Michael A. Rosen

On Teams, Teamwork, and Team Performance: Discoveries and Developments

Objective: We highlight some of the key discoveries and developments in the area of team performance over the past 50 years, especially as reflected in the pages of Human Factors. Background: Teams increasingly have become a way of life in many organizations, and research has kept up with the pace. Method: We have characterized progress in the field in terms of eight discoveries and five challenges. Results: Discoveries pertain to the importance of shared cognition, the measurement of shared cognition, advances in team training, the use of synthetic task environments for research, factors influencing team effectiveness, models of team effectiveness, a multidisciplinary perspective, and training and technological interventions designed to improve team effectiveness. Challenges that are faced in the coming decades include an increased emphasis on team cognition; reconfigurable, adaptive teams; multicultural influences; and the need for naturalistic study and better measurement. Conclusion: Work in human factors has contributed significantly to the science and practice of teams, teamwork, and team performance. Future work must keep pace with the increasing use of teams in organizations. Application: The science of teams contributes to team effectiveness in the same way that the science of individual performance contributes to individual effectiveness.

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.

Team-training in healthcare: a narrative synthesis of the literature

Background Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings. Methods A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes. Results Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice. Conclusions Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.

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.

Toward an Understanding of Macrocognition in Teams: Predicting Processes in Complex Collaborative Contexts

Objective: This article presents a model for predicting complex collaborative processes as they arise in one-of-a-kind problem-solving situations to predict performance outcomes. The goal is to outline a set of key processes and their interrelationship and to describe how these can be used to predict collaboration processes embedded within problem-solving contexts. Background: Teams are increasingly called upon to address complex problem-solving tasks in novel situations. This represents a domain of performance that to date has been underrepresented in the research literature. Method: Multidisciplinary theoretical and empirical literature relating to knowledge work in teams is synthesized. Results: A set of propositions developed to guide research into how teams externalize cognition and build knowledge in service of problem solving is presented. First, a brief overview of macrocognition in teams is provided to distinguish the present work from other views of team cognition. Second, a description of the foundational theoretical concepts driving the theory of macrocognition in teams presented here is provided. Third, a set of propositions described within the context of a model of macrocognition in teams is forwarded. Conclusion: The theoretical framework described in this article provides a set of empirically testable propositions that can ultimately guide practitioners in efforts to support macrocognition in teams. Application: A theory of macrocognition in teams can provide guidance for the development of training interventions and the design of collaborative tools to facilitate knowledge-based performance in teams.

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.

Performance Measurement in Simulation-Based Training

Simulation-based training (SBT) is a methodology for providing systematic and structured learning experiences. The effectinvess of this methodology is dependent on the quality of performance measurement practices in place. Performance measurement during SBT must be diagnosed; that is, the causes of effective and ineffective performance must be determined. This diagonstic measurement drives the systematic decisions concerning corrective feedback and remediation. The purpose of this article is to provide a state of the science review of human performance measurement systems in SBT. To this end, three specific goals are addressed. First, a review of the theoretical foundations being used to drive performance measurement systems in SBT is provided. Second, an overview of the methodologies and approaches to measurement in SBT is provided. Third, a set of best practices for designing performance measurement systems for use in SBT are provided. These best practices are based on the scientific and practice-based literatures.

Reducing Medical Errors and Adverse Events

Medical errors account for ∼98,000 deaths per year in the United States. They increase disability and costs and decrease confidence in the health care system. We review several important types of medical errors and adverse events. We discuss medication errors, healthcare-acquired infections, falls, handoff errors, diagnostic errors, and surgical errors. We describe the impact of these errors, review causes and contributing factors, and provide an overview of strategies to reduce these events. We also discuss teamwork/safety culture, an important aspect in reducing medical errors.

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.