Reflection in the heat of the moment: The role of in‐action team reflexivity in health care emergency teams

Abstract

Team reflexivity (TR)-defined as a team's conscious reflection on their objectives, strategies, and processes-is an important team process that fosters adaptation and information processing. However, traditional conceptualizations frame TR as a process that occurs in periods of downtime to reflect on past, terminated performance, largely ignoring reflective team processes occurring during intense performance events of action teams. To address this gap, we conceptualize TR as a team process that occurs not only during periods of downtime after the action but also during performance events as brief TR moments. We elaborate on the concept of in-action TR and explore it by delineating its relationship to task type and timing during a performance event. Further, we test a team level contingency model of in-actionTR, namely, team size and performance. Using behavior observation, we test our hypothesis with 70 medical teams responding to simulated in-hospital emergencies. Task type is related to in-actionTR and reflection tends to increase as action progresses. Further, in-action TR is related to team performance and is especially important for larger teams. Our study is the first to investigate in-action TR and provides theoretical and practical implications on how in-action TR operates in extreme action teams.

When I say … team reflexivity

“…Explicit TR allows less experienced colleagues to gain valuable insights into the case and supports context‐specific learning. Research has shown that in‐action TR is especially important for complex diagnostic tasks, as well as when team size increases . In our example, the senior emergency physician entering the room engages in in‐action TR in its fullest form: as a brief timeout.…”

“…Research has shown that in-action TR is especially important for complex diagnostic tasks, as well as when team size increases. 3 In our example, the senior emergency physician entering the room engages in in-action TR in its fullest form: as a brief timeout. Such timeouts can 'reboot' the team and bring everybody back to the same page when coordination gets out of hand.…”

Time to go wild: How to conceptualize and measure process dynamics in real teams with high-resolution

“…This approach advances theory by comparing fluctuations of team processes across different team phases (e.g., Schmutz et al, 2018;Manser et al, 2008) or across varying task levels (Hoogeboom & Wilderom, 2019;Lei et al, 2016), thus, challenging assumptions from the static approach by recognizing that activities are contingent on dynamic task characteristics. Teams are part of socio-technical organizational systems and changes of the technical system are tightly related with changes of the social system, that is, the extent to which specific activities play a fundamental role for team performance (Rousseau et al, 2006;Tiferes & Bisantz, 2018;Waller, 1999).…”

“…This process approach has studied how volatile task features affected team process dynamics in medical emergency teams (Manser et al, 2008) and flight crews (Waller et al, 2004). For example, flight crews change their communication patterns when they encounter unexpected events (David & Schraagen, 2018), cardiac anesthesia teams adapt their coordination processes contingent on the level of task interdependence during an operation (Manser et al, 2008), and health care teams increase reflection processes over time during medical emergencies (Schmutz et al, 2018).…”

“…• Does in-action team reflexivity increase over the phases of a team performance episode? (Schmutz et al, 2018) • How do support team leadership behaviors differently stimulate team member voice in action versus transition phases? (Farh & Chen, 2018) • How do adaptive crew behaviors (e.g., collecting information and task distribution) vary with changes in dynamic task demands (routine vs. non-routine situations)?…”