Interventions to improve team effectiveness within health care

Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research t

A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH)

BACKGROUND: Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. METHODS: In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. RESULTS: Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. CONCLUSIONS: Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare

Understanding of Interprofessional Communication to Impact Patient Safety in the Operating Room: A Grounded Theory Study

Indiana University-Purdue University Indianapolis (IUPUI)Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment

Mobilising or standing still? A narrative review of Surgical Safety Checklist knowledge as developed in 25 highly cited papers from 2009 to 2016

The Surgical Safety Checklist (SSC) was implemented as part of the World Health Organization’s Safer Surgery saves lives campaign. The SSC and its reported positive influence in the operating room was first published in 2008. Since then, this positive perception has changed. New research has identified mixed results showing limited or no change in outcomes following SSC implementation. Such research has prompted calls for the reconsideration of policies mandating the SSC as an organisational safety practice. In the context of this debate, the purpose of this narrative review was to evaluate how knowledge about SSC has been represented and reconstructed in high impact SSC papers. We used the h-index to identify highly impactful articles published between 2009 and 2016. We analysed these articles using three criteria that emerged as we reviewed them: 1) Whether the SSC was conceptualized as a ‘thing’ or a ‘process’, 2) Whether the SSC problem and solution were characterized as straightforward or complex issues and, 3) How the SSC knowledge was reconstructed from one paper to the next. We found that many papers in the sample exhibited a pattern of simplifying the story of SSC from earlier work, even when that work may itself have discussed a more nuanced characterization of SSC. This simplicity suggests that knowledge has not been mobilizing effectively across this body of work. We conclude that knowledge mobilization would be improved with a new generation of SSC research that particularly explores and enhances our understanding of the socio-cultural nuances of SSC practices

Paradoxes and coping mechanisms in the servitisation journey

Servitisation is conceptualised as product manufacturers' transition towards bundling products and services to offer customers enhanced value. Scholars have raised concerns regarding the potential challenges that firms face during servitisation, often termed servitisation paradoxes. Limited studies have explored the paradoxes experienced during the servitisation journey and the associated coping mechanisms. We utilise the open-ended essay methodology to unravel various paradoxes and coping mechanisms to address the gap. We collected data in two stages—from 69 participants in the first stage and 32 in the second stage. The study's findings reveal three broad paradoxes: the paradox of organising (autonomy and control, efficiency and flexibility, formal and informal information flow, and employee and customer needs), the paradox of learning (prior knowledge and new knowledge), and the paradox of performance (short-term and long-term performance). In addition, we identify four coping practices: change management, open communication, training programmes and digitalisation. The study augments the prior literature by developing a conceptual framework that elucidates the coexistence of numerous paradoxes and coping mechanisms. © 2022 The Author

The effect of a communication protocol implementation on nurse/physician collaboration and communication.

This study examined the effect on physician/nurse collaboration and communication of the implementation of the SBAR protocol, used as nurses reported patient changes to physicians, in a Midwestern community hospital ICU. The design was a two-phased descriptive design. Data were collected through two surveys, one of which addressed collaboration and the other which addressed communication factors. The surveys were administered to ICU nurses (n = 28) and physicians (n = 30) three times. The study also explored attitudes regarding the efficacy of SBAR and interdisciplinary collaboration through interviews with a representative sample of physicians (n = 10) and nurses (n = 10). The collaboration and communication scores analyses, which employed a significance level of (p = .05) and repeated measures ANOV A, established the following key findings: (a) Nurses perceived that nurse-physician collaboration had significantly improved between Time 1 and Time 3; (b) physicians did not perceive that nurse-physician collaboration had significantly improved; (c) at Time 1, the physicians scored significantly higher than the nurses on communication elements of openness and understanding; and (d) the nurses perceived that understanding had significantly improved between Time I and Time 2 and between Time I and Time 3. Interview data generally confirmed the survey findings. Nurses affirmed that SBAR should be taught to all new nurses, but both nurses and physicians perceived the Recommendation statement as overly assertive. Several implications arose from this study: (a) Nurses wanted more collaboration with physicians and perceived that SBAR increased collaboration and improved understanding; (b) physicians did not voice wanting improved collaboration and perceived that SBAR had not changed either collaboration or communication; and (c) authors of SBAR might study the effectiveness of the Recommendation statement