Institutionalizing an interprofessional simulation education program: an organizational case study using a model of strategic change

Initiatives to implement interprofessional simulation education programs (ISEP) often fail due to lack of support, resources from management or proper integration into the organization system. This paper aims to identify factors that ensure the successful implementation of an ISEP. Further, the study explores the potential effects an ISEP can have on organizational processes and culture. The case study describes the implementation process of an ISEP in a non-academic community hospital using interviews, participative observations and archival data over six years. A thematic approach has been used to analyze the data guided by Kotter's 8-step model for organizational change. Strategies for a successful implementation of an ISEP include: 1) make a case for interprofessional simulation-based education (SBE), 2) search for healthcare champions, 3) define where the ISEP will lead the organization, 4) spread the word about interprofessional SBE, 5) ensure that structures, skills and supervisors align with the change effort, 6) win over smaller entities, 7) enable peer feedback and create more change, 8) institutionalize the ISEP. Indicators of how the ISEP impacted hospital culture are presented and discussed. ISEPs - if implemented effectively - provide powerful opportunities to span boundaries between professional groups, foster interprofessional collaboration, and eventually improve patient care

Do team processes really have an effect on clinical performance? A systematic literature review

There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical setting

Exceeding the Ordinary: A Framework for Examining Teams Across the Extremeness Continuum and Its Impact on Future Research

Work teams increasingly face unprecedented challenges in volatile, uncertain, complex, and often ambiguous environments. In response, team researchers have begun to focus more on teams whose work revolves around mitigating risks in these dynamic environments. Some highly insightful contributions to team research and organizational studies have originated from investigating teams that face unconventional or extreme events. Despite this increased attention to extreme teams, however, a comprehensive theoretical framework is missing. We introduce such a framework that envisions team extremeness as a continuous, multidimensional variable consisting of environmental extremeness (i.e., external team context) and task extremeness (i.e., internal team context). The proposed framework allows every team to be placed on the team extremeness continuum, bridging the gap between literature on extreme and more traditional teams. Furthermore, we present six propositions addressing how team extremeness may interact with team processes, emergent states, and outcomes using core variables for team effectiveness and the well-established input-mediator-output-input model to structure our theorizing. Finally, we outline some potential directions for future research by elaborating on temporal considerations (i.e., patterns and trajectories), measurement approaches, and consideration of multilevel relationships involving team extremeness. We hope that our theoretical framework and theorizing can create a path forward, stimulating future research within the organizational team literature to further examine the impact of team extremeness on team dynamics and effectiveness

How Team Familiarity Mitigates Negative Consequences of Team Composition Disruptions: An Analysis of Premier League Teams

In today’s dynamic work environment, teams are increasingly confronted with disruptions. While there are different types of disruptions that teams face, we contend that team composition disruptions that occur during the completion of a team’s task can be especially challenging. We also argue that it is important to consider different types of team composition changes as they create different demands for team adaptation. Specifically, we assess the effects of loss of a team member and change in team membership resulting from injury substitution. We examine how these two types of team composition disruptions impact coordination and team outcomes (i.e., goals scored) by leveraging data from 2,280 soccer games in the English Premier League. We found that team member loss impaired both team coordination and outcomes while team member substitution only impacted team coordination. Moreover, we build upon and extend existing research that has examined team familiarity by distinguishing between familiarity that is built amongst members on the current team (i.e., current team familiarity) and familiarity that has developed as a result of members working together in prior teams (i.e., prior team familiarity). This distinction appears important as we did not find evidence of a main effect of prior team familiarity on coordination but found evidence of a reversing curvilinear effect of current team familiarity on coordination. Finally, the indirect effect of team member loss on team outcomes through team coordination was more pronounced when teams had low (compared to high) prior team familiarity

WHO 'My five moments for hand hygiene' in anaesthesia induction: a video-based analysis reveals novel system challenges and design opportunities

BACKGROUND: Anaesthesia induction is a fast-paced, complex activity that involves a high density of hand-to-surface exposures. Hand hygiene (HH) adherence has been reported to be low, which bears the potential for unnoticed pathogen transmission between consecutive patients. AIM: To study the fit of the World Health Organization's (WHO) five moments of HH concept to the anaesthesia induction workflow. METHODS: Video recordings of 59 anaesthesia inductions were analysed according to the WHO HH observation method considering each hand-to-surface exposure of every involved anaesthesia provider. Binary logistic regression was used to determine risk factors for non-adherence, i.e. professional category, gender, task role, gloves, holding of objects, team size and HH moment. Additionally, half of all videos were recoded for quantitative and qualitative analysis of provider self-touching. FINDINGS: Overall, 2240 HH opportunities were met by 105 HH actions (4.7%). The drug administrator role (odds ratio (OR): 2.2), the senior physician status (OR: 2.1), donning (OR: 2.6) and doffing (OR: 3.6) of gloves were associated with higher HH adherence. Notably, 47.2% of all HH opportunities were caused by self-touching behaviour. Provider clothes, face, and patient skin were the most frequently touched surfaces. CONCLUSION: The high density of hand-to-surface exposures, a high cognitive load, prolonged glove use, carried mobile objects, self-touching, and personal behaviour patterns were potential causes for non-adherence. A purpose-designed HH concept based on these results, involving the introduction of designated objects and provider clothes to the patient zone, could improve HH adherence and microbiological safety

Teamwork in Antarctica

This document regards the report of the research project "Team Adaptation during Antarctica Summer Campaigns", supported by the Portuguese Polar Program (PROPOLAR). It contains general findings about teamwork in Antarctica and recommendations for practice

Genome-wide association study for bone strength in laying hens

Bone fracture in egg laying hens is a growing welfare and economic concern in the industry. Although environmental conditions and management (especially nutrition) can exacerbate it, the primary cause of bone weakness and the resulting fractures is believed to have a genetic basis. To test this hypothesis, we performed a genome-wide association study to identify the loci associated with bone strength in laying hens. Genotype and phenotype data were obtained from 752 laying hens belonging to the same pure line population. These hens were genotyped for 580,961 SNPs, with 232,021 SNPs remaining after quality control. Each of the SNPs were tested for association with tibial breaking strength using the family-based score test for association. A total of 52 SNPs across chromosomes 1, 3, 8, and 16 were significantly associated with tibial breaking strength with the genome-wide significance threshold set as a corrected P value of 10e−5. Based on the local linkage disequilibrium around the significant SNPs, 5 distinct and novel QTLs were identified on chromosomes 1 (2 QTLs), 3 (1 QTL), 8 (1 QTL) and 16 (1 QTL). The strongest association was detected within the QTL region on chromosome 8, with the most significant SNP having a corrected P value of 4e−7. A number of candidate genes were identified within the QTL regions, including the BRD2 gene that is required for normal bone physiology. Bone-related pathways involving some of the genes were also identified including chloride channel activity, which regulates bone reabsorption, and intermediate filament organization, which plays a role in the regulation of bone mass. Our result supports previous studies that suggest that bone strength is highly regulated by genetics. It is therefore possible to reduce bone fractures in laying hens through genetic selection and ultimately improve hen welfare.</p