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

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.     

The process of rater training for observational instruments: implications for interrater reliability

Although the process of rater training is important for establishing interrater reliability of observational instruments, there is little information available in current literature to guide the researcher. In this article, principles and procedures that can be used when rater performance is a critical element of reliability assessment are described. Three phases of the process of rater training are presented: (a) training raters to use the instrument; (b) evaluating rater performance at the end of training; and (c) determining the extent to which rater training is maintained during a reliability study. An example is presented to illustrate how these phases were incorporated in a study to examine the reliability of a measure of patient intensity called the Patient Intensity for Nursing Index (PINI).     

Identifying key nursing and team behaviours to achieve high reliability

Aim  The aim of the present study was to measure markers of key nursing behaviours in interdisciplinary teams during critical events to assess the extent of high reliability.
Background  Technical and team competence are necessary to achieve high reliability to ensure safe patient care. Technical competence is generally assured because of professional training, licensure and practice standards. During critical events, team competence is difficult to observe, measure and evaluate in interdisciplinary teams.
Method  During critical events, in situ simulation was the method used to observe interdisciplinary interaction of nursing behaviours regarding communication. Seventeen trials were conducted and videotaped for evaluation at four hospital sites.
Results  Key nursing behavioural markers for interdisciplinary interaction were described: situational awareness, use of situation, background, assessment, recommendation-response (SBAR-R), closed-loop communication and shared mental model.
Conclusion  Skills necessary for nurses to contribute to highly reliable, interdisciplinary teams are not consistently observed during critical events and constitute breaches in defensive barriers for ensuring patient safety.
Implications for nursing management  Nurses have a key role in assuring effective team performance through the transfer of critical information. Nurses need to recognize and identify important clinical and environmental cues, and act in order to ensure that the team progresses along the optimal course for patient safety.     

Enhancing healthcare process design with human factors engineering and reliability science, part 1: setting the context

The design and implementation of efficient, effective, and safe processes are never-ending challenges in healthcare. Less than optimal performance levels and rising concerns about patient safety suggest that traditional process design methods are insufficient to meet design requirements. In this 2-part series, the author presents human factors engineering and reliability science as important knowledge to enhance existing operational and clinical process design methods in healthcare. An examination of these theories, application approaches, and examples are presented.     

Crew resource management: applications in healthcare organizations

Healthcare organizations continue their struggle to establish a culture of open communication and collaboration. Lessons are learned from the aviation industry, which long ago acknowledged that most errors were the result of poor communication and coordination rather than individual mistakes. The author presents a review of how some healthcare organizations have successfully adopted aviation's curriculum called Crew Resource Management, which promotes and reinforces the conscious, learned team behaviors of cooperation, coordination, and sharing.     

Building social capital in healthcare organizations: thinking ecologically for safer care

Research on patient safety and health human resources, 2 critical issues for 21st century healthcare, converges on similar findings. Specifically, it is apparent that along with the patients, families, and communities we serve, nurses and other healthcare professionals navigate a volatile health care system where persistent restructuring, market pressures, and workforce instability present ongoing threats to the delivery of safer care. Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, we outline the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: (1) forge relations to foster bonding, bridging and linking social capital; (2) build solidarity and trust; (3) foster collective action and cooperation; (4) strengthen communication and knowledge exchange; and (5) create capacity for social cohesion and inclusion.     

Leading tomorrow's healthcare organizations: strategies and tactics for effective succession planning

Hospitals and health systems today are challenged by the lack of consistent workforce planning which has resulted in a significant dearth of effective succession planning strategies and tactics for the executive suite as well as middle management. This article discusses how the healthcare industry lags behind other corporate organizations in creating a succession plan and in retaining top leadership talent. It also provides practical approaches for succession planning in healthcare and identifies the key elements of succession planning for the chief executive officer and other senior leaders.     

Knowledge workers and knowledge-intense organizations, Part 1: A promising framework for nursing and healthcare.

Although some of the models and practices imported from business and industry have dubious or uncomfortable application to healthcare, one of the rapidly emerging paradigms appears to fit nursing and healthcare well. The concept of the knowledge-intense or knowledge work company or firm, staffed primarily by a workforce of knowledge workers, appears to describe the healthcare organization more accurately than the traditional industrial organization model drawn from the production floor or the sales organization.     

Motor vehicle-related fatalities: implications for home healthcare

A nationwide epidemic of motor vehicle-related fatalities is increasing that can have a direct effect on home care employees. Managers in home care need to become involved immediately to assure that this epidemic does not affect their staffs.     

Enhancing healthcare process design with human factors engineering and reliability science, part 2: applying the knowledge to clinical documentation systems

The demand to redesign healthcare processes that achieve efficient, effective, and safe results is never-ending. Part 1 of this 2-part series introduced human factors engineering and reliability science as important knowledge to enhance existing operational and clinical process design methods in healthcare organizations. In part 2, the author applies this knowledge to one of the most common operational processes in healthcare: clinical documentation. Specific implementation strategies and anticipated results are discussed, along with organizational challenges and recommended executive responses.     

Schistosomiasis: implications for world travelers and healthcare providers.

Schistosomiasis ranks second, behind malaria, among human parasitic diseases in terms of public health and socioeconomic importance in tropical and sub-tropical areas. Worldwide, 1 of 30 people has schistosomiasis. Up to 300 million people are infected, and 600 million live in environments where infection is a risk. Tourists from non-endemic areas are contracting schistosomiasis due to the rise in "off-the-beaten-track" tourism.Praziquantel is effective against all species of schistosomes and early treatment is curative. Schistosomiasis is an insidious disease, however, so worldwide the disease is not diagnosed early. The most frequent and dangerous complication of the disease is variceal hemorrhage due to hepatic fibrosis. Variceal hemorrhage is the first symptom in 58% of cases. A variety of treatments for variceal hemorrhage are available. Exsanguination from variceal hemorrhage is possible; therefore, aggressive stabilization of the patient by the use of multiple therapies is appropriate. Most patients treated after esophageal hemorrhages do not experience reversal of hepatic fibrosis. For this reason, healthcare providers need an increased awareness of schistosomiasis to enable earlier detection and treatment in world travelers.