Lauren E. Benishek

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

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.

The power of coaching: a meta-analytic investigation

Coaching is defined as a one-to-one relationship in which the coach and coachee work together to identify and achieve organisationally, professionally, and personally beneficial developmental goals. However, it is often unclear what the relative effects of coaching are on specific coaching outcomes. We adopt meta-analytic techniques to investigate the predictive power of coaching on coach–coachee relationship outcomes, and coachee goal-attainment outcomes. Our findings suggest that coaching has stronger effects on eliciting relationship outcomes with the coachee than goal-attainment outcomes. Moreover, of the goal-attainment outcomes, coaching has the strongest effect on behavioural changes as opposed to attitudinal changes. Sample type, study design, background of the coach, and number of coaching sessions all emerged as significant moderators. Implications of these findings are discussed.

Enhancing the Effectiveness of Team Debriefings in Medical Simulation: More Best Practices

BACKGROUND Teamwork is a vital component of optimal patient care. In both clinical settings and medical education, a variety of approaches are used for the development of teamwork skills. Yet, for team members to receive the full educational benefit of these experiential learning opportunities, postsimulation feedback regarding the teams performance must be incorporated. Debriefings are among the most widely used form of feedback regarding team performance. A team debriefing is a facilitated or guided dialogue that takes place between team members following an action period to review and reflect on team performance. Team members discuss their perceptions of what occurred, why it occurred, and how they can enhance their performance. Simulation debriefing allows for greater control and planning than are logistically feasible for on-the-job performance. It is also unique in that facilitators of simulation-based training are generally individuals external to the team, whereas debriefing on the job is commonly led by an internal team member or conducted without a specified facilitator. Consequently, there is greater opportunity for selecting and training facilitators for team simulation events. Thirteen Best Practices: The 13 best practices, extracted from existing training and debriefing research, are organized under three general categories: (1) preparing for debriefing, (2) facilitator responsibilities during debriefing, and (3) considerations for debriefing content. For each best practice, considerations and practical implications are provided to facilitate the implementation of the recommended practices. CONCLUSION The 13 best practices presented in this article should help health care organizations by guiding team simulation administrators, self-directed medical teams, and debriefing facilitators in the optimization of debriefing to support learning for all team members.

The Template of Events for Applied and Critical Healthcare Simulation (TEACH Sim): a tool for systematic simulation scenario design.

Summary Statement Simulation-based training (SBT) affords practice opportunities for improving the quality of clinicians’ technical and nontechnical skills. However, the development of practice scenarios is a process plagued by a set of challenges that must be addressed for the full learning potential of SBT to be realized. Scenario templates are useful tools for assisting with SBT and navigating its inherent challenges. This article describes existing SBT templates, explores considerations in choosing an appropriate template, and introduces the Template of Events for Applied and Critical Healthcare Simulation (TEACH Sim) as a tool for facilitating the formation of practice scenarios in accordance with an established evidence-based simulation design methodology. TEACH Sim’s unique contributions are situated within the landscape of previously existing templates, and each of its component sections is explained in detail.

A Systematic Review of Team Training in Health Care: Ten Questions

BACKGROUND As a result of the recent proliferation of health care team training (HTT), there was a need to update previous systematic reviews examining the underlying structure driving team training initiatives. METHODS This investigation was guided by 10 research questions. A literature search identified 197 empirical samples detailing the evaluation of team training programs within the health care context; 1,764 measures of HTT effectiveness were identified within these samples. Trained coders extracted information related to study design and training development, implementation, and evaluation to calculate percentages detailing the prevalence of certain training features. RESULTS HTT was rarely informed by a training needs analysis (k = 47, 23.9%) and most commonly addressed communication strategies (k = 167, 84.8%). HTT programs that incorporated practice (k = 163, 82.7%) often employed high-fidelity patient simulators (k = 38, 25.2%) and provided participants with feedback opportunities (k = 107, 65.6%). Participants were typically practicing clinicians (k = 154, 78.2%) with a lower prevalence of health care students (k = 35, 17.8). Evaluations primarily relied on repeated measures designs (k = 123, 62.4%) and self-reported data (k = 1,257, 71.3%). Additional trends were identified and are discussed. CONCLUSIONS Many trends in HTT practice and evaluation were identified. The results of this review suggested that, in the literature, HTT programs are more frequently following recommendations for training design and implementation (for example, providing feedback) in comparison to findings from previous reviews. However, there were still many areas in which improvement could be achieved to improve patient care.

Utilizing telemedicine in the trauma intensive care unit: does it impact teamwork?

BACKGROUND The aim of this study was to examine the impact of a telemedical robot on trauma intensive care unit (TICU) clinician teamwork (i.e., team attitudes, behaviors, and cognitions) during patient rounds. MATERIALS AND METHODS Thirty-two healthcare providers who conduct rounds volunteered to take surveys assessing teamwork attitudes and cognitions at three time periods: (1) the onset of the study, (2) the end of the 30-day control period, and (3) the end of the 30-day experimental period, which immediately followed the control period. Rounds were recorded throughout the 30-day control period and 30-day experimental period to observe provider behaviors. For the initial 30 days, there was no access to telemedicine. For the final 30 days, the rounding healthcare providers had access to the RP-7 robot (Intouch Health Inc., Santa Barbara, CA), a telemedical tool that can facilitate patient rounds conducted away from bedside. RESULTS Using a one-tailed, one-way repeated-measures analysis of variance (ANOVA) to compare trust at Times 1, 2, and 3, there was no significant effect on trust: F(2, 14)=1.20, p=0.16. When a one-tailed, one-way repeated-measures ANOVA to compare transactive memory systems (TMS) at Times 1, 2, and 3 was conducted, there was no significant effect on TMS: F(2, 15)=1.33, p=0.15. We conducted a one-tailed, one-way repeated-measures ANOVA to compare team psychological safety at Times 1, 2, and 3, and there was no significant effect on team psychological safety: F(2,15)=1.53, p=0.12. There was a significant difference in communication between rounds with and without telemedicine [t(25)=-1.76, p<0.05], such that there was more task-based communication during telerounds. Telemedicine increased task-based communication and did not negatively impact team trust, psychological safety, or TMS during rounds. CONCLUSIONS Telemedicine may offer advantages for some teamwork competencies without sacrificing the efficacy of others and may be adopted by intact rounding teams without hindering teamwork.

On Being a Team Player: Evidence-Based Heuristic for Teamwork in Interprofessional Education

Identifying the need of a team-based approach for improving quality care, there has been growth in creating and implementing interprofessional education (IPE). The goal of IPE curricula should be to instill the knowledge, skills, and attitudes required for optimal teamwork. With this objective in mind, this paper will provide a streamlined, evidence-based, memorable heuristic of teamwork that could guide interprofessional educators. Rooted in science, this heuristic consists of the six Cs of teamwork — cooperation, communication, conflict, coordination, coaching, and cognition. This paper will define the ‘Cs’ of teamwork and describe their importance, implications, and strategies for integration within interprofessional curricula.

The 6 "ws" of rapid response systems: best practices for improving development, implementation, and evaluation.

Delays in care have been cited as one of the primary contributors of preventable mortality; thus, quality patient safety is often contingent upon the delivery of timely clinical care. Rapid response systems (RRSs) have been touted as one mechanism to improve the ability of suitable staff to respond to deteriorating patients quickly and appropriately. Rapid response systems are defined as highly skilled individual(s) who mobilize quickly to provide medical care in response to clinical deterioration. While there is mounting evidence that RRSs are a valid strategy for managing obstetric emergencies, reducing adverse events, and improving patient safety, there remains limited insight into the practices underlying the development and execution of these systems. Therefore, the purpose of this article was to synthesize the literature and answer the primary questions necessary for successfully developing, implementing, and evaluating RRSs within inpatient settings—the Who, What, When, Where, Why, and How of RRSs.

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.