Shirley C. Sonesh

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

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.

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.

A Framework to Guide the Assessment of Human–Machine Systems:

Objective: We have developed a framework for guiding measurement in human–machine systems. Background: The assessment of safety and performance in human–machine systems often relies on direct measurement, such as tracking reaction time and accidents. However, safety and performance emerge from the combination of several variables. The assessment of precursors to safety and performance are thus an important part of predicting and improving outcomes in human–machine systems. Method: As part of an in-depth literature analysis involving peer-reviewed, empirical articles, we located and classified variables important to human–machine systems, giving a snapshot of the state of science on human–machine system safety and performance. Using this information, we created a framework of safety and performance in human–machine systems. Results: This framework details several inputs and processes that collectively influence safety and performance. Inputs are divided according to human, machine, and environmental inputs. Processes are divided into attitudes, behaviors, and cognitive variables. Each class of inputs influences the processes and, subsequently, outcomes that emerge in human–machine systems. Conclusion: This framework offers a useful starting point for understanding the current state of the science and measuring many of the complex variables relating to safety and performance in human-machine systems. Application: This framework can be applied to the design, development, and implementation of automated machines in spaceflight, military, and health care settings. We present a hypothetical example in our write-up of how it can be used to aid in project success.

Success and failure in international assignments: A review and a proposed multi-dimensional model

Purpose The purpose of this paper is to review the literature on how success and failure for international assignments have been defined, and integrate several proposals for these definitions into a multi-dimensional model that considers task performance, relationship building, contextual performance and retention as all being part of how success or failure should be defined. The authors also discuss two proposed pre-requisites for success – absorptive capacity (operationalized at both the individual and the unit levels) and adjustment. The authors conclude by bringing in literature on performance management and how ideas about performance management must also be integrated into the discussion of the success or failure of international assignments. Design/methodology/approach This paper reviews existing proposals regarding the definition of expatriate success and failure, and proposes a multidimensional model of success based on the past literature. Based on this literature the authors also propose two pre-requisites for success and discuss several requisite KSAOs, as well as some suggestions from the literature on performance management. Findings The authors argue for a multidimensional model of expatiate success which includes task performance, relationship building, contextual performance and retention as part of what constitutes a successful assignment. The authors also argue that absorptive capacity and adjustment should be considered as pre-requisites for success, and that principles from performance management should be applied to dealing with international assignments. Research limitations/implications A more comprehensive definition of success and failure should aid research by providing a better dependent variable, and by leading to research on various aspects of this outcome. Practical implications The proposed model and approach can hopefully help practice by clarifying the different dimensions of success and how performance management techniques can be applied to dealing with international assignments. Originality/value There has been a lot written about how we should operationalize the success or failure of international assignments. The present paper reviews that literature and integrates a number of ideas and suggestions into a multi-dimensional model which includes information about pre-requisites for success and relevant KSAOs, along with ideas from performance management to help insure the success of these assignments.

Leveraging HFACS to Understand Medication Error in Emergency Medical Services (EMS) A Systemtic Review

Medication errors are prevalent in EMS settings, and can occur in as frequently as 21% of patient calls (Vilke et al.., 2006), significantly impacting patient care. However, even with the Human Factors Analysis and Classification System (HFACS), a widely accepted human factors error taxonomy, there is currently no widely accepted systematic method for organizing and understanding medication errors and its antecedents. The current effort seeks to synthesize the EMS medication error literature with the goal of extracting current themes and gaps to offer recommendations for which use of HFACS could to improve EMS medication error research. By leveraging HFACs and incorporating the emerging knowledge of EMS medication error, medication error can be better understood by practitioners and inform interventions aimed to target specific underlying issues.

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.

Chapter 13 Disaster and Response in Emergency Medical Services: Team Training to the Rescue

Resilience has always been a critical property of all human (and most other “live”) systems, but its more recent use in the safety literature has brought an old term to a new understanding. As such, this newer usage has the potential to be more insightful and, thus, more useful when trying to understand accident causation. Prior to the relatively new concepts of the new view of human error and how organizations and people are resilient to failure, investigators relied on a blame-and-train-type 204mentality. That is, actors at the sharp end, being the last ones involved, are blamed for the event and are retrained, so they will perform better next time. However, more frequently, the actors at the sharp end are either fired and/or prosecuted, which further represents a strictly old view mentality.

Teammate Familiarity, Teamwork, and Risk of Workplace Injury in Emergency Medical Services Teams

Introduction: Increased teammate familiarity in emergency medical services (EMS) promotes development of positive teamwork and protects against workplace injury. Methods: Measures were collected using archival shift records, workplace injury data, and cross‐sectional surveys from a nationally representative sample of 14 EMS agencies employing paramedics, prehospital nurses, and other EMS clinicians. One thousand EMS clinicians were selected at random to complete a teamwork survey for each of their recent partnerships and tested the hypothesized role of teamwork as a mediator in the relationship between teammate familiarity and injury with the PROCESS macro. Results: We received 2566 completed surveys from 333 clinicians, of which 297 were retained. Mean participation was 40.5% (standard deviation [SD] = 20.5%) across EMS agencies. Survey respondents were primarily white (93.8%), male (67.3%), and ranged between 21‐62 years of age (M = 37.4, SD = 9.7). Seventeen percent were prehospital nurses. Respondents worked a mean of 3 shifts with recent teammates in the 8 weeks preceding the survey (M = 3.06, SD = 4.4). We examined data at the team level, which suggest positive views of teamwork (M = 5.92, SD = 0.69). Our hypothesis that increased teammate familiarity protects against adverse safety outcomes through development of positive teamwork was not supported. Teamwork factor Partner Adaptability and Backup Behavior is a likely mediator (odds ratio = 1.03, P = .05). When dyad familiarity is high and there are high levels of backup behavior, the likelihood of injury is increased. Discussion: The relationship between teammate familiarity and outcomes is complex. Teammate adaptation and backup behavior is a likely mediator of this relationship in EMS teams with greater familiarity.