Measuring team performance in healthcare: Review of research and implications for patient safety

Centre for Research Excellence in Patient Safety, Monash University, Australia. <>
Journal of Critical Care (Impact Factor: 2). 07/2008; 23(2):188-96. DOI: 10.1016/j.jcrc.2007.12.005
Source: PubMed


Effective team performance is important to measure in order to determine how clinicians should be trained for safe and effective patient care. Team performance is challenging to measure. In this paper, we describe different methodologies used to capture team performance metrics including clinical surveys, direct observation, and video-based analyses of real-life clinical performance. Despite much effort, the instruments reported thus far suffer from a variety of shortcomings that prevent their wide application in assessing team behaviors and performance. A consensus is needed on a conceptual model of clinical team performance that can encompass many real and simulated healthcare settings and account for interdependencies of their outcome criteria.

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    • "Video recording is part of a quality assurance program in our institution. To our opinion, video recording represents the only valid tool to assess current practice in DR-management [11,12], since other methods like surveys or structured direct observations do have severe limitations [13-15]. As a consequence of the current analysis, DR-management was questioned and medical staff was trained concerning the following issues. "
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    ABSTRACT: Background Whereas good data are available on the resuscitation of infants, little is known regarding support of postnatal transition in low-risk term infants after c-section. The present study was performed to describe current delivery room (DR) management of term infants born by c-section in our institution by analyzing videos that were recorded within a quality assurance program. Methods DR- management is routinely recorded within a quality assurance program. Cross-sectional study of videos of term infants born by c-section. Videos were analyzed with respect to time point, duration and number of all medical interventions. Study period was between January and December 2012. Results 186 videos were analyzed. The majority of infants (73%) were without support of postnatal transition. In infants with support of transition, majority of infants received respiratory support, starting in median after 3.4 minutes (range 0.4-14.2) and lasting for 8.8 (1.5-28.5) minutes. Only 33% of infants with support had to be admitted to the NICU, the remaining infants were returned to the mother after a median of 13.5 (8-42) minutes. A great inter- and intra-individual variation with respect to the sequence of interventions was found. Conclusions The study provides data for an internal quality improvement program and supports the benefit of using routine video recording of DR-management. Furthermore, data can be used for benchmarking with current practice in other centers.
    BMC Pregnancy and Childbirth 07/2014; 14(1):225. DOI:10.1186/1471-2393-14-225 · 2.19 Impact Factor
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    • "This suggests that the dynamics reflected in our results may influence performance in other diverse teams and indicates the potential for our findings to be replicated enabling greater generalisability. In addition, although the limitations to generalisability associated with our study setting are also recognised, there is evidence that health-care teams share many characteristics in common with other organisational workgroups including the complexity of decisions, dynamic context and multiple demands (Jeffcott and Mackenzie 2008). This indicates potential for the results to be relevant in other organisational settings. "
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    ABSTRACT: This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
    The International Journal of Human Resource Management 06/2012; 23(17). DOI:10.1080/09585192.2012.654807 · 0.93 Impact Factor
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    • "Regardless of the content of teamwork interventions, these need to be translated into practice in order to achieve target outcomes [16,17]. Whether interventions succeed or not do not only depend on the content of the intervention but also to what degree the intervention is implemented [18]. "
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    ABSTRACT: Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 11/2011; 19(1):70. DOI:10.1186/1757-7241-19-70 · 2.03 Impact Factor
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