Hamman WR. The complexity of team training: what we have learned from aviation and its applications to medicine. Qual Saf Health Care.13(suppl 1):i72-i79

Quality and Safety in Health Care (Impact Factor: 2.16). 11/2004; 13 Suppl 1(suppl_1):i72-9. DOI: 10.1136/qhc.13.suppl_1.i72
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Errors in health care that compromise patient safety are tied to latent failures in the structure and function of systems. Teams of people perform most care delivered today, yet training often remains focused on individual responsibilities. Training programmes for all healthcare workers need to increase the educational experience of working in interdisciplinary teams. The complexities of team training require a multifunctional (systems) approach, which crosses organisational divisions to allow communication, accountability, and creation and maintenance of interdisciplinary teams. This report identifies challenges for medical education in performing the research, identifying performance measurements, and modifying educational curricula for the advancement of interdisciplinary teams, based on the complexity of team training identified in commercial aviation.

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    • "Work has become complex enough to require the use of teams at all hierarchical levels, with organizational success depending to a large extent on the ability of teams to collaborate and work effectively in solving complex problems (DeChurch & Mesmer-Magnus, 2010). Problem solving is also a learning process (Cooke et al. 2000) and team training benefits from a curriculum designed by a task analysis (Hamman, 2004). In the process of researching and understanding new information, the newly acquired understanding is added into the team's knowledge base, accumulating its experience from solving similar types of problems (Hung, 2013). "
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    ABSTRACT: The study demonstrates the use of the expanded TLX instrument (Helton, Funke & Knott, 2014) for cognitive and team-related workload self-assessment of 38 participants, solving the UNISDR – ONU stop disasters game simulation. Subjects in one group (GF; n=30) performed group decision-making without prior individual practice on the simulation. A subset of GF participants (n=6) subsequently reiterated the simulation alone, reassessing their cognitive workload. Another group (IF; n=8) individually performed the simulation and reiterated it in groups. Most GF participants, moving from group to singly conditions, reported decreasing physical and temporal demands, unchanged self-assessed performance, and increased mental demands, effort and frustration. IF participants incurred increasing mental, physical and temporal demands, as well as increased effort, with decreasing frustration and better performance, from singly to group conditions. Team workload results differed across groups; GF had higher levels of reported team dissatisfaction, equivalent assessments of team support and lower assessments of coordination and communication demands coupled with decreased time sharing as well as lower team effectiveness, compared to IF. Results bear implications on training of decision- making teams; singly training team members preceding group training supports team-decision making effectiveness and individual performance within teams going through first stages of a system learning curve.
    Human Factors and Ergonomics Society Europe Chapter 2014 Annual Conference; 10/2014
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    • "c o m / l o c a t e / p a t e d u c o u an impact on safety without including the experiences of nurses and other health care professionals who provide care [6]. Others have concluded that team training and adoption of standardized processes and behaviors that are effective in improving operational performance in aviation and can potentially have a similar benefit in healthcare [11] [12]. While a number of analogies have been made to aviation practices in the literature to improve healthcare practice, none to our knowledge has dealt with the effect of increasing the potential sites of attention and added interactional complexity that the EHR adds to the face-to-face interaction dynamics of the medical encounter. "
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    ABSTRACT: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.
    Patient Education and Counseling 08/2013; 93(3). DOI:10.1016/j.pec.2013.08.011 · 2.20 Impact Factor
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    • "This process of recovery from a loss of control is typically dealt with by means of crisis management training. Team training concepts, with their origin in industries such as aviation [3], have been introduced into healthcare with the aim of enhancing non-technical skills such as leadership [4], situation awareness [5], communication, and decision making [6,7]. Team training typically is performed in simulated environments [8,9] and researchers have put much effort into the development of these environments and methods to assess the effects of such training. "
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    ABSTRACT: This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
    BMC Health Services Research 06/2012; 12(1):161. DOI:10.1186/1472-6963-12-161 · 1.71 Impact Factor
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