Changing Systems Through Effective Teams: A Role for Simulation

Abstract

Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.

Time perspective balance and team adaptation in dynamic task contexts

“…Considering the existing work concerning BTP and situation awareness, it seems reasonable, therefore, to postulate that the more balanced an individual's TP, the higher the individual's situation awareness in dynamic contexts. This differs considerably from the idea that individuals with BTPs would perceive cues from the environment and optimally shift to the one TP that best fits the situation; instead, Endsley's work and subsequent empirical research based on it (e.g., Rosenman et al, ; Uitdewilligen & Waller, ) would suggest that to attain the highest level of situation awareness within their dynamic task contexts, individuals with BTPs continually build upon present and past views to extrapolate forward, effectively accomplishing “temporal multitasking” by simultaneously cycling among and attending to the past, present, and future. For example, an acute care nurse with BTP might achieve a high level of situation awareness by continuously monitoring a patient's oxygen levels in real time (present focus); hypothesizing causes for a downward trend, for example, that an increased fluid collection may be growing over time near the lungs (past and present focus); and recommending diagnostic tests in anticipation of a needed procedure to drain the fluid collection (future focus).…”

Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations

“…This includes supporting the attitudes, behaviors, and cognition of the team. 40 A rigorous evaluation of trauma teams characterized leadership as (1) contingent, depending on the needs of team; (2) functional, with the team leader picking up tasks or roles to ensure the job is done; (3) flexible, adapting to changing team and patient conditions; and (4) shared, allowing for emergence of leadership behaviors from other team members. 41 Although this work was specific to trauma teams, it may be applicable in other resuscitation teams that face similar challenges, such as variability in team composition.…”

Barriers and Solutions to Advancing Emergency Medicine Simulation–based Research: A Call to Action

“…Although medical simulation has significant overlap with medical education, simulation‐based research also has roots within the fields of health care safety and quality, especially when simulation technology is used as the platform to generate new knowledge rather than as a training or assessment modality. As a result, mentorship may need to come from experts and scholars outside the field of EM or even health care, including human factors, systems engineering, and psychology …”