Heidi B. King

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.

Measuring team performance in simulation-based training: Adopting best practices for healthcare

Team performance measurement is a critical and frequently overlooked component of an effective simulation-based training system designed to build teamwork competencies. Quality team performance measurement is essential for systematically diagnosing team performance and subsequently making decisions concerning feedback and remediation. However, the complexities of team performance pose a challenge to effectively measuring team performance. This article synthesizes the scientific literature on this topic and provides a set of best practices for designing and implementing team performance measurement systems in simulation-based training.

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.

Promoting Teamwork: An Event‐based Approach to Simulation‐based Teamwork Training for Emergency Medicine Residents

The growing complexity of patient care requires that emergency physicians (EPs) master not only knowledge and procedural skills, but also the ability to effectively communicate with patients and other care providers and to coordinate patient care activities. EPs must become good team players, and consequently an emergency medicine (EM) residency program must systematically train these skills. However, because teamwork-related competencies are relatively new considerations in health care, there is a gap in the methods available to accomplish this goal. This article outlines how teamwork training for residents can be accomplished by employing simulation-based training (SBT) techniques and contributes tools and strategies for designing structured learning experiences and measurement tools that are explicitly linked to targeted teamwork competencies and learning objectives. An event-based method is described and illustrative examples of scenario design and measurement tools are provided.

Integrating the science of team training: Guidelines for continuing education

The provision of high-quality, efficient care results from the coordinated, cooperative efforts of multiple technically competent health care providers working in concert over time, spanning disciplinary and professional boundaries. Accordingly, the role of medical education must include the development of providers who are both expert clinicians and expert team members. However, the competencies underlying effective teamwork are only just beginning to be integrated into medical school curricula and residency programs. Therefore, continuing education (CE) is a vital mechanism for practitioners already in the field to develop the attitudes, behaviors (skills), and cognitive knowledge necessary for highly reliable and effective team performance.The present article provides an overview of more than 30 years of evidence regarding team performance and team training in order to guide, shape, and build CE activities that focus on developing team competencies. Recognizing that even the most comprehensive and well-designed team-oriented CE programs will fail unless they are supported by an organizational and professional culture that values collaborative behavior, ten evidence-based lessons for practice are offered in order to facilitate the use of the science of team-training in efforts to foster continuous quality improvement and enhance patient safety.

Saving lives: A meta-analysis of team training in healthcare.

As the nature of work becomes more complex, teams have become necessary to ensure effective functioning within organizations. The healthcare industry is no exception. As such, the prevalence of training interventions designed to optimize teamwork in this industry has increased substantially over the last 10 years (Weaver, Dy, & Rosen, 2014). Using Kirkpatricks (1956, 1996) training evaluation framework, we conducted a meta-analytic examination of healthcare team training to quantify its effectiveness and understand the conditions under which it is most successful. Results demonstrate that healthcare team training improves each of Kirkpatricks criteria (reactions, learning, transfer, results; d = .37 to .89). Second, findings indicate that healthcare team training is largely robust to trainee composition, training strategy, and characteristics of the work environment, with the only exception being the reduced effectiveness of team training programs that involve feedback. As a tertiary goal, we proposed and found empirical support for a sequential model of healthcare team training where team training affects results via learning, which leads to transfer, which increases results. We find support for this sequential model in the healthcare industry (i.e., the current meta-analysis) and in training across all industries (i.e., using meta-analytic estimates from Arthur, Bennett, Edens, & Bell, 2003), suggesting the sequential benefits of training are not unique to medical teams. Ultimately, this meta-analysis supports the expanded use of team training and points toward recommendations for optimizing its effectiveness within healthcare settings. (PsycINFO Database Record

Tools for evaluating team performance in simulation-based training

Teamwork training constitutes one of the core approaches for moving healthcare systems toward increased levels of quality and safety, and simulation provides a powerful method of delivering this training, especially for face-paced and dynamic specialty areas such as Emergency Medicine. Team performance measurement and evaluation plays an integral role in ensuring that simulation-based training for teams (SBTT) is systematic and effective. However, this component of SBTT systems is overlooked frequently. This article addresses this gap by providing a review and practical introduction to the process of developing and implementing evaluation systems in SBTT. First, an overview of team performance evaluation is provided. Second, best practices for measuring team performance in simulation are reviewed. Third, some of the prominent measurement tools in the literature are summarized and discussed relative to the best practices. Subsequently, implications of the review are discussed for the practice of training teamwork in Emergency Medicine.

Building team and technical competency for obstetric emergencies: The mobile obstetric emergencies simulator (moes) system

The infrequent and high-stakes nature of obstetric emergencies requires staff members to respond quickly and proficiently to a complex and high-stress situation, a situation they have likely had little opportunity to experience. This situation requires a systematic approach to preparing personnel to manage these situations. Therefore, this article seeks to contribute to the growing literature on training programs for obstetric emergencies by documenting the development and implementation of the Mobile Obstetric Emergencies Simulator (MOES) system. MOES is a comprehensive package of simulation technology, standardized curriculum, and instructional features that combines traditional classroom learning activities and simulation-based training on the actual labor and delivery (L&D) ward. Specifically, the MOES system leverages the TeamSTEPPS teamwork training being implemented throughout the US military healthcare system with opportunities to practice teamwork and technical skills using mannequin-based patient simulation embedded within L&D units. The primary goals of this article are twofold. First, this article explicitly identifies the unique training needs for preparing staff for obstetric emergencies through a comprehensive review and synthesis of the literature. Second, this article documents the approach taken in MOES to meet these needs.

Validation of a teamwork perceptions measure to increase patient safety

Background TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is a team-training intervention which shows promise in aiding the mitigation of medical errors. This article examines the construct validity of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), a self-report survey that examines multiple dimensions of perceptions of teamwork within healthcare settings. Method Using survey-based methods, 1700 multidisciplinary healthcare professionals and support staff were measured on their perceptions of teamwork. Confirmatory factor analysis was conducted to examine the relationship between the five TeamSTEPPS dimensions: Leadership, Mutual Support, Situation Monitoring, Communication, and Team Structure. Results The analysis indicated that the T-TPQ measure is more reliable than previously thought (Cronbachs α=0.978). Further, our final tested model showed a good fit with the data (x2 (df) 3601.27 (546), p<0.0001, Tucker–Lewis Index (TLI)=0.942, Comparative fit index (CFI)=0.947, root mean square error of approximation (RMSEA)=0.057), indicating that the measure appears to have construct validity. Further, all dimensions correlated with one another, but were shown to be independent constructs. Conclusions The T-TPQ is a construct-valid instrument for measuring perceptions of teamwork. This has beneficial implications for patient safety and future research that studies medical teamwork.

Improving teamwork and safety: Toward a practical systems approach, a commentary on Deneckere et al.

Department of Psychology, and Institute of Simulation and Training, University of Central Florida, 3100 Technology Drive, Orlando, United States United States Department of Defense Patient Safety Program, United States Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, United States Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, United States