Heather A. Priest

Using Simulation-Based Training to Improve Patient Safety: What Does It Take?

BACKGROUND Through simulations health care workers can learn by practicing skills taught and experiencing mistakes before interacting with an actual patient. A number of areas within the health care industry are currently using simulation-based training to help individuals and teams improve patient safety. WHAT IS SIMULATION-BASED TRAINING? The key components of simulation-based training are as follows: performance history/skill inventory, tasks/competencies, training objectives, events/exercises, measures/metrics, performance diagnosis, and feedback and debrief. WHAT DOES IT TAKE FOR SIMULATION-BASED TRAINING TO BE EFFECTIVE? To be effective, simulation-based training must be implemented appropriately. The guidelines are as follows: understand the training needs and requirements; instructional features, such as performance measurement and feedback, must be embedded within the simulation; craft scenarios based on guidance from the learning outcomes; create opportunities for assessing and diagnosing individual and/or team performance within the simulation; guide the learning; focus on cognitive/psychological simulation fidelity; form a mutual partnership between subject matter experts and learning experts; and ensure that the training program worked. CONCLUSION The health care community can gain significantly from using simulation-based training to reduce errors and improve patient safety when it is designed and delivered appropriately.

Errors in the Heat of Battle: Taking a Closer Look at Shared Cognition Breakdowns Through Teamwork

Objective: We developed a theoretically based taxonomy for classifying shared cognition breakdowns related to teamwork which contribute to fratricide incidents. Background: Fratricide on the battlefield is an inescapable cost of war. A number of technological advancements have been made in terms of combat identification systems to reduce the risk of these incidents. However, fratricide continues to occur at alarming rates. Method: We take a human-centered approach to understanding errors leading to fratricide incidents by focusing on shared cognition. We turn to the literature and provide the theoretical foundations for an error classification taxonomy to improve understanding of why fratricide incidents occur. Results: Based on our review of the literature, we identified a number of problem areas leading to fratricide incidents. However, many of the cited contributing factors were broad terms (e.g., poor coordination) and did little to tell us why the breakdown occurred and where improvements are needed. Therefore, we chose to focus on one specific area — teamwork breakdowns — and discuss in depth how these breakdowns contribute to fratricide. Conclusion: In this paper, we take a first step toward proposing a taxonomy that allows for the diagnostic assessment of what causes teamwork breakdowns in fratricide. We understand that a taxonomy is only as good as the data available and encourage richer case studies from which to learn. Application: To apply this taxonomy in an operational setting, we provide a set of behavioral markers that can be used to identify teamwork breakdowns on the battlefield.

Understanding Team Adaptability: Initial Theoretical and Practical Considerations:

Team adaptability is just beginning to be understood by researchers. Team training, team effectiveness, and adaptability have provided researchers with a pool of evidence that can be leveraged into meaningful team adaptability research. However, team adaptability is different from individual adaptability. Teams have processes that individuals do not. Furthermore, team adaptability refers to more than just effective performance. The following paper identifies 2 team processes that past literature indicates is important to adaptability (feedback and shared mental models). Theoretical issues and practical training issues are examined to help determine their role in adaptive teams.

Distributed Team Performance: A Multi-Level Review of Distribution, Demography, and Decision Making

Distributed performance arrangements are increasingly used by organizations to structure dyadic and team interactions. Unfortunately, distributed teams are no panacea. This chapter reviews some of the advantages and disadvantages associated with the geographical and temporal distribution of team members. An extended discussion of the implications of distributed team performance for individual, team, and organizational decision making is provided, with particular attention paid to selected cultural factors. Best practices and key points are advanced for those stakeholders charged with offsetting the performance decrements in decision making that can result from distribution and culture.

The Continued Evolution of Team Research: A Theoretical Model of Performance in Multiteam Systems

The growth of global companies and partnerships in and across organizations and the growth of coalitions in military campaigns have brought about new needs in team research. Specifically, organizations and the military alike are beginning to utilize teams of teams or multiteam systems (MTS) to complete more complex tasks. A MTS has been defined as “two or more teams that interface directly and interdependently in response to environmental contingencies toward the accomplishment of collective goals” (Mathieu, Marks, & Zaccaro, 2001, p. 290). We believe that MTS represent the next evolution of team research. Because of the growing importance and of MTS to the military and organizations this paper introduces a theoretical model of MTS performance, the Joint Operations Effectiveness Model. We provide a brief synopsis of teams and findings from previous team research before presenting a more detailed description of the proposed model.

Are there Differences in Teamwork Across Team Type

Team performance is a complex and illusive phenomena that has not yet been fully understood. Teams rely on certain underlying processes to shape their performance. These underlying processes (i.e., “the black box”) have been investigated over the last few years. However, a significant amount of the research has relied on command-and-control teams. The current study focuses on the differentiation of teams based on interdependence, performance arrangement and shared awareness to test the relationship between performance and teamwork behaviors. In addition, the effects of stress, operationalized as workload using a secondary task was also tested. Results showed some support for different communication patterns in different team types. No effects of workload were found. These results should be further investigated and applied to future team research.

Tips for Creating a Safety Culture in Organizations

Establishing, supporting, communicating, and implementing clear safety policies will always benefit any organization.

Distributed Team Performance: Continuing the Dialogue

Stagl, Salas, Rosen, Priest, Burke, Goodwin, and Johnston (this volume) conducted a review of distributed team performance and discussed some of the implications of distributed, multicultural operations for individual, team, and organizational decision making. Expanding upon Stagl and colleagues’ discussion, Alutto (this volume), and Coovert and Burke (this volume) provided thought-provoking commentary on these issues. The current note briefly responds to some of the questions posed and comments made by Alutto, Coovert, and Burke and concludes by calling for a continued dialogue by all stakeholders concerned with fostering effective distributed teams.

Guidelines for Developing a Safety Culture to Support the Implementation and Use of Technology

Research suggests that human error contributes to unsafe practices and accidents more than two-thirds of the time in technologically advanced industries, such as aviation. Therefore, we sought to determine the factors that contribute to unsafe practices in these industries by reviewing the available literature regarding safety and safety culture. We found an overwhelming number of studies that suggest that a poor organizational safety culture is a significant contributor to errors and accidents. We also found that there was a lack of consistency between what the literature prescribes in terms of promoting safety and what organizations actually practice. As organizations are using more complex technologies, the need to develop a safety culture that encourages the safe implementation and use of technologies is apparent. As such, we developed guidelines to assist in the development of a safety culture that encourages safe practices at all levels of the organizations. We hope that the information provided will help organizations to improve safety within their organization.