Outcomes of classroom-based team training interventions for multiprofessional hospital staff. A systematic review
Danish Society for Patient Safety, Hvidovre Hospital, Dept 023, Kettegard Alle 30, 2650 Hvidovre, Denmark. Quality and Safety in Health Care
(Impact Factor: 2.16).
12/2010; 19(6):e27. DOI: 10.1136/qshc.2009.037184
Several studies show that communication errors in healthcare teams are frequent and can lead to adverse events. Team training has been suggested as a way to safer communication and has been implemented in healthcare as classroom-based or simulation-based team training or a combination of both. The objective of this paper is to systematically review studies evaluating the outcomes of classroom-based multiprofessional team training for hospital staff.
The authors searched PubMed, EMBASE, ERIC, PsycInfo, Cinahl and the Cochrane Reviews database and selected 18 studies for description and comparison of learners and setting, objective, design, intervention, evaluation methods (reaction, learning, behaviour and results), intervention time before evaluation, outcomes and risk of bias.
Participant reactions were positive. Learning and behaviour were positive in all studies, but for some only partially. The effect on clinical processes was in most instances positive. Results at patient level were limited. Only one study reported results at all four evaluation levels. Fifteen studies were uncontrolled, and 17 studies had a moderate or high risk of bias. More than half of the studies ended evaluation within 6 months. No studies reported qualitative measures that could have provided an insight as to why the interventions had the effect they had.
Classroom-based team training for multiprofessional hospital staff is recommended as a way to improve patient safety. This review shows mainly positive effects of the intervention on participant reaction, learning and behaviour. The results at clinical level are still very limited.
Available from: Dirk F De Korne
- "Both in aviation and health care, little is known about how TRM affects the " black box " of safety culture. A systematic review conducted by Rabøl et al. (2010) showed that more than half the studies ended evaluation within six months, but Sax et al. (2009) concluded TRM's influence on personal behavior and empowerment may take years to be integrated into the culture. Although definitions vary, safety culture is commonly defined as " the product of the individual and group values, attitudes, perceptions, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of an organization's health and safety management " (Nieva and Sorra, 2003, p. ii18). "
[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program's content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture.
Pre- and post-assessments of the hospitals' safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice.
The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction.
The study was observational and the hospital's variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention.
Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on "team" instead of "profession" seems both necessary and difficult in hospital care.
Available from: Catherine Carr
- "Intervention group received live, interactive sessions plus guidelines; control groups received guidelines only and no intervention. Rabol L et al. 2010 Systematic review: 18 studies reviewed to determine outcomes of live, classroom-based, multi-professional team training Health professionals Media: live Although most studies had weak design methods, findings from the 18 studies concluded that team-based training led to positive participant evaluation, knowledge gain and behaviour change. However, the impact on clinical outcomes was limited. "
[Show abstract] [Hide abstract]
ABSTRACT: In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE.
A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education.
The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Very limited quality data are available from low- to middle-income countries.
Educational techniques are critical to learning outcomes. Targeted, repetitive interventions can result in better learning outcomes. Setting should be selected to support relevant and realistic practice and increase efficiency. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. CPE can lead to improved learning outcomes if effective techniques are used. Limited data indicate that there may also be an effect on improving clinical practice behaviours. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries.
Available from: Peter F Kemper
- "Most of the studies evaluate the effect of CRM within six months , which is a relatively short period for an innovation to be completely adopted and to become part of the daily routine . In addition, most evaluations rely on a pre- and post training comparison, but do not include a control group . In some studies the trained and non-trained participants were not separated in data gathering. "
[Show abstract] [Hide abstract]
ABSTRACT: Crew resource management (CRM) has the potential to enhance patient safety in intensive care units (ICU) by improving the use of non-technical skills. However, CRM evaluation studies in health care are inconclusive with regard to the effect of this training on behaviour and organizational outcomes, due to weak study designs and the scarce use of direct observations. Therefore, the aim of this study is to determine the effectiveness and cost-effectiveness of CRM training on attitude, behaviour and organization after one year, using a multi-method approach and matched control units. The purpose of the present article is to describe the study protocol and the underlying choices of this evaluation study of CRM in the ICU in detail.
Six ICUs participated in a paired controlled trial, with one pre-test and two post test measurements (respectively three months and one year after the training). Three ICUs were trained and compared to matched control ICUs. The 2-day classroom-based training was delivered to multidisciplinary groups. Typical CRM topics on the individual, team and organizational level were discussed, such as situational awareness, leadership and communication. All levels of Kirkpatrick's evaluation framework (reaction, learning, behaviour and organisation) were assessed using questionnaires, direct observations, interviews and routine ICU administration data.
It is expected that the CRM training acts as a generic intervention that stimulates specific interventions. Besides effectiveness and cost-effectiveness, the assessment of the barriers and facilitators will provide insight in the implementation process of CRM.
Netherlands Trial Register (NTR): NTR1976.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.