A comparison of speaking up behavior during conflict with real and virtual humans

Robb, Andrew; White, C. T.; Cordar, Andrew; Wendling, Adam; Lampotang, Samsun; Lok, Benjamin

doi:10.1016/j.chb.2015.05.043

Cited by 34 publications

(26 citation statements)

References 35 publications

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“…Prior research has explored whether the agency of an antagonist (e.g., the surgeon who must be spoken up to) impacts the rate and manner in which participants speak up (Robb et al, 2015b). This research found that the antagonist's agency had no significant effect (p = 0.869).…”

Section: Discussionmentioning

confidence: 48%

“…Examples include virtual teammates for procedural skills training (Rickel and Lewis Johnson, 1999), military negotiation training (Hill et al, 2003), operations training (Remolina et al, 2005), unmanned Ariel vehicle operation (Ball et al, 2010), postoperative care training (Chuah et al, 2013), and patient safety negotiations (Robb et al, 2016). Similar to team training studies involving teams comprised of humans only, research involving virtual teammates has also demonstrated positive effects on skill development (Kroetz, 1999), team performance (Demir and Cooke, 2014), and issues involving patient safety (Robb et al, 2015b).…”

Section: Introductionmentioning

confidence: 99%

“…This is a simplified coding scheme based on previous research exploring speaking up behaviors (Robb et al, 2015b). The speaking up code was created by merging three infrequently used codes that constituted various objections to the surgeon but did not culminate in stopping the line, specifically filing an incident report, shifting responsibility to the surgeon, and giving in to the surgeon.…”

Section: Coding Processmentioning

confidence: 99%

“…The majority of virtual human-based training programs yet developed have been explicitly designed to support a single human trainee. When researchers have investigated virtual human-based training programs capable of supporting multiple human teammates, all but one of the human teammates have been played by confederates, i.e., actors who are not part of the research team [e.g., Robb et al (2015b)]. In these cases, the use of human confederates makes it impossible to judge whether new behaviors emerge when multiple humans work together alongside virtual teammates, as opposed to when a single human works with virtual teammates.…”

Section: Introductionmentioning

confidence: 99%

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Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

et al. 2016

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Despite research showing that team training can lead to strong improvements in team performance, logistical difficulties can prevent team training programs from being adopted on a large scale. A proposed solution to these difficulties is the use of virtual humans to replace missing teammates. Existing research evaluating the use of virtual humans for team training has been conducted in settings involving a single human trainee. However, in the real world, multiple human trainees would most likely train together. In this paper, we explore how the presence of a second human trainee can alter behavior during a medical team training program. Ninety-two nurses and surgical technicians participated in a medical training exercise, where they worked with a virtual surgeon and virtual anesthesiologist to prepare a simulated patient for surgery. The agency of the nurse and the surgical technician were varied between three conditions: human nurses and surgical technicians working together; human nurses working with a virtual surgical technician; and human surgical technicians working with a virtual nurse. Variations in agency did not produce statistically significant differences in the training outcomes, but several notable differences were observed in other aspects of the team's behavior. Specifically, when working with a virtual nurse, human surgical technicians were more likely to assist with speaking up about patient safety issues that were outside of their normal responsibilities; human trainees spent less time searching for a missing item when working with a virtual partner, likely because the virtual partner was physically unable to move throughout the room and assist with the searching process; and more breaks in presence were observed when two human teammates were present. These results show that some behaviors may be influenced by the presence of multiple human trainees, though these behaviors may not impinge on core training goals. When developing virtual human-based training programs, designers should consider that the presence of other humans may reduce involvement during training moments perceived to be the responsibility of other trainees and also should consider that a virtual teammate's limitations may cause human teammates to limit their own behaviors in corresponding ways (e.g., searching less).

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Coding Processmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

et al. 2016

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“…The last studies in this group examined the methods of speaking up and their effectiveness. 35,42,43 A pilot program which taught staff at a Congolese hospital to implement the surgical safety checklist was examined. Participants reported that training had a positive effect on teamwork, organisation, and safe anaesthesia practices.…”

Section: Do Qualitatively Identified Barriers Have a Significant Effementioning

confidence: 99%

Challenging authority and speaking up in the operating room environment: a narrative synthesis

Pattni

Arzola

Malavade

et al. 2019

British Journal of Anaesthesia

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Multidisciplinary care teams exist throughout healthcare systems. In the operating room (OR), effective communication between teams is essential, especially during crisis situations where patient safety can be in acute danger. An oftenneglected skillset in educational curriculums is challenging authority. This narrative synthesis aims to explore the literature on challenging authority in the OR environment. A systematic search of Medline, EBM reviews and PsycINFO was conducted using terms related to challenging authority, speaking up, communication, patient safety, gradients and hierarchy. The initial search identified 4822 publications, out of which 31 studies were included. The data synthesis of the included studies was grouped into three distinct categories following a meta-aggregative approach: discussion and review articles, observational or qualitative studies, and studies identifying the role of specific barriers or investigating the effect of educational interventions. Themes emerging from expert beliefs, what reality tells us and what we test are consistent. Hierarchy, organisational culture and education are the most frequently observed and tested themes. Simulation research has been successful in eliciting and confirming the role of specific barriers to speaking up. Barriers and enablers are largely modifiable within institutions however, education regarding the importance of speaking up will need to accompany these modifications for any significant changes to occur. Editor's key pointsThe authors examined the literature on speaking up in the operating theatre environment using narrative synthesis. They demonstrate emerging themes from the literature consistent with our intuitive understanding e hierarchy gradients, organisational culture, and education are the most frequently observed factors affecting ability to challenge authority. Barriers and enablers to speaking up are largely modifiable. Promoting speaking up within health teams requires organisations to cultivate a culture of open, safe communication, accompanied by education regarding the importance of speaking up.

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Using Virtual Human Technology in Perioperative Team Training Simulations

Brunges¹,

Hughes²

2020

AORN Journal

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Incorporating virtual human (VH) technology into simulation programs for perioperative education and training can improve interdisciplinary teamwork and communication. The development of VHs allowed interdisciplinary teams at the University of Florida Health Shands Hospital to overcome obstacles during training, such as communication gaps. A multidisciplinary team that included perioperative leaders and quality specialists developed three scenarios for interdisciplinary training to provide participants with the opportunity to practice their communication skills and improve patient safety. Using validated tools to promote standardized communication, participants had to address patient safety concerns assertively during the simulations. After each simulation session, quality specialists conducted a debriefing, collected data via surveys, and identified areas for improvement. As a result of the VH simulation sessions, perioperative staff members reported increased confidence and competence when providing patient care. Using VHs to enhance education is an innovative strategy that is useful for both novice and experienced perioperative nurses.

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A comparison of speaking up behavior during conflict with real and virtual humans

Abstract: 2016-11-02T18:49:00

Cited by 34 publications

References 35 publications

Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

Training Together: How Another Human Trainee’s Presence Affects Behavior during Virtual Human-Based Team Training

Challenging authority and speaking up in the operating room environment: a narrative synthesis

Using Virtual Human Technology in Perioperative Team Training Simulations

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