unit data routinely collected by the ICUs. We conducted multilevel regression analyses to detect relationships between study variables. Clinicians who worked predominantly dayshifts reported better teamwork and lower burnout. Physicians and clinicians in leadership positions also reported better teamwork. Clinicians in leadership positions furthermore reported higher personal accomplishment, whereas clinicians in training reported higher emotional exhaustion. Of the unit characteristics, workload was positively associated with self-reported burnout. Clinicians working in medical and surgical ICUs (compared with interdisciplinary and paediatric ICUs) reported higher emotional exhaustion. Clinicians working in university hospitals and in surgical/medical ICUs reported lower teamwork quality and higher burnout. We identified several demographic and unit-based factors in Swiss ICUs that were associated with lower perceptions of the quality of teamwork and higher self-reported burnout. Discrepant experiences regarding the quality of teamwork based on professional role, professional status and experience might affect team effectiveness. Furthermore, this study showed the importance of workload management, as objectively measured workload was associated with higher self-reported burnout. Results suggested that certain clinician groups (e.g., working predominantly night shifts) were at higher risk for burnout, thus highlighting the importance of providing additional support to these groups. Lastly, special attention should be paid to medical and surgical ICUs, which reported the highest level of burnout. Because this is a cross-sectional study, no conclusions can be drawn regarding causal relationships.

Measuring situation awareness and team effectiveness in pediatric acute care by using the situation global assessment technique

Situation awareness (SA) is an important human factor and necessary for effective teamwork and patient safety. Human patient simulation (HPS) with video feedback allows for a safe environment where health care professionals can develop both technical and teamwork skills. It is, however, very difficult to observe and measure SA directly. The Situation Global Assessment Technique (SAGAT) was developed by Endsley to measure SA during real-time simulation. Our objective was to measure SA among team members during simulation of acute pediatric care scenarios on the medical ward and its relationship with team effectiveness. Twenty-four pediatric teams, consisting of two nurses, one resident, and one consultant, participated in three acute care scenarios, using high-fidelity simulation. Individual SAGAT scores contained shared and complimentary knowledge questions on different levels of SA. Within each scenario, two “freezes” were incorporated to assess SA of each team members’ clinical assessment and decision-making. SA overlap within the team (team SA) was computed and compared to indicators of team effectiveness (time to goal achievement, consensus on primary problem, diagnosis, task prioritization, leadership, and teamwork satisfaction). In 13 scenarios (18%), the team failed to reach the primary goals within the prescribed time of 1200 s. There was no significant difference in failure of goal completion between the scripted scenarios; however, there was a significant difference between scenario 3 and the other scenarios in time to goal completion. In all three scenarios, SA overlap level 2 (consensus on primary problem during the first freeze and consensus on diagnosis during the second freeze) leads to significantly faster achievement of the predefined goals. There was a strong relationship between team SA on the primary problem and diagnosis and team SA on task prioritization. Consensus on leadership within the team was low. Teamwork satisfaction was more influenced by knowledge about the importance of the assigned task than outcome of the scenario.Conclusion: The use of SAGAT enables us to measure SA of team members during real-time simulation of acute care scenarios. Although there is no direct connection between team SA and goal achievement, SAGAT provides insight in differences in SA among team members, and the process of shared mental model formation. By measuring SA, issues that may improve team effectiveness (prioritizing tasks, enhancing shared mental models, and providing leadership) can be trained and assessed during medical team simulation, enhancing teamwork in health care settings.What is known?• Teamwork skills such as communication, leadership, and situational awareness have become increasingly recognized as essential for good performance in pediatric resuscitation. However, the assessment of pediatric team performance in these clinical situations has been traditionally difficult.• The Situation Awareness Global Assessment Technique (SAGAT) is a method of objectively and directly measuring SA during a team simulation using “freezes” at predetermined points in time with participants reporting on “what is going on” from their perspective on the situation.What is new?• We assessed SA, and its relationship with team effectiveness, in multidisciplinary pediatric teams performing simulated critical events in critically ill children on the medical ward using the SAGAT model, outside the emergency room setting.• In all three scenarios, consensus on the primary problem (shared mental model) leads to faster achievement of predefined goals. Consensus on leadership was overall low, without a significant impact on goal achievement.

Understanding and improving multidisciplinary team working in geriatric medicine.

Geriatric medicine is a speciality that has historically relied on team working to best serve patients. The nature of frailty in older people means that people present with numerous comorbidities, which in turn require a team-based approach to be managed, including allied health professionals, social work and nursing alongside medicine. The 'engine room' of the speciality has thus for many years been the multidisciplinary team (MDT) meeting-something other specialities have discovered only recently. Yet, rather paradoxically, the speciality has been slow compared to others (e.g. trauma, surgery, cancer) to reflect more formally on how team working can be enhanced, trained and supported in geriatric teams. This paper is a reflective review, grounded on our respective expertise in geriatric medicine and improvement science, on practice and its changing patterns within geriatric medicine, and the role of MDTs within it (Part 1). It offers a perspective from behavioural safety science, which has been studying team-working in healthcare for the last 20 years (Part 2) and concludes with practical suggestions, based on evidence, on how to integrate evidence and best practice into modern geriatric medicine-to address current and future challenges (Part 3).

Medical teamwork and the evolution of safety science: a critical review

There is widespread consensus that teamwork constitutes one of the key requirements in today’s multidisciplinary and highly complex system of delivering care. In recent years, increasing attention has been given to questions of how to define, teach, measure, and improve teamwork in healthcare. However, one cannot help but feel a certain disconnect between this ongoing trend in healthcare with an associated bias towards judgemental and normative language, and contemporary thinking in safety science that explores concepts from complexity thinking, such as emergence and resilience. The aim of this critical review is to contrast prevailing approaches to teamwork in healthcare with current concepts in safety science. After identifying relevant articles through multiple formal search methods, we found that, although current teamwork literature acknowledges a lack of comprehensive investigations linking team training in healthcare and patient outcomes, the predominant strategy to achieve safety remains a traditional, reactive approach that regulates behaviour and constrains performance variability. As this strategy is focussed on competencies, much of the responsibility for unwanted results is pushed towards the ‘sharp end’ by the quality agenda, emphasizing personal and professional competence while obscuring systemic issues. Teamwork, while indispensable in the highly subspecialized reality of healthcare, is oftentimes reduced to an aggregated set of individual behaviours. It appears that in the current state of entangled quality and safety agendas, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept.

The need to pay attention to teamwork in pre-hospital emergency

Background: The importance of teamwork to improve the quality of care and overcome the complexity of health system is clear to everyone. Therefore the current study aimed to review the studies in the field of team-work assessment in hospital and pre-hospital emergency. Methods: In this review study, scientific texts with the key-words of teamwork, paramedic, emergency medical technician, emergency department and inter-professional practice were searched in Google scholar, PubMed, scientific information database(SID), and Magiran. Results: Several studies have been found on the training and evaluation of teamwork in different parts, particularly in the treatment section. The results show that training and promotion of teamwork in health care lead to better performance and results, reducing clinical errors and reducing patient long length of stay In wards especially in the emergency department. Studies indicate that organizational support and teamwork training has the greatest impact in teamwork facilitate. In the pre-hospital emergency, there was a wide variety of teammates and less familiarity with teammates in EMS is associated with more occupational injuries. Conclusion: According to the aid team of pre-hospital emergency and their interaction with the hospital emergency department and other relief teams, training and evaluation of teamwork is important in EMS. However, there are few studies on teamwork in pre-hospital emergency especially in Iran. According to the importance of pre-hospital emergency mission, it is necessary to pay attention to teamwork in the emergency training curriculum and evaluation of teamwork in pre-hospital EMT.

Factors influencing hand hygiene among dental personnel at the outpatient clinic of a Tertiary Hospital in Indonesia

Background: Nosocomial infections are acquired during hospitalization, and they are strongly influenced by the healthcare workers' hand hygiene. Many factors can affect hand sanitation compliance, including healthcare worker's perception, profession, high workload, lack of time, access to hand washing materials, presence of skin irritation, team of healthcare workers, and knowledge regarding the importance of hand sanitation. Objective: The aim of this study was to determine the influence of individual factors (knowledge, perception, and profession), the availability of hand sanitation facilities, and the hand hygiene workload on the hand sanitation compliance among dental personnel. Method: This quantitative observational study involved 36 dentists and 14 dental hygienists at the outpatient dental clinic of the Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from July 2013 to January 2014. The data were obtained via observation and questionnaires, and it was analyzed using univariate and bivariate analyses (Chi-square test) and a multivariate analysis with a logistic regression. Result: There were no correlations between the knowledge (P = 0.086) or profession (P = 0.181) and the hand sanitation compliance. However, significant correlations were found between the hand sanitation compliance and the individual perception toward hand sanitation (P = 0.000), availability of hand sanitation facilities (P = 0.000), and hand hygiene workload (P = 0.029). Conclusion: The factors that influenced the dental personnel's compliance to the hand sanitation procedures at the outpatient dental clinic were the availability of the hand sanitation facilities and the individual perceptions of the dental personnel. However, further research is needed to determine the level of hand sanitation compliance when using hand rubs and liquid soap.

STUDENTS’ AND ACADEMIC STAFFS’ PERSPECTIVES ON AN INTERPROFESSIONAL EDUCATION MODEL

Background: Teamwork in health care is beneficial because it allows a holistic approach to patient care. Interprofessional education (IPE) provides students with an opportunity to develop their professional roles and their functions as team members. Understanding Interprofessional Collaboration (IPC) from the perspective of student and academic staff is an essential assessment for creating IPE model.Methods: This was a qualitative study with phenomenology approach. We explored students’and academic staff’s perspective of IPE by focus group discussions. We selected fifteen midwifery student, twenty medical students and twenty-two lecturers (midwifery and obstetrician gynecologist doctor) who were involved in IPE project. Data analysis used thematic analysis technique.Results: Findings showed four themes that presented the most common perspective in collaborative experience, (1) interprofessional communication, (2) the role each profession, (3) IPE learning model, and (4) suggested IPE model. The major obstacle was poor communication in daily practices. Developing an IPE model is important to improve patient care.Conclusion: The main common problem of IPC was interprofessional communication. That poor communication problem can be solved by developing intra-curricular and extra-curricular IPE model and train the effective interprofessional communication.

Learning histories as an ethnographic method for designing teamwork in healthcare

ABSTRACTDesigning for teamwork in healthcare requires a thorough understanding of the working context and routines of the different user groups involved. This paper presents a design project in the context of child oncology in which we demonstrate the use of a newly developed ethnographic method for design research called the learning history method. The results of this design research project demonstrate that the method provides the designer with a clear path to gather in-depth insights into the needs and wishes of different users and their interactions, while maintaining flexibility in execution. Moreover, the results also show that the proposed tangible outcomes of each design research step focuses high-quality feedback loops between the designer and the different users.

Las cardiopatías congénitas en el 2018

We present an update of the most relevant advances of three-dimensional echocardiography for the diagnosis of congenital heart diseases. The evolution of its treatment is analyzed, showing the results obtained in recent years. The functional and structural changes experienced in women with congenital heart disease during pregnancy are discussed, as well as the main health risks and the importance of teamwork in healthcare to treat these patients. Finally, we provide a review on the current situation in Mexico and outline some improvement recommendations.

Dynamics of an orthopaedic team: Insights to improve teamwork through a design thinking approach.

BACKGROUND:Supporting teamwork in healthcare is a way to foster both the quality and safety of care, and better working conditions for all the team members. Although increasing attention is paid to this topic on a general level, there is less knowledge about its unfolding in orthopaedic units and its translation to interventions.OBJECTIVE:To identify concrete opportunities for teamwork intervention through a design thinking approach by analysing the teamwork dynamics of an orthopaedic team.METHODS:An adaptation of the learning history method, comprising shadowing, observations and interviews involving 26 orthopaedic team members at a top clinical teaching hospital in the Netherlands, was applied. A thematic analysis was conducted to derive themes that describe team dynamics and to subsequently extrapolate opportunities for intervention.RESULTS:We identified five themes and translated them into four design opportunities for intervention, namely: a) Improve daily rounds by reducing cognitive overload and promoting confidence; b) Improve collaboration by building empathy; c) Connect the patient with the professional team; and d) Support changes by fostering learning. Suggestions for concrete actions are presented for each opportunity.CONCLUSIONS:Opportunities to improve teamwork among healthcare professionals, specifically those in orthopaedics, revolve around the creation of common knowledge, the fostering of mutual understanding, and the design of tools and activities that support these processes.

Book Review

British Journal of Cardiac NursingVol. 13, No. 7 Book ReviewBook ReviewBelinda LindenBelinda LindenSearch for more papers by this authorBelinda LindenPublished Online:10 Jul 2018https://doi.org/10.12968/bjca.2018.13.7.338AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Barr J, Dowding L. Leadership in Healthcare. 3rd Edition. London: Sage Publications Ltd; 2015. Google ScholarEllis P, Bach S. Leadership, Management and Team-Working in Healthcare (transforming Nursing Practice Series) 2nd Edition. London: Learning Matters, Sage Publications Ltd; 2015. Google ScholarGopee N, Galloway J. Leadership and Management in Healthcare 3rd Edition London: Sage Publications Ltd; 2017. Google ScholarMarquis B, Huston C. Leadership roles and management functions in nursing – theory and application. 9th edn. Philadelphia: Lippincott Williams and Wilkins; 2017. Google ScholarMurray R. Priorities for the NHS for 2018/2019 and beyond. The Kings Fund blog. 2018. https://tinyurl.com/y75ygb56 (accessed 26 June 2018) Google ScholarParente ST. Editorial. Factors contributing to higher health care spending in the United States compared with other high-income countries JAMA. 2018;319(10):988–990. https://doi.org/https://doi.org/10.1001/jama.2018.1149 Google Scholar FiguresReferencesRelatedDetails 2 July 2018Volume 13Issue 7ISSN (online): 2052-2207 Metrics History Published online 10 July 2018 Published in print 2 July 2018 Information© MA Healthcare LimitedPDF download

A Psychometric Property of the Attitudes Toward Health Care Teamwork Scale Among University Students

Background: Teamwork improves self-reporting efficiency on inter-professional practice. It can also increase the self-confidence, awareness, and the ability of members to manage high-risk situations. The aim of this study was to translate and assess psychometrically the attitudes toward healthcare teamwork scale; adopted from previous studies. Methods: This cross sectional study consisted of 200 students who were recruited from the nursing and medical schools in Tehran. Convenience sampling method was used to select subjects. Initial instrument comprised 15 items with Likert type response. The impact score, content validity index (CVI) and content validity ratio (CVR) were assessed and an exploratory factor analysis (EFA) was used to extract factors. Confirmatory factor analysis was used to confirm the factorial structure of the questionnaire using SPSS (version 19) and Amos (version 23), respectively. The reliability of the questionnaire was calculated using Cronbach�s alpha coefficient and test-re-test. Results: Eleven items were considered valid on the basis of impact score of more than 1.5, CVR above 0.62, and CVI above 0.7. The exploratory factor analysis deemed all the 11 items valid. With respect to the eigenvalue above one for each factor, three factors were extracted. This instrument had 55 of variance in the attitude toward healthcare teamwork scale. Conclusions: The results of this study are a suitable evidence on the strength of the factor structure and good reliability for the psychometric property of the attitudes toward health careteamworkscale. The results of this study can be used by education centers and institutes to assess student�s attitudes towards healthcare teamwork. © 2018, Author(s).

Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial

IntroductionAdults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary...

Self-cannulation of the vascular access in home hemodialysis: Overcoming patient-level barriers.

Patients with end-stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self-cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self-cannulating patients have superior outcomes. Patient-level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients. The healthcare team must address patient fears while instructing the patient to perform self-cannulation safely. Identification and understanding of the barriers perceived by the patient will allow the patient and healthcare team work collaboratively, toward the goal of independence with self-cannulation both during initial training and follow-up care. The aim of this review was to provide a practical resource to aid in the identification and resolution of these patient-level barriers, with the overall goal of improving the patient experience and medical outcomes in home hemodialysis programs.

Teamwork and leadership in cardiovascular health care

Teamwork and leadership in cardiovascular health care

Teamwork in healthcare: Key discoveries enabling safer, high-quality care.

Few industries match the scale of health care. In the United States alone, an estimated 85% of the population has at least 1 health care encounter annually and at least one quarter of these people experience 4 to 9 encounters annually. A single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are a public health issue. Health care delivery systems exemplify complex organizations operating under high stakes in dynamic policy and regulatory environments. The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries. In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the science and to highlight gaps in which studies can further illuminate our evidence-based understanding of teamwork and collaboration. Specifically, we highlight evidence concerning (a) the relationship between teamwork and multilevel outcomes, (b) effective teamwork behaviors, (c) competencies (i.e., knowledge, skills, and attitudes) underlying effective teamwork in the health professions, (d) teamwork interventions, (e) team performance measurement strategies, and (f) the critical role context plays in shaping teamwork and collaboration in practice. We also distill potential avenues for future research and highlight opportunities to understand the translation, dissemination, and implementation of evidence-based teamwork principles into practice. (PsycINFO Database Record

Using Social Network Analysis to Investigate Positive EOL Communication

ContextEnd-of-life (EOL) communication is a complex process involving the whole family and multiple care providers. Applications of analysis techniques that account for communication beyond the patient and patient/provider will improve clinical understanding of EOL communication. ObjectivesThe objectives of the study were to introduce the use of social network analysis to EOL communication data and to provide an example of applying social network analysis to home hospice interactions. MethodsWe provide a description of social network analysis to model communication patterns during home hospice nursing visits. We describe three social network attributes (i.e., magnitude, directionality, and reciprocity) in the expression of positive emotion among hospice nurses, family caregivers, and hospice cancer patients. Differences in communication structure by primary family caregiver across gender and time were also examined. ResultsMagnitude (frequency) in the expression of positive emotion occurred most often between nurses and caregivers or between nurses and patients. Female caregivers directed more positive emotion to nurses, and nurses directed more positive emotion to other family caregivers when the primary family caregiver was male. Reciprocity (mutuality) in positive emotion declined toward day of death but increased on day of actual patient death. There was a variation in reciprocity by the type of positive emotion expressed. ConclusionOur example demonstrates that social network analysis can be used to better understand the process of EOL communication. Social network analysis can be expanded to other areas of EOL research, such as EOL decision making and health care teamwork.