Few industries match the scale of health care. In the United States alone, an estimated 85% of the population has at least 1 health care encounter annually and at least one quarter of these people ...experience 4 to 9 encounters annually. A single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are a public health issue. Health care delivery systems exemplify complex organizations operating under high stakes in dynamic policy and regulatory environments. The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries. In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the science and to highlight gaps in which studies can further illuminate our evidence-based understanding of teamwork and collaboration. Specifically, we highlight evidence concerning (a) the relationship between teamwork and multilevel outcomes, (b) effective teamwork behaviors, (c) competencies (i.e., knowledge, skills, and attitudes) underlying effective teamwork in the health professions, (d) teamwork interventions, (e) team performance measurement strategies, and (f) the critical role context plays in shaping teamwork and collaboration in practice. We also distill potential avenues for future research and highlight opportunities to understand the translation, dissemination, and implementation of evidence-based teamwork principles into practice.
Teams have been a ubiquitous structure for conducting work and business for most of human history. However, today's organizations are markedly different than those of previous generations. The ...explosion of innovative ideas and novel technologies mandate changes in job descriptions, roles, responsibilities, and how employees interact and collaborate. These advances have heralded a new era for teams and teamwork in which previous teams research and practice may not be fully appropriate for meeting current requirements and demands. In this article, we describe how teams have been historically defined, unpacking five important characteristics of teams, including membership, interdependence, shared goals, dynamics, and an organizationally bounded context, and relating how these characteristics have been addressed in the past and how they are changing in the present. We then articulate the implications these changes have on how we study teams moving forward by offering specific research questions.
This Viewpoint discusses the need for clinicians to be involved in every stage of the development of patient safety interventions in order to not only improve patient care, but also maximize the ...interventions’ effectiveness and ensure clinician well-being and buy-in.
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's (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's criteria (reactions, learning, transfer, results; 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.
Teams and other collaborative structures have become commonplace in American schools, although historically school staff members functioned more independently from one another. In this article, we ...describe the growing influence of collaboration and teaming in a variety of school contexts, but focus on the empirical literature on problem-solving teams as reflecting the state of research and practice in the schools. A review of the research on problem-solving teams, using an input-mediator-outcome-input framework, provides evidence for how teaming could become more effective and efficient in this context as well as sets an agenda for what additional research is needed. Key challenges to school teams are considered next, along with recommendations for change. The first challenge is the lack of training of school staff in the key components of teaming. A second issue is the difficulty in implementing teams in the organizational context of schools.
Assess COVID-19 vaccine uptake among veterinarians and describe unvaccinated veterinarians' perceptions of COVID-19 disease and vaccines.
2,721 (14%) of 19,654 randomly sampled AVMA members.
A survey ...of AVMA members was conducted between June 8 and June 18, 2021. Information was collected on COVID-19 experience, vaccination intention, and perceptions of COVID-19 disease and vaccines.
A total of 2,721 AVMA members completed the survey. Most respondents reported receiving a COVID-19 vaccine (89% 2,428/2,721). Most unvaccinated respondents disagreed with concerns about contracting (67% 196/292) or being harmed by (65% 187/287) COVID-19 but agreed with concerns about short- (79% 228/290) and long-term (89% 258/289) side effects of COVID-19 vaccines. Over 91% (268/292) did not agree that COVID-19 vaccine benefits outweigh the risk. Although 83% (244/293) of unvaccinated respondents reported being unlikely to get a COVID-19 vaccine, 47% (137/291) agreed they would be more likely if they knew people vaccinated without serious side effects. Perceptions of COVID-19 disease severity and susceptibility, beliefs about COVID-19 vaccine benefits, and barriers and facilitators to COVID-19 vaccination varied with vaccination intention.
Results of the AVMA survey suggested that COVID-19 vaccination was widespread among veterinarians in June 2021. Understanding unvaccinated respondents' health beliefs about COVID-19 and COVID-19 vaccines may facilitate veterinarian vaccination participation. Veterinarians who abstained from COVID-19 vaccination cited concerns about the safety, efficacy, and necessity of COVID-19 vaccines. Our results suggested that demonstrating vaccine safety and a favorable risk-to-benefit ratio of vaccination may help reduce vaccine hesitancy and increase uptake of COVID-19 vaccines among veterinarians.
IMPORTANCE: Enhanced recovery pathways (ERPs) have the potential to reduce length of hospital stay, costs, and complications following surgery but can be challenging to implement. OBJECTIVE: To ...examine the body of literature on ERPs to assess how authors describe barriers and facilitators of ERP implementation and identify, in aggregate, the best practices that should be considered utilizing the Consolidated Framework for Implementation Research (CFIR) to extract these elements and summarize common barriers and facilitators according to its 5 major domains: (1) intervention characteristics, (2) inner setting, (3) outer setting, (4) characteristics of the individuals, and (5) the process of implementation. EVIDENCE REVIEW: A systematic review was conducted in accordance with the PRISMA statement. An ERP was defined as a bundle of multiple perioperative interventions that involve a multidisciplinary team, had a label different than traditional care, and had a formal way of measuring outcomes. Six databases (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature Complete, Web of Science, PsychINFO, and Cochrane Central Register of Controlled Trials) of articles published from 1990 to November 30, 2016, were searched. Articles that were included had to address barriers and facilitators of ERP implementation and provide sufficient detail that the CFIR domain could be identified. Data were abstracted by 2 independent researchers using a standardized extraction form. FINDINGS: The initial search strategy returned 4563 results; 3883 studies were eliminated by screening titles and abstracts, leaving 680 articles for full-text screening. Of these, 53 studies were included in the review. The key facilitating factors were (1) adapting the program to fit local contexts, (2) achieving and demonstrating early “wins,” (3) gaining buy-in from both frontline clinicians and hospital leadership, (4) having a strong ERP team that met regularly, and (5) leveraging supporters and full-time ERP staff. The major barriers identified were (1) meeting with resistance to change from frontline clinicians, (2) not having enough resources for implementation, and (3) external factors, such as patient complexity or rural hospital location. CONCLUSIONS AND RELEVANCE: Most ERP literature focuses on the efficacy, safety, or cost-effectiveness of these protocols. To promote the spread of ERP programs, more high-quality studies on the implementation process are needed.
To systematically assess enhanced personal protective equipment (PPE) doffing safety risks.
We employed a 3-part approach to this study: (1) hierarchical task analysis (HTA) of the PPE doffing ...process; (2) human factors-informed failure modes and effects analysis (FMEA); and (3) focus group sessions with a convenience sample of infection prevention (IP) subject matter experts.
A large academic US hospital with a regional Special Pathogens Treatment Center and enhanced PPE doffing protocol experience.ParticipantsEight IP experts.
The HTA was conducted jointly by 2 human-factors experts based on the Centers for Disease Control and Prevention PPE guidelines. The findings were used as a guide in 7 focus group sessions with IP experts to assess PPE doffing safety risks. For each HTA task step, IP experts identified failure mode(s), assigned priority risk scores, identified contributing factors and potential consequences, and identified potential risk mitigation strategies. Data were recorded in a tabular format during the sessions.
Of 103 identified failure modes, the highest priority scores were associated with team members moving between clean and contaminated areas, glove removal, apron removal, and self-inspection while preparing to doff. Contributing factors related to the individual (eg, technical/ teamwork competency), task (eg, undetected PPE contamination), tools/technology (eg, PPE design characteristics), environment (eg, inadequate space), and organizational aspects (eg, training) were identified. Participants identified 86 types of risk mitigation strategies targeting the failure modes.
Despite detailed guidelines, our study revealed 103 enhanced PPE doffing failure modes. Analysis of the failure modes suggests potential mitigation strategies to decrease self-contamination risk during enhanced PPE doffing.
To understand healthcare worker (HCW) perceptions of infection risk associated with aerosol-generating procedures (AGPs) and their affective response to performing AGPs.
Systematic review.
Systematic ...searches of PubMed, CINHAL Plus, and Scopus were conducted using combinations of selected keywords and synonyms. To reduce bias, titles and abstracts were screened for eligibility by 2 independent reviewers. Also, 2 independent reviewers extracted data from each eligible record. Discrepancies were discussed until consensus was reached.
In total, 16 reports from across the globe were included in this review. Findings suggest that AGPs are generally perceived to place HCWs at high risk of becoming infected with respiratory pathogens and that this perception stimulates a negative affective response and hesitancy to participate in the procedures.
AGP risk perception are complex and context dependent but have important influences on HCW infection control practices, decision to participate in AGPs, emotional welfare, and workplace satisfaction. New and unfamiliar hazards paired with uncertainty lead to fear and anxiety about personal and others' safety. These fears may create a psychological burden conducive to burnout. Empirical research is needed to thoroughly understand the interplay between HCW risk perceptions of distinct AGPs, their affective responses to conducting these procedures under various conditions, and their resulting decision to participate in these procedures. Results from such studies are essential for advancing clinical practice; they point to methods for mitigating provider distress and better recommendations for when and how to conduct AGPs.
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