Exploring objective measures for assessing team performance in healthcare: an interview study

As exploration of new frontiers continues, the need for team training in extreme environments grows. Operating in isolated, confined, and extreme environments (ICE) demands novel approaches to team performance measurement, as well as new strategies and methods for ensuring teams members are (1) equipped with the knowledge, skills, and attitudes critical for effective team performance over time, and (2) are supported by just-in-time training or other resources when breakdowns in performance inevitably occur. This panel brings together a range of experts in human performance in extreme environments to provide a comprehensive overview and discussion of the most current approaches and trends regarding team training and performance measurement in ICE environments.

Teamwork is a critical aspect of patient care and is especially salient in response to multiple patient casualties. Effective training and measurement improve team performance. However, the literature currently lacks a scientifically developed measure of team performance within multiple causality scenarios, making training and feedback efforts difficult. The present effort addresses this gap by integrating the input of subject matter experts and the science of multicasualty teams and training to (1) identify overarching teamwork processes and corresponding behaviors necessary for team performance and (2) develop a behavioral observation tool to optimize teamwork in multicasualty training efforts. A search of articles including team performance frameworks associated with team training was conducted, leading to the identification of a total of 14 articles. Trained coders extracted teamwork processes and the corresponding team behaviors indicative of effective performance from these articles. Five subject matter experts were interviewed using the critical incident technique to identify additional behaviors. Team situation awareness, team leadership, coordination, and information exchange emerged as the four core team processes required for team performance in scenarios with multiple patient casualties. Relevant behaviors and subbehaviors within these overarching processes were identified to inform a pilot behavioral framework of team performance. The processes and associated behaviors identified within this effort serve as scientifically grounded behaviors of team performance in the case of multiple patient casualties simulated training scenarios. Future work can use and further refine these results to ensure that measures of team performance are grounded in specific, observable, and scientifically delineated behaviors.

Organizations increasingly set up multiteam projects for the development of highly complex products. While team research has emphasized the importance of team-internal processes for smaller scale projects, we know little about collaborative processes (especially between teams) in such large-scale projects. This study utilizes a multi-informant longitudinal research design on a product development project (39 teams, 36 months) in the European automotive industry investigating collaboration between and within teams. The results of the study demonstrate that interteam coordination, project commitment, and teamwork quality as rated by the team members at Time 1 (Month 12; end of concept phase) are significantly correlated to project managers’ ratings of overall team performance at Time 3 (Month 36; end of project). The process variables measured at Time 2 (Month 24; end of design phase) display generally weaker correlations with team performance at Time 3. Multiple regression analyses further detail the effects of collaborative processes within and between teams on different measures of team performance (i.e., overall performance, quality, budget, schedule). The results show that collaborative processes during the project have predictive properties in regard to later team performance and can serve as early warning indicators. Furthermore, the results of this study provide support for our hypotheses predicting positive relationships between interteam coordination, project commitment, and teamwork quality. Theoretical and practical implications of this study are discussed.

BackgroundNon-technical skills (NTS) have gained increasing recognition in recent years for their role in safe, effective team performance in healthcare. Gastrointestinal endoscopy is a procedure-based specialty with rapidly advancing technology,...

Introduction: The quality of team performance during medical crises impacts patient outcomes. Team performance can be enhanced by simulated or case-based education. Survival after pediatric cardiac arrest is excellent when effective CPR is performed. Measuring team performance during CPR events can identify errors, allowing development of focused team training. Multiple personnel are involved in resuscitative events and hence, multidisciplinary feedback of perceived errors must be sought. Hypothesis: There is a high rate of qualitative errors that occur during CPR events in the PICU and discordance in perception of errors by team members. Methods: A survey was created of demographics and 3 broad categories of errors- 1. Systems issues 2. Improper BLS/PALS application 3. Crisis resource management (CRM) deficiencies. Personnel conducting the surveys were educated about error categories and debriefing techniques. For all cardiopulmonary arrests(CPAs) in the PICU, the Critical Care (CCM) Attending, Fellow, PICU nurse and respiratory therapist that participated in the resuscitation were interviewed, using formatted, yet open-ended questions. Results: There were 30 CPA events from February to July 2012. 6 patients had 2 events each. Spontaneous circulation returned in 24 events (80%). 21 of the 24 patients survived to hospital discharge (84%). The team leader did multidisciplinary code debriefing following 10 events (33%). 360 degree surveys were successfully done for all team members in 28 cases(93%). Only 2 events(6%) were perceived as error-free by all primary respondents. Systems issues were identified by at least 1 team member in 18 events(60%), BLS/PALS deficiencies in 18 events(60%) and CRM deficiencies in 25 events(83%). More than 1 category of error was identified in 23 events(76%). In 14 events(46%), there was lack of clarity about team leadership. Conclusions: There is a significant rate of errors in PICU CPR team performance. Ample opportunity exists to improve the quality of CPR through team training. Based on our results, CRM is the commonest category of qualitative deficiencies during CPAs and must be primarily targeted during multidisciplinary simulation training and mock codes to enhance patient care.

While prior research has focused on differences in entrepreneurial orientation between organizations, we direct attention to differences in entrepreneurial orientation within organizations. We propose that individual members in entrepreneurial teams may differ in their dispositions to act in entrepreneurial ways, that is, in their individual entrepreneurial orientation (iEO) and that these differences have meaningful implications for team performance. Drawing upon research in team diversity and entrepreneurial orientation, we argue that the three iEO diversity dimensions—proactiveness, risk taking, and innovativeness diversity—affect team outcomes in different ways, although they belong to the same diversity type and even belong to a common superordinate construct. Empirical data gathered in 104 dyadic entrepreneurial teams supports our theory: Diversity in proactiveness within a team impairs team performance. Risk-taking diversity also harms team performance by heightening relationship conflict. However, innovativeness diversity facilitates team performance. The present study contributes to two streams of research, namely, entrepreneurial team research and research on entrepreneurial orientation and is of practical significance to entrepreneurial team formation and performance.

PurposeThis study aims to examine empirically the effect of emotional intelligence of the team, as calculated by the average of all team members’ individual emotional intelligence measurements, on the cohesiveness of the team, and the effect of the perception of self-efficacy of the team members on the relationship between emotional intelligence and team cohesion. Finally, certain financial indicators were analyzed to evaluate team performance.Design/methodology/approachThis study used quasi-experimental design. Participated in the experiment a total of 146 students (35 teams) who were senior business major students in the mid-sized university in the USA. In the experiment, the participants played a business simulation game over an eight-year simulated time frame. After the final round of the simulation game, the variables of emotional intelligence, self-efficacy and team cohesion were measured using the survey questionnaire and team performance and participation data were collected from the business simulation game. In the support of the quantitative data analysis, the current study also collected and analyzed qualitative data comments on other group members’ contribution to the group task.FindingsResults indicated that team cohesion was highest when team members demonstrated greater emotional intelligence. Self-efficacy also had a positive influence on team cohesion. High self-efficacy was found to be an important mediator of the relationship between emotional intelligence and team cohesion. High emotional intelligence promoted the development of self-efficacy, resulting in increased team cohesion. Increased team cohesion resulted in improved team performance and participation.Research limitations/implicationsThe current study has several limitations. First, the sample is mostly business major students in the mid-sized university in the USA. There is a limitation in generalizing the findings into other populations. Second, this study accessed information on 35 teams comprising a total of 146 students. While the number of students and teams is sufficient for a study, more data would improve the robustness of the results. Third, this study collected and analyzed cross-sectional data, so there is the possibility for the reversed causal relationship in the findings. Although the authors concluded that team cohesion had a positive impact on team performance and participation, they also found the reverse relationship from the additional analysis. Fourth, the validity of the construct for emotional intelligence has some detractors, mainly because of the subjective nature of the measurement that tends to overlap existing personality measures and the objective measurement which involves a consensual scoring method with poor reliability.Practical implicationsThis paper implies practical strategies to manage teams and team members for enhanced team productivity. Teams are critical resources within companies. This study demonstrates that high team cohesion leads to better team performance. As team cohesion is important for team performance, the authors found that two antecedents for team cohesion are emotional intelligence and self-efficacy within team members. Therefore, it is important for managers to hire and select team members with high levels of emotional intelligence and self-efficacy. Managers can train employees to internalize increased levels of these traits.Originality/valueThe current study demonstrated that self-efficacy mediated emotional intelligence and team cohesion during a research project lasting one semester. There have been few studies examining the mediating effect of self-efficacy on the relationship between emotional intelligence and team cohesion. In particular, unlike many other studies that use short-term laboratory experiments, the duration of this study could provide enough time to more thoroughly develop cohesion among members. The current study collected both quantitative and qualitative data. In addition to the quantitative data analysis, the analysis of qualitative data reinforced the findings of the quantitative data analysis.

Assessing team performance is a difficult task for instructors because of factors such as high workload. Automated performance measurement systems may provide assistance to instructors and improve the quality of performance assessment. However, little research is available to guide such interventions or to document their effects. This research compared the ability of flight instructors to give diagnostic ratings of team performance with or without computer assistance using the Enhancing Performance With Improved Coordination (EPIC) tool. It was found that the instructor group operating with EPIC (n = 10) had more differentiated and accurate ratings of team performance compared to the control group (n = 10). These results suggest that approaches such as EPIC can serve to complement and augment instructor capabilities, providing more powerful and diagnostic team performance assessment systems.

The Law of the Best or the Law of Averages? Modeling and Evidence from the Digital Game Industry

Background:Teamwork and communication have been identified as root causes of sentinel events involving infant death and injury during delivery. However, despite the emphasis on team training as a way to...

Teamwork in emergency medical services

To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI) and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey [CISS] score) were evaluated. There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli, and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5 and 10°) appeared normal pre-OBVT and did not show any significant change after treatment. This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time and suggest that these measures could be used in a large-scale randomized clinical trial of concussion-related CI as outcome measures.

Whereas previous studies have attempted to investigate the correlation between mode of operation (virtual versus face-to-face) and team performance, these studies have been primarily focused on project management and distance learning. However, few studies, if any, have addressed the performance of virtual teams carrying complex technical support tasks in telecommunication companies. The primary proposition of the study that there is a relationship between team performance (comprised of three factors, namely, goals achievement, customer satisfaction, and team health) and the mode of operation was tested. A secondary proposition that team size has a significant effect on the relationship between the mode of operation and support team performance was tested also. One hundred twenty support professionals working for telecommunication companies based in California's Silicon Valley completed web-based surveys, which offered data on support operations in virtual and face-to-face settings and assessment of teams' performance in each setting. Whereas the findings indicated correlations between the mode of operation and the three factors of support team, further analysis indicated weak linear relationships among the variables. In addition, data analysis failed to support a significant effect of team size on the relationships between mode of operation and the three measures of support team performance.

List of Tables. Editors. List of Contributors. Foreword. Preface. Part I: Conceptualizing Model and Measurement. 1. Teams in Health Care Settings G.D. Heinemann. 2. Measuring Team Performance in Health Care Settings A.M. Zeiss. 3. A Model of Team Performance G.D. Heinemann, A.M. Zeiss. 4. Organizational and Team Structure S.A. Brallier, R.A. Tsukuda. 5. Organizational and Team Context S.K. Harmon, S.A. Brallier, G.F. Brown. 6. Team Process L.O. Nichols, A.M. Defriese, C.C. Malone. 7. Team Productivity M.S. Waite, S.B. Hoffman. Part II: Reviewing and Evaluating Team Performance Instruments. 8. Critiquing and Summarizing Instruments S. Brallier, S. Lovett, T.F. Miller. 9. Focused Instruments R.A. Tsukuda. 10. Middle-Range Instruments S.B. Hoffman. 11. Broad-Spectrum Instruments M.S. Waite, L.O. Nichols. 12. Full-Spectrum Instruments G.F. Brown, E.P. Mahairas. 13. Instruments for Health Care Teams G.F. Brown, M.S. Waite. 14. Assessment and Development: Now and in the Future S. Lovett, A.M. Zeiss, G.D. Heinemann. Index.

This study measures the interaction between two opposing teams in ice hockey by regressing a number of performance measures to a single measure which enables assessment of a team's performance during the course of a game. The notion of 'phases of play', whereby players and teams fluctuate through periods of 'high phase' and 'low phase' during a game, is used as a theoretical underpinning for the research. We also consider 'relative phase' that describes the overall interaction between the two teams. Team game data from the 2005/06 National Hockey League season were collected along with data for the games played up to time of research in the 2006/07 season. An optimized binary logistic regression model for both home and away teams was naturally found to model match outcome better than other methods when a team's score was included as a performance variable. This model correctly classified 91% of games as either a win or a loss. Using live match data, these logistic regression models were then used to create phases of play plots of a home team's and away team's performance throughout the progress of a number of games in the 2006/07 season. These scores were smoothed using a Tukey's T4253H smoother to eliminate excess noise in the phases of play plots. It was concluded that the results of this analysis gave an objective, simple and all-round measure of a team's performance which would be a valuable evaluative asset to coaches, the media and spectators.