Deborah DiazGranados

Does team training improve team performance? A meta-analysis.

Objective: This research effort leveraged the science of training to guide a taxonomic integration and a series of meta-analyses to gauge the effectiveness and boundary conditions of team training interventions for enhancing team outcomes. Background: Disparate effect sizes across primary studies have made it difficult to determine the true strength of the relationships between team training techniques and team outcomes. Method: Several meta-analytic integrations were conducted to examine the relationships between team training interventions and team functioning. Specifically, we assessed the relative effectiveness of these interventions on team cognitive, affective, process, and performance outcomes. Training content, team membership stability, and team size were investigated as potential moderators of the relationship between team training and outcomes. In total, the database consisted of 93 effect sizes representing 2,650 teams. Results: The results suggested that moderate, positive relationships exist between team training interventions and each of the outcome types. The findings of moderator analyses indicated that training content, team membership stability, and team size moderate the effectiveness of these interventions. Conclusion: Our findings suggest that team training interventions are a viable approach organizations can take in order to enhance team outcomes. They are useful for improving cognitive outcomes, affective outcomes, teamwork processes, and performance outcomes. Moreover, results suggest that training content, team membership stability, and team size moderate the effectiveness of team training interventions. Application: Applications of the results from this research are numerous. Those who design and administer training can benefit from these findings in order to improve the effectiveness of their team training interventions.

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 trainings 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.

Expertise-Based Intuition and Decision Making in Organizations

There has been a growing popular fascination with how experts make rapid and effective decisions. This interest has been paralleled in various scientific research communities. Across these disciplinary boundaries, researchers have found that intuition plays a critical role in expert decision making. Therefore, an understanding of how experts develop and use intuition effectively within organizations has the potential to greatly influence organizational practices and effectiveness. The purpose of this review is to integrate the extant literature related to expertise-based intuition—intuition rooted in extensive experience within a specific domain—in decision making. To that end, this review addresses four specific goals. First, the authors review the scientific literature on expertise and intuition to define expertise-based intuition, the type of intuition of most value to organizations. Second, the authors propose a set of descriptive developmental and performance mechanisms of expertise-based intuition in decision making. Third, the authors discuss the multilevel nature of expertise-based intuition. Fourth, the authors propose future directions for research and application.

Does Teamwork Improve Performance in the Operating Room? A Multilevel Evaluation

BACKGROUND Medical care is a team effort, especially as patient cases are more complex. Communication, cooperation, and coordination are vital to effective care, especially in complex service lines such as the operating room (OR). Team training, specifically the TeamSTEPPS training program, has been touted as one methodology for optimizing teamwork among providers and increasing patient safety. Although such team-training programs have transformed the culture and outcomes of other dynamic, high-risk industries such as aviation and nuclear power, evidence of team training effectiveness in health care is still evolving. Although providers tend to react positively to many training programs, evidence that training contributes to important behavioral and patient safety outcomes is lacking. METHOD A multilevel evaluation of the TeamSTEPPS training program was conducted within the OR service line with a control location. The evaluation was a mixed-model design with one between-groups factor (TeamSTEPPS training versus no training) and two within-groups factors (time period, team). The groups were located at separate campuses to minimize treatment diffusion. Trainee reactions, learning, behaviors in the OR, and proxy outcome measures such as the Hospital Survey on Patient Safety Culture (HSOPS) and Operating Room Management Attitudes Questionnaire (ORMAQ) were collected. RESULTS All levels of evaluation demonstrated positive results. The trained group demonstrated significant increases in the quantity and quality of presurgical procedure briefings and the use of quality teamwork behaviors during cases. Increases were also found in perceptions of patient safety culture and teamwork attitudes. DISCUSSION The hospital system has integrated elements of TeamSTEPPS into orientation training provided to all incoming hospital employees, including nonclinical staff.

Does Team Building Work

This research reports the results of a comprehensive investigation into the effectiveness of team building. The article serves to update and extend Salas, Rozell, Mullen, and Driskells (1999) team-building meta-analysis by assessing a larger database and examining a broader set of outcomes. Our study considers the impact of four specific team-building components (goal setting, interpersonal relations, problem solving, and role clarification) on cognitive, affective, process, and performance outcomes. Results (based on 60 correlations) suggest that team building has a positive moderate effect across all team outcomes. In terms of specific outcomes, team building was most strongly related to affective and process outcomes. Results are also presented on the differential effectiveness of team building based upon the team size.

The Anatomy of Health Care Team Training and the State of Practice: A Critical Review

Purpose As the U.S. health care system enters a new era, the importance of team-based care approaches grows. How is the health care community ensuring that providers and administrators are equipped with the knowledge, skills, and attitudes (KSAs) foundational for effective teamwork? Are these KSAs transferring into daily practice? This review summarizes the present state of practice for health care team training described in published literature. Drawing from empirical investigations of training effectiveness, the authors explore training design, implementation, and evaluation to provide insight into the shape, structure, and anatomy of team training in health care. Method A 2009 literature search yielded 40 peer-reviewed articles detailing health care team training evaluations. Guided by 11 focal questions, two trained raters extracted details regarding training design, implementation, evaluation metrics, and outcomes. Results Findings indicate that team training is being implemented across a wide spectrum of providers and is primarily targeting communication, situational awareness, leadership, and role clarity. Relatively few details indicate how training needs were established. Most studies collected data immediately posttraining; however, less than 30% collected data six months or more posttraining. Content analyses highlight the need for enhanced detail in published training evaluation reports. Conclusions In many respects, health care team training implementation and evaluation align with best practices suggested from the science of training, adult learning, and human performance; however, opportunities for improvement exist. The authors suggest several mechanisms for furthering the health care team training evidence base to enhance patient safety and work environment quality for clinicians.

The productivity measurement and enhancement system: a meta-analysis.

Meta-analytic procedures were used to examine data from 83 field studies of the Productivity Measurement and Enhancement System (ProMES). The article expands the evidence on effectiveness of the intervention, examines where it has been successful, and explores moderators related to its success. Four research questions were explored and results indicate that (a) ProMES results in large improvements in productivity; (b) these effects last over time, in some cases years; (c) the intervention results in productivity improvements in many different types of settings (i.e., type of organization, type of work, type of worker, country); and (d) moderator variables are related to the degree of productivity improvement. These moderator variables include how closely the study followed the original ProMES methodology, the quality of feedback given, whether changes were made in the feedback system, the degree of interdependence of the work group, and centralization of the organization. Implications based on these findings are discussed for future use of this intervention, and the system is discussed as an example for evidence-based management.

Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare

This article provides a qualitative review of the published literature dealing with the design, implementation, and evaluation of simulation-based team training (SBTT) in healthcare with the purpose of providing synthesis of the present state of the science to guide practice and future research. A systematic literature review was conducted and produced 27 articles meeting the inclusion criteria. These articles were coded using a low-inference content analysis coding scheme designed to extract important information about the training program. Results are summarized in 10 themes describing important considerations for what occurs before, during, and after a training event. Both across disciplines and within Emergency Medicine (EM), SBTT has been shown to be an effective method for increasing teamwork skills. However, the literature to date has underspecified some of the fundamental features of the training programs, impeding the dissemination of lessons learned. Implications of this study are discussed for team training in EM.

There’s a Science for That: Team Development Interventions in Organizations

As teams have become an increasingly necessary component of organizational structure, organizations have turned to team development interventions in hopes of facilitating performance gains in their teams. However, it is critical to understand that team development interventions are not “one size fits all.” This review provides a close examination of the two most prevalent intervention approaches, team training and team building, in order to highlight their contributions to improving teams when designed according to team development science.

Applying organizational science to health care: a framework for collaborative practice.

Developing interprofessional education (IPE) curricula that improve collaborative practice across professions has proven challenging. A theoretical basis for understanding collaborative practice in health care settings is needed to guide the education and evaluation of health professions trainees and practitioners and support the team-based delivery of care. IPE should incorporate theory-driven, evidence-based methods and build competency toward effective collaboration. In this article, the authors review several concepts from the organizational science literature and propose using these as a framework for understanding how health care teams function. Specifically, they outline the team process model of action and planning phases in collaborative work; discuss leadership and followership, including how locus (a leader’s integration into a team’s usual work) and formality (a leader’s responsibility conferred by the traditional hierarchy) affect team functions; and describe dynamic delegation, an approach to conceptualizing escalation and delegation within health care teams. For each concept, they identify competencies for knowledge, attitudes, and behaviors to aid in the development of innovative curricula to improve collaborative practice. They suggest that gaining an understanding of these principles will prepare health care trainees, whether team leaders or members, to analyze team performance, adapt behaviors that improve collaboration, and create team-based health care delivery processes that lead to improved clinical outcomes.