Promoting Teamwork in Translational Medical Teams: Insights and Recommendations from Science and Practice

Translational medical teams are transdisciplinary, highly collaborative, and operate within dynamic environments to solve time-sensitive and complex problems. These teams are tasked with turning observations in the laboratory and clinic into effective interventions that improve the health of individuals and the public. The nature of the problems they seek to solve requires coordination among clinicians, scientists, and experts from various scientific disciplines. Characteristically, translational medical teams have complex compositions, structure, and pluralistic goals, which pose significant challenges and barriers to enacting effective teamwork, compromising team performance. Given these challenges, it is imperative to glean insights from teams research and the science of team science on how to execute efficacious teamwork. Consequently, the purpose of this paper is to discuss specific teamwork processes (i.e., trust, communication, self-correction, backup behavior, shared mental models, and conflict management) that are critical to translational medical team performance and offer mechanisms to better equip such teams. Utilizing a theoretical framework of transdisciplinary teamwork adapted from the science of team science and tailored to translational medical teams, we describe each of these processes, their relation to translational medical team outcomes, and how they can be leveraged to improve teamwork. Such a discussion aims to provide practical guidance for conceptualizing and enhancing teamwork in translational medical teams

The Categorization Of Expatriates And The Support Offered By Host Country Nationals

Purpose – Although several authors have suggested that host country nationals (HCNs) play an important role in the management of expatriates (e.g. Toh and DeNisi, 2003; Farh et al., 2010), research has also suggested that this relationship is not always good, and the flow of critical information to expatriates can be limited. This is especially true when HCNs categorize the expatriates as “out-group” members. The purpose of this paper is to examine potential determinants of categorization decisions as well as potential outcomes related to expatriate socialization. Design/methodology/approach – The paper employs a dyadic survey approach to determine the antecedents to expatriate categorization and HCN socialization behaviors from the perspective of both the expatriate and HCN. Findings – The results of survey data from 65 expatriate-HCN dyads indicated that expatriate ethnocentrism and the salience of the expatriates’ nationality were important predictors of categorization, but that categorization was related to only one dimension of socialization. However, affect was found to play a role in predicting socialization behaviors. Research limitations/implications – There is potential selection bias since expatriates chose HCNs as respondents, but results suggested this was not a serious problem. Other limitations include a relatively small sample size and the fact that a number of contextual issues such as national stereotypes and MNC strategy, are not controlled for. Practical implications – Implications of these findings for the successful management of expatriate assignments include sending over expatriates with the right relational skills, and those low in ethnocentrism, rather than just the right technical skills. Originality/value – The present study was one of the first to empirically test the potential role of categorization in the process of socialization

The categorization of expatriates and the support offered by host country nationals

Purpose – Although several authors have suggested that host country nationals (HCNs) play an important role in the management of expatriates (e.g. Toh and DeNisi, 2003; Farh et al., 2010), research has also suggested that this relationship is not always good, and the flow of critical information to expatriates can be limited. This is especially true when HCNs categorize the expatriates as “out-group” members. The purpose of this paper is to examine potential determinants of categorization decisions as well as potential outcomes related to expatriate socialization. Design/methodology/approach – The paper employs a dyadic survey approach to determine the antecedents to expatriate categorization and HCN socialization behaviors from the perspective of both the expatriate and HCN. Findings – The results of survey data from 65 expatriate-HCN dyads indicated that expatriate ethnocentrism and the salience of the expatriates’ nationality were important predictors of categorization, but that categorization was related to only one dimension of socialization. However, affect was found to play a role in predicting socialization behaviors. Research limitations/implications – There is potential selection bias since expatriates chose HCNs as respondents, but results suggested this was not a serious problem. Other limitations include a relatively small sample size and the fact that a number of contextual issues such as national stereotypes and MNC strategy, are not controlled for. Practical implications – Implications of these findings for the successful management of expatriate assignments include sending over expatriates with the right relational skills, and those low in ethnocentrism, rather than just the right technical skills. Originality/value – The present study was one of the first to empirically test the potential role of categorization in the process of socialization

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. Copyright © 2014 Lippincott Williams & Wilkins

Team Training In Obstetrics: A Multi-Level Evaluation

Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB. Method: An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick\u27s (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews. Results: Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies\u27 hospital length of stay. Discussion: These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments

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 Kirkpatrick\u27s (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 Kirkpatrick\u27s criteria (reactions, learning, t s; 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

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

Using Telemedicine in Mass Casualty Disasters

The goal of this study is to test an implementation and examine users' perceptions about the usefulness of telemedicine in mass casualty and disaster settings and to provide recommendations for using telemedicine in these settings. Ninety-two US Army Forward Surgical Team (FST) members participated in a high-fidelity mass casualty simulation at the Army Trauma Training Center (ATTC). Telemedicine was implemented into this simulation. Only 10.9% of participants chose to use telemedicine. The most common users were surgeons and nurses. Participants believed it somewhat improved patient care, attainment of expert resources, decision-making, and adaptation, but not the timeliness of patient care. Participants reported several barriers to using telemedicine in the mass casualty setting, including (1) confusion around team roles, (2) time constraints, and (3) difficultly using in the mass casualty setting (eg, due to noise and other conditions). There appear to be barriers to the use and usefulness of telemedicine in mass casualty and disaster contexts. Recommendations include designating a member to lead the use of telemedicine, providing telemedical resources whose benefits outweigh the perceived cost in lost time, and ensuring telemedicine systems are designed for the conditions inherent to mass casualty and disaster settings

The pre-anesthesia induction patient safety (PIPS) checklist: Testing dynamic versus static implementation strategies

Background: Retrospective studies and large-scale reviews suggest multiple properties of effective checklist implementation, such as active leadership, ongoing feedback, and local modification. We hypothesized that the use of these effective checklist implementation strategies would yield better results as compared to a more fixed implementation strategy of the Pre-anesthesia Induction Patient Safety (PIPS) checklist. Methods: We conducted a prospective, pre-post, pragmatic cohort trial of a checklist implementation using a prospective difference-in-difference design observing simultaneous implementation of the same PIPS checklist in two community hospitals. At one hospital, we created a multidisciplinary committee of stakeholders to oversee implementation and provide active leadership, ongoing feedback, and local modification of the checklist (“Dynamic Implementation”). At the second hospital, a single clinical champion implemented the checklist with no local modification (“Static Implementation”). We examined checklist compliance and proximal outcomes three months before and nine months after implementation. We conducted surveys and interviews to examine attitudes and implementation barriers. Results: We observed 477 anesthesia inductions. The “Dynamic” cohort demonstrated significantly greater checklist compliance post-implementation compared to the “Static” cohort (B = 0.26, p < .001 for observable action and B = 0.24, p < .001 for verbal compliance). We were underpowered to detect changes in errors, or near-misses, but observers captured anecdotal checklist-related patient safety evidence, suggesting more research should be done in this area. There were no differences between cohorts on changes in team communication, or attitudes toward checklists. Participant interviews showed that two of the major criticisms of the PIPS checklist, ambiguity and redundancy, were more effectively resolved with the “Dynamic” implementation. Conclusions: Dynamic implementation yielded significantly better compliance with the checklist than a more static approach. However, barriers such as time pressure and lack of team buy-in remain. Larger scale studies are needed to determine the full impact of the PIPS checklist on safety related outcomes such as near-misses

Coaching In The Wild: Identifying Factors That Lead To Success

Although executive coaching has been shown to be effective, few research initiatives have attempted to understand the importance of the emergent relationship between a coach and coachee. This article explores the factors that influence coaching outcomes from both the coach and coachee\u27s perspective and presents the results of the mediating effect that working alliance and information sharing have on coachee goal attainment and coachee insight outcomes. The authors explored these factors in both an academic coachee sample as well as an executive field sample. Results showed that coachee motivation was significantly positively related with coachee goal attainment and coachee insight in an academic sample but not in a field sample. Moreover, working alliance and information sharing partially mediated the relationship between a coach\u27s psychological mindedness and coachee insight in an academic, but not field, sample. Another notable result was that the difficulty of the coaching goal did not impact how successful the coaching engagement was in terms of goal attainment. Implications of these findings for both research and practice are discussed