Sarah Henrickson Parker

Teamwork and Collaboration

Safety and quality of health care depend on collaborative efforts of multiprofessional and multidisciplinary teams of care providers. Team research in aviation and the military has produced a wealth of knowledge in terms of concepts and intervention strategies to improve team performance. Research on collaborative work in health care in the past 20 years has uncovered unique characteristics and requirements of teams in hospitals and other health care settings and has provided early assessment of the utility of the theoretical concepts, methodologies, and interventions developed outside health care. In this chapter, we review a set of concepts that have been used in characterizing teams in health care and in improving teamwork. These concepts include the organizational shell to capture the sociotechnical environment in which teams reside as well as nontechnical skills, team leadership, team mental models, and so on. We will review a number of leading interventions to enhance team performance, such as teamw...

Classification and team response to nonroutine events occurring during pediatric trauma resuscitation.

BACKGROUND Errors directly causing serious harm are rare during pediatric trauma resuscitation, limiting the use of adverse outcome analysis for performance improvement in this setting. Errors not causing harm because of mitigation or chance may have similar causation and are more frequent than those causing adverse outcomes. Analyzing these error types is an alternative to adverse outcome analysis. The purpose of this study was to identify errors of any type during pediatric trauma resuscitation and evaluate team responses to their occurrence. METHODS Errors identified using video analysis were classified as errors of omission or commission and selection errors using input from trauma experts. The responses to error types and error frequency based on patient and event features were compared. RESULTS Thirty-nine resuscitations were reviewed, identifying 337 errors (range, 2–26 per resuscitation). The most common errors were related to cervical spine stabilization (n = 93, 27.6%). Errors of omission (n = 135) and commission (n = 106) were more common than errors of selection (n = 96). Although 35.9% of all errors were acknowledged and compensation occurred after 43.6%, no response (acknowledgement or compensation) was observed after 51.3% of errors. Errors of omission and commission were more often acknowledged (40.7% and 39.6% vs. 25.0%, p = 0.03 and p = 0.04, respectively) and compensated for (50.4% and 47.2% vs. 29.2%, p = 0.004 and p = 0.01, respectively) than selection errors. Response differences between errors of omission and commission were not observed. The number of errors and the number of high-risk errors that occurred did not differ based on patient or event features. CONCLUSIONS Errors are common during pediatric trauma resuscitation. Teams did not respond to most errors, although differences in team response were observed between error types. Determining causation of errors may be an approach for identifying latent safety threats contributing to adverse outcomes during pediatric trauma resuscitation. LEVEL OF EVIDENCE Therapeutic study, level III.

Decisionmaking in practice: The dynamics of muddling through

An alternative to conventional models that treat decisions as open-loop independent choices is presented. The alterative model is based on observations of work situations such as healthcare, where decisionmaking is more typically a closed-loop, dynamic, problem-solving process. The article suggests five important distinctions between the processes assumed by conventional models and the reality of decisionmaking in practice. It is suggested that the logic of abduction in the form of an adaptive, muddling through process is more consistent with the realities of practice in domains such as healthcare. The practical implication is that the design goal should not be to improve consistency with normative models of rationality, but to tune the representations guiding the muddling process to increase functional perspicacity.

Developing Team Cognition: A Role for Simulation

Summary Statement Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.

Making MATB-II medical: Pilot testing results to determine a novel lab-based, stress-inducing task:

The purpose of this project was to adapt an existing computer-based task called Multi-Attribute Task Battery (MATB-II), developed by NASA and frequently used to induce acute stress among air craft crew members and general populations, for use in medical populations. We gathered continuous electrocardiography (ECG) data while medical students completed four different versions of the MATB-II of varying difficulties alongside questions probing medical knowledge, comprising a new task called medically-focused multitasking game (MFMG). After completing each version, participants responded to questionnaires to assess subjective states of stress (State Trait Anxiety Inventory for Adults) and cognitive workload (NASA Task Load Index). Responses to these questionnaires, physiological data from continuous ECG, and overall performance scores were combined to determine one version of MFMG that represented the highest level of elicited stress, and one that represented the lowest level of elicited stress. The results of this pilot study are promising, and have converged to reveal one high-stress and one low-stress version of MFMG, which will later be used to induce acute stress in biofeedback intervention studies among surgical residents and fellows. Beyond this specific application, MFMG can have broader applications in measuring acute stress induction and/or reduction among populations of healthcare practitioners.

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.

Human Factors Science: Brief History and Applications to Healthcare

This section will define the science of human factors, its origins, its impact on safety in other domains, and its impact and potential for impact on patient safety.

Biofeedback as a stress management tool: a systematic review

Inappropriate management of acute stress can negatively affect cognition and task performance. Frequently occurring acute stress encounters can lead to cardiovascular and immunity deficiencies, and psychological disorders such as depression, fatigue, and burnout. Biofeedback can be used as a non-invasive, passive, continuous method of managing stress in real time. A systematic review of biofeedback as a real-time stress management intervention for non-patients was conducted to identify literature between 2000 and 2017, yielding 17 studies evaluating physiological, psychological, and/or performance metrics. Participants represent convenience samples (N = 9 studies) and deliberately selected samples, whose optimal performance under stress is critical for occupational success (N = 8 studies). Various methods to collect data, display biofeedback, induce stress, and measure performance were reported. Overall, biofeedback is an effective intervention that can be used to reduce physiological and subjective stress, and enhance performance. This is especially true among professionals, whose job performance requires appropriate stress management.

Identifying influential individuals on intensive care units: using cluster analysis to explore culture

AIM The objective of this paper is to identify attribute patterns of influential individuals in intensive care units using unsupervised cluster analysis. BACKGROUND Despite the acknowledgement that culture of an organisation is critical to improving patient safety, specific methods to shift culture have not been explicitly identified. METHODS A social network analysis survey was conducted and an unsupervised cluster analysis was used. RESULTS A total of 100 surveys were gathered. Unsupervised cluster analysis was used to group individuals with similar dimensions highlighting three general genres of influencers: well-rounded, knowledge and relational. CONCLUSIONS Culture is created locally by individual influencers. Cluster analysis is an effective way to identify common characteristics among members of an intensive care unit team that are noted as highly influential by their peers. To change culture, identifying and then integrating the influencers in intervention development and dissemination may create more sustainable and effective culture change. Additional studies are ongoing to test the effectiveness of utilising these influencers to disseminate patient safety interventions. IMPLICATIONS FOR NURSING MANAGEMENT This study offers an approach that can be helpful in both identifying and understanding influential team members and may be an important aspect of developing methods to change organisational culture.

Proactive Risk Assessment for Ebola-Infected Patients: A Systematic Approach to Identifying and Minimizing Risk to Healthcare Personnel

Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks. Infect Control Hosp Epidemiol 2016;37:867-871.