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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

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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
Source: PubMed

ABSTRACT 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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    • "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 · 2.60 Impact Factor
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    • "The clinicians in my study rarely work in isolation. Teamwork is identified as increasingly important to patient outcomes, the reduction of critical incidents and improved patient safety (Hamman, 2004; Musson and Helmreich, 2004). Teamwork is of particular importance in this critical care setting, as members of the team work closely together, with professional boundaries becoming increasingly blurred. "
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