No size fits all – a qualitative study of factors that enable adaptive capacity in diverse hospital teams

Introduction: Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. By examining how performance emerges in everyday work in different healthcare settings, the research seeks to receive knowledge of the enablers for adaptive capacity. Hospitals are defined as complex organizations with a large number of actors collaborating on increasingly complexity tasks. Consequently, most of today’s work in hospitals is team based. The study aims to explore and describe what kind of team factors enable adaptive capacity in hospital teams. Methods: The article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation (115 h) and interviews (30), followed by a combined deductive and inductive analysis of the material. Results: The study identified four main themes of team related factors for enabling adaptive capacity; (1) technology and tools, (2) roles, procedures, and organization of work, (3) competence, experience, knowledge, and learning, (4) team culture and relations. Discussion: Investigating adaptive capacity in four different types of teams allowed for consideration of a range of team types within healthcare and how the team factors vary within and across these teams. All of the four identified team factors are of importance in enabling adaptive capacity, the various attributes of the respective team types prompt differences in the significance of the different factors and indicates that different types of teams could need diverse types of training, structural and relational emphasis in team composition, leadership, and non-technical skills in order to optimize everyday functionality and adaptive capacity.publishedVersio

The Influence of Self Mastery Agenda, Change Diagnosis Agenda, Innovation Agenda and Effective Team Agenda on Adaptive Leadership Relating to Regional Development (Case Study on Echelon III Officials in North Sumatra Province)

Regional development is one of the efforts in order to utilize the potential of the existing area to obtain better conditions and life arrangements for the benefit of the community. For this reason, in the effort to develop regional areas, the government hopes that through the implementation of training and education, change leaders will be able to make changes and adapt to changes that occur in their environment. These changes were made in order to maintain the organization with a high level of performance. There are several agendas that become factors in influencing the formation of adaptive leadership in the implementation of education and training teams, namely the self mastery agenda, the diagnostic reading agenda, the innovation agenda and the effective team agenda. The purpose of this research is to determine the effect of the self mastery agenda, diagnostic reading agenda, innovation agenda, and effective team agenda on adaptive leadership and its relation to regional development. The method of analysis used in this research is multiple linear regression using descriptive methods through a quantitative approach. The number of respondents is 160 people. The results showed that: the self mastery agenda had a positive and significant effect on adaptive leadership, the diagnostic reading agenda had a positive and significant effect on adaptive leadership, the innovation agenda had a positive and significant effect on adaptive leadership, the effective team agenda had a positive and significant effect on adaptive leadership and there were a fairly close relationship between adaptive leadership to regional development

Resilience and Adaptive Capacity in Hospital Teams

Introduction Resilient Healthcare, a field derived from Resilience Engineering, provides a set of theoretical principles for understanding quality and safety in complex systems. So far, these principles have been used to capture individual, departmental, and organisational proactive responses to variable conditions and how this flexibility, involving anticipating, monitoring, responding, learning, and coordinating, contributes to safety. Empirical exploration of Resilient Healthcare has primarily taken place in specific healthcare settings such as emergency departments and surgery, with specific activities such as flow procedures, anaesthesia, blood transfusion, nurse handover, electronic charting, and patient discharge. Understanding healthcare work beyond these limited settings and activities is important, as most patient encounters in the hospital occur in ward settings beyond surgery and emergency care. The role of the team in flexible adaptation also needs to be explored, as effective teamwork is widely recognised as a contributor to healthcare safety.Healthcare teams are diverse and their need for adaptive capacity, the challenges they face, and their ability to coordinate are also likely to be different. Current research on healthcare teams involves teams that are easily defined, such as resuscitation teams, surgical teams, or teams in a simulation lab. Thus, the full range of healthcare teams and their capacity to adapt has not yet been captured. To better understand how to improve teamwork and safety, we must first understand how teams are already adapting to variable conditions in complex organisations. This includes aspects such as the clinical and organisational challenges they face, the dynamics of the team, how flexible teamworking can be supported, as well as more broadly understanding and categorising the different types of teams that exist in healthcare. Aims and objectives The aim of this PhD was to investigate how adaptive capacity is hindered or supported by organisational and contextual factors in different types of hospital teams.The study objectives were to: 1. Review the concept of adaptive teamwork, synthesising available cross-disciplinary research, clarifying key definitions, and identifying factors that might impact team adaptive capacity 2. Develop an empirically derived typology for classifying types of hospital teams based on their structure, membership, and function3. Identify the misalignments, adaptions, pressures, and trade-off decisions of hospital teams in practice 4. Understand differences between types of hospital teams, both in the misalignments and pressures they experience and in the adaptations and trade-off decisions they make, using mixed qualitative methods in two hospitals in England Methods The study was conducted in three phases: - Phase 1: A scoping review of adaptive teamwork Phase one involved a scoping literature review to systematically map existing research on adaptive teamwork and to identify gaps in knowledge. The primary research question was: What do we know about the structure and function of adaptive teams in practice? - Phase 2: Theory development Phase two involved analysis of data previously collected by the larger research team to better understand work-as-done and team structure in hospital teams. The data included 88.5 hours of hospital ethnography on five different hospital wards. An inductive-deductive approach to data analysis was undertaken. - Phase 3: A case study of adaptive teamwork in England Phase three consisted of data collection in two hospitals situated within one Trust (one large and one community hospital), with five teams per hospital (two total teams of each type). In total, 144 hours and 54 minutes of ethnography were completed across the two hospitals and 24 semi-structured interviews were conducted. The overarching aim of the case study was to investigate how adaptive capacity is hindered or supported by organisational and contextual factors in different types of teams. This phase was conducted in a directed rather than exploratory way, building on the data from phase two and increasing the depth of understanding of all five team types. In this phase, both interview and observational data were analysed using the typology and two frameworks produced in phase two. The England case study will eventually contribute to a comparative, cross-country analysis to synthesise and compare findings between countries and healthcare systems (Anderson, Aase, et al., 2020). Ethics and dissemination The overall Resilience in Healthcare research programme that this study is part of has been granted ethical approval by the Norwegian Centre for Research Data (Ref.No. 8643334). Ethical approval to conduct the study in England was granted through King’s College London Research Ethics Office (LRS/DP-21/22-26055). HRA REC approval was 10also granted (22/HRA/1621; IRAS 312079). A research passport was obtained, and letter of access received from local Trust R&D.Results The phase one scoping review included 204 documents and mapped their geographies, fields, settings, and designs. Terminology used to describe elements of the adaptive process were compared. A new conceptualisation of the team adaptive cycle was proposed, along with a new definition for team adaptive capacity. Future opportunities for research were proposed, including the opportunity to study adaptive teams in situ and to consider differences in team adaptive capacity based on unique team features. The second phase of the study resulted in the conceptualisation of: a typology of healthcare teams (paper under review), the Concepts for Applying Resilience Engineering Model 2.0 (published paper), and the Pressures Diagram (published paper). Building on this, the third phase suggested that teams’ adaptive strategies varied based on team type, although demand-capacity misalignments occurred across all team types, suggesting that team type impacts adaptive capacity. While adaptations supported teams’ abilities to overcome misalignments, they also required resources and were more or less possible depending on team type. Likewise, while pressures occurred across all team types, trade-off decisions varied depending on the team type. These findings have implications for team training, workforce planning, and resourcing, and can inform future work that aims to strengthen adaptive capacity and teamworking.Conclusions Overall, this thesis makes unique and important contributions to the literature on both resilient healthcare and adaptive teamwork. It has developed multiple new practical and theoretical models and typologies that have subsequently been used internationally in research. A novel approach combining teamwork and resilient healthcare theory was used successfully to understand and compare healthcare misalignments, adaptations, pressures, and trade-offs in five different team types. The finding that adaptive strategies and trade-off decisions differ based on team type challenges existing teamwork improvement practices, which take a one-size-fits-all approach to conceptualising and training teams. The results provide foundational knowledge to guide future intervention design, which may potentially bring about wider changes in training and sustaining successful teams and supporting their adaptive capacity

Implementation of Team-Based Learning in Aviation Education

Recent research in the field of Aviation Education and Educational Psychology has shown that students are in need of greater interaction and social skills. Additionally, although Part 141 flight training programs and ground school classes offer many opportunities for collaboration and for dynamic teamwork, often those opportunities are missed as flight training is still largely a one-on-one effort between the student and the certificated flight instructor. Within the last decade, Team-Based Learning has come to prominence in a variety of disciplines across the academic landscape. Team Based-learning incorporates both individual test taking, and group based test taking into one academic environment. Social benefits include development of organic bonds between students and faculty, higher retention rates, and increased patterns of adaptive learning. Team-Based Learning has been implemented in three sections of ground schools at the freshman and sophomore level, and have shown a positive increase in Stage Exam and FAA Written Exam results. Additionally, upcoming research shows how this implementation of Team-Based Learning has created new positive classroom dynamics. This presentation guides fellow aviation educators step-by-step on what Team-Based Learning is, and how to implement Team-Based Learning in their aviation education environments. Major pitfalls, and surprising benefits will be discussed at length

Real-Time Evolutionary Learning of Cooperative Predator-Prey Strategies

Despite games often being used as a testbed for new computational intelligence techniques, the majority of artificial intelligence in commercial games is scripted. This means that the computer agents are non-adaptive and often inherently exploitable because of it. In this paper, we describe a learning system designed for team strategy development in a real time multi-agent domain. We test our system in a prey and predators domain, evolving adaptive team strategies for the predators in real time against a single prey opponent. Our learning system works by continually training and updating the predator strategies, one at a time for a designated length of time while the game us being played. We test the performance of the system for real-time learning of strategies in the prey and predators domain against a hand-coded prey opponent. We show that the resulting real-time team strategies are able to capture hand-coded prey of varying degrees of difficulty without any prior learning. The system is highly adaptive to change, capable of handling many different situations, and quickly learning to function in situations that it has never seen before

Effects of Experience and Workplace Culture in Human-Robot Team Interaction in Robotic Surgery: A Case Study

International audienceRobots are being used in the operating room to aid in surgery, prompting changes to workflow and adaptive behavior by the users. This case study presents a methodology for examining human-robot team interaction in a complex environment, along with the results of its application in a study of the effects of experience and workplace culture, for human-robot team interaction in the operating room. The analysis of verbal and non-verbal events in robotic surgery in two different surgical teams (one in the US and one in France) revealed differences in workflow, timeline, roles, and communication patterns as a function of experience and workplace culture. Longer preparation times and more verbal exchanges related to uncertainty in use of the robotic equipment were found for the French team, who also happened to be less experienced. This study offers an effective method for studying human-robot team interaction and has implications for the future design and training of teamwork with robotic systems in other complex work environments

Improving sensemaking, exploring adaptive team performance: a rapid scoping review

Measuring adaptive performance at the individual level has been examined by cognitive and organizational psychologists across a range of contexts (e.g., sport, military, health) over the past two decades. This work has had some success and research continues to explore the underpinnings of adaptive cognition to develop training that will improve performance (see Ward, Gore et al., 2017). Attempts to measure, assess and train adaptive performance at the team level, is, however, a relatively nascent area. Prior research has raised concerns that the concept of “adaptivity” is not an empirically robust one (Hutton et al., 2017; Ward et al., 2017). This is further excaerbated at the team level, given the challenges of operationalising and measuring team-based constructs (Burke et al, 2006). Whilst research has examined behavioural markers of effective teams (Salas et al., 2007; Flin, 2008), measuring adaptivity in teams suggests further layers of complexity. The aim of this paper is to review existing measures of team adaptation, with a view to identify an appropriate measure for use in a military context. A validated measure could be used to test training outcomes by providing a before and after assessment of team adaptation, therefore informing the development of effective training

Team Learning, Development, and Adaptation

[Excerpt] Our purpose is to explore conceptually these themes centered on team learning, development, and adaptation. We note at the onset that this chapter is not a comprehensive review of the literature. Indeed, solid conceptual and empirical work on these themes are sparse relative to the vast amount of work on team effectiveness more generally, and therefore a thematic set of topics that are ripe for conceptual development and integration. We draw on an ongoing stream of theory development and research in these areas to integrate and sculpt a distinct perspective on team learning, development, and adaptation

Getting to Know You: Self-awareness Is Key for High-Performing, Adaptive Teams

KEY FINDINGS · Role identification behaviors, or information exchanges among team members regarding individuals’ roles within a team, are crucial to the development of a team’s self awareness. · If team members do not accurately exchange information about their roles, their responsibilities and duties may be unclear, important tasks may go unaddressed, and other tasks may be performed inefficiently (e.g., performed with redundant efforts). · The more that team members engage in role identification exchanges early in the team’s life cycle, the better the team’s performance