Jan B. Schmutz

Do team processes really have an effect on clinical performance? A systematic literature review

There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical setting.

Five steps to develop checklists for evaluating clinical performance: an integrative approach.

Purpose The process of developing checklists to rate clinical performance is essential for ensuring their quality; thus, the authors applied an integrative approach for designing checklists that evaluate clinical performance. Method The approach consisted of five predefined steps (taken 2012–2013). Step 1: On the basis of the relevant literature and their clinical experience, the authors drafted a preliminary checklist. Step 2: The authors sent the draft checklist to five experts who reviewed it using an adapted Delphi technique. Step 3: The authors devised three scoring categories for items after pilot testing. Step 4: To ensure the changes made after pilot testing were valid, the checklist was submitted to an additional Delphi review round. Step 5: To weight items needed for accurate performance assessment, 10 pediatricians rated all checklist items in terms of their importance on a scale from 1 (not important) to 5 (essential). Results The authors have illustrated their approach using the example of a checklist for a simulation scenario of infant septic shock. The five-step approach resulted in a valid, reliable tool and proved to be an effective method to design evaluation checklists. It resulted in 33 items, most consisting of three scoring categories. Conclusions This approach integrates published evidence and the knowledge of domain experts. A robust development process is a necessary prerequisite of valid performance checklists. Establishing a widely recognized standard for developing evaluation checklists will likely support the design of appropriate measurement tools and move the field of performance assessment in health care forward.

Promoting Learning and Patient Care Through Shared Reflection: A Conceptual Framework for Team Reflexivity in Health Care

Health care teams are groups of highly skilled experts who may often form inexpert teams because of a lack of collective competence. Because teamwork and collaboration form the foundation of effective clinical practice, factors that promote collective competence demand exploration. The authors review team reflexivity (TR), a concept from the psychology and management literatures, and how it could contribute to the collective competence of health care teams. TR captures a teams ability to reflect collectively on group objectives, strategies, goals, processes, and outcomes of past, current, and future performance to process key information and adapt accordingly. As an overarching process that promotes team functioning, TR builds shared mental models as well as triggering team adaptation and learning.The authors present a conceptual framework for TR in health care, describing three phases in which TR may occur: pre-action TR (briefing before patient care), in-action TR (deliberations during active patient care), and post-action TR (debriefing after patient care). Depending on the phase, TR targets either goals, taskwork, teamwork, or resources and leads to different outcomes (e.g., optimal preparation, a shared mental model, adaptation, or learning). This novel conceptual framework incorporates various constructs related to reflection and unites them under the umbrella of TR. Viewing reflection through a team lens may guide future research about team functioning, optimize training efforts, and elucidate mechanisms for workplace learning, with better patient care as the ultimate goal.

Infectious Risk Moments: A Novel, Human Factors–Informed Approach to Infection Prevention

We pilot tested a novel human factors-informed concept to identify infectious risk moments (IRMs) that occur with high frequency during routine intensive care. Following 30 observation-hours, 28 potential IRMs related to hand hygiene, gloves, and objects were expert rated. A comprehensive IRM inventory may provide valuable taxonomy for research, training, and intervention.

Structured Performance Assessment in Three Pediatric Emergency Scenarios: A Validation Study

OBJECTIVE To develop and validate 3 performance evaluation checklists (PECs) for systematic performance assessment in 3 clinical scenarios: cardiopulmonary arrest, dyspnea with oxygen desaturation after intubation, and respiratory syncytial virus (RSV). STUDY DESIGN The 3 PECs were developed using an integrative approach and used to rate 50 training sessions in a simulator environment by different raters. Construct validity was tested by correlating the checklist scores with external constructs (ie, global rating, team experience level, and time to action). Further interrater reliability was tested for all 3 PECs. RESULTS The PECs for the desaturation and cardiopulmonary arrest scenarios were valid and reliable, whereas the PEC for RSV had limited validity and reliability. CONCLUSION For 2 pediatric emergencies, the PEC is a valid and reliable tool for systematic performance assessment. The unsatisfactory results for the PEC for RSV may be related to limitations of the simulation setting and require further investigation. Structured assessment of clinical performance can augment feedback on technical performance aspects and is essential for training purposes as well as for research. Only reliable and valid performance measures will allow medical educators to accurately evaluate the behavioral effects of training interventions and further enhance the quality of patient care.

Investigating predictive power of agency and communion for interprofessional learner outcomes: A before–after study

ABSTRACT As interprofessional education (IPE) continues to be instituted, much attention has been paid to training-intervention effectiveness. Less attention has been paid to the selection side of the IPE model; however, efficient delivery is necessary to sustain the development of IPE. This short report investigates the “two big social cognitions” (agency and communion) as individual-difference predictors of attitude change and knowledge acquisition. A 3-week before–after observational design with survey methodology was conducted in a pre-licensure IPE setting (n = 82). Results indicated significant interactions of agency and communion in predicting learner outcomes. Our findings should stimulate future IPE researchers to identify additional, selection-relevant design factors (e.g., individual differences) that may enhance comparative-effectiveness of IPE.

Twelve tips for integrating team reflexivity into your simulation-based team training

Abstract Due to increasing complexity in healthcare, clinicians must often make decisions under uncertain conditions in which teams must be flexible and process emerging information “on the fly” in order to adapt to changing circumstances. A crucial strategy that helps teams to adapt, learn, and develop is team reflexivity (TR) – a team’s ability to collectively reflect on group objectives, strategies, processes, and outcomes of past and current performance and to adapt accordingly. We provide 12 evidence-based tips on incorporating TR into simulation-based team training (SBTT). The first three points elaborate on basic principles of TR, when TR can take place and why it matters. The following nine tips are then organized according to three phases in which teams are able to engage in TR: pre-action, in-action, and post-action. SBTT represents an ideal venue to train various TR behaviors that foster team learning and improve patient care.

Training Needs for Adaptive Coordination: Utilizing Task Analysis to Identify Coordination Requirements in Three Different Clinical Settings:

A team’s ability to coordinate and adapt their performance to meet situational demands is critical to excellent patient care. The goal of this article is to identify common coordination characteristics that enable health care action teams to ensure effective patient care and to discuss specific examples of adaptive coordination within the health care setting. Task analyses were conducted to identify situational demands, in three different clinical settings: cardiac anesthesia, pediatric sepsis simulation, and trauma resuscitation. Each task analysis identified specific coordination requirements for pertinent tasks. The research team compared these task analyses, identified emerging themes, and agreed on core coordination characteristics common across all three environments by consensus through iterative abductive analysis. Findings across these diverse clinical settings showed that expert action teams (a) continually appraise their dynamic environment, (b) identify and define points of coordination, and (c) respond to the demands of nonroutine events by making coordination highly explicit. Specific examples of adaptive coordination within the health care setting are discussed, and implications for training are articulated. Findings are also pertinent outside of health care and may contribute to the understanding of coordination behaviors within action teams across multiple settings.

Measuring spatial presence: Introducing and validating the pictorial presence sam

The aim of the present study was to develop a pictorial presence scale using self-assessment-manikins (SAM). The instrument assesses presence sub-dimensions (self-location and possible actions) as well as presence determinants (attention allocation, spatial situation model, higher cognitive involvement, and suspension of disbelief). To qualitatively validate the scale, think-aloud protocols and interviews (n = 12) were conducted. The results reveal that the SAM items are quickly filled out as well as easily, intuitively, and unambiguously understood. Furthermore, the instruments validity and sensitivity was quantitatively examined in a two-factorial design (n = 317). Factors were medium (written story, audio book, video, and computer game) and distraction (non-distraction vs. distraction). Factor analyses reveal that the SAM presence dimensions and determinants closely correspond to those of the MEC Spatial Presence Questionnaire, which was used as a comparison measure. The findings of the qualitative and quantitative validation procedures show that the Pictorial Presence SAM successfully assesses spatial presence. In contrast to the verbal questionnaire data (MEC), the significant distraction–effect suggests that the new scale is even more sensitive. This points out that the scale can be a useful alternative to existing verbal presence self-report measures.

Verhalten ist messbar: Behavioural Marker Systeme und Kompetenzentwicklung

Von den in Hoch-Risiko-Arbeitsfeldern tatigen Personen wird ein hohes Mas an Kompetenz erwartet, unabhangig davon, ob es sich um Beschaftigte in der Nuklearindustrie, der Luftfahrt oder der Medizin handelt. Doch was macht eine hochgradig kompetente Person aus? Was ist es jenseits von ausgezeichnetem Fachwissen und hervorragenden technischen Fertigkeiten, das diese Personen »mehr« besitzen? Mit einer gewissen Erfahrung in einem Arbeitsgebiet kann man erkennen, wer »es« hat. Doch worin genau besteht »es«? Und wie kann man »es« beschreibbar machen und Personen gezielt im Erwerb und in der Weiterentwicklung dieser Kompetenzen unterstutzen?