Laborious but Elaborate: The Benefits of Really Studying Team Dynamics

Objective Communication Patterns Associated With Team Member Effectiveness in Real-World Virtual Teams

OBJECTIVE

We explore the relationships between objective communication patterns displayed during virtual team meetings and established, qualitative measures of team member effectiveness.

BACKGROUND

A key component of teamwork is communication. Automated measures of objective communication patterns are becoming more feasible and offer the ability to measure and monitor communication in a scalable, consistent and continuous manner. However, their validity in reflecting meaningful measures of teamwork processes are not well established, especially in real-world settings.

METHOD

We studied real-world virtual student teams working on semester-long projects. We captured virtual team meetings using the Zoom video conferencing platform throughout the semester and periodic surveys comprising peer ratings of team member effectiveness. Leveraging audio transcripts, we examined relationships between objective measures of speaking time, silence gap duration and vocal turn-taking and peer ratings of team member effectiveness.

RESULTS

Speaking time, speaking turn count, degree centrality and (marginally) speaking turn duration, but not silence gap duration, were positively related to individual-level team member effectiveness. Time in dyadic interactions and interaction count, but not interaction length, were positively related to dyad-level team member effectiveness.

CONCLUSION

Our study highlights the relevance of objective measures of speaking time and vocal turn-taking to team member effectiveness in virtual project-based teams, supporting the validity of these objective measures and their use in future research.

APPLICATION

Our approach offers a scalable, easy-to-use method for measuring communication patterns and team member effectiveness in virtual teams and opens the opportunity to study these patterns in a more continuous and dynamic manner.

Using interbrain synchrony to study teamwork: A systematic review and meta-analysis

It has been proposed that interbrain synchrony (IBS) may help to elucidate the neural mechanisms underpinning teamwork. As hyperscanning studies have provided abundant findings on IBS in team environments, the current review aims to synthesize the findings of hyperscanning studies in a way that is relevant to the teamwork research. A systematic review was conducted. Included studies were classified according to the IPO (i.e. input, process, output) model of teamwork. Three multi-level meta-analyses were performed to quantify the associations between IBS and the three IPO variables. The methodology followed PRISMA guidelines and the protocol was pre-registered (https://osf.io/7h8sa/). Of the 229 studies, 41 were included, representing 1326 teams. The three meta-analyses found statistically significant positive effects, indicating a positive association between IBS and the three IPO teamwork variables. This study provides evidence that IBS is a relevant measure of the teamwork process and argues for the continued use of IBS to study teamwork.

Joint problem-solving orientation, mutual value recognition, and performance in fluid teamwork environments

Introduction

Joint problem-solving orientation (JPS) has been identified as a factor that promotes performance in fluid teamwork, but research on this factor remains nascent. This study pushes the frontier of understanding about JPS in fluid teamwork environments by applying the concept to within-organization work and exploring its relationships with performance, mutual value recognition (MVR), and expertise variety (EV).

Methods

This is a longitudinal, survey-based field study within a large United States healthcare organization n = 26,319 (2019 response rate = 87%, 2021 response rate = 80%). The analytic sample represents 1,608 departmental units in both years (e.g., intensive care units and emergency departments). We focus on departmental units in distinct locations as the units within which fluid teamwork occurs in the hospital system setting. Within these units, we measure JPS in 2019 and MVR in 2021, and we capture EV by unit using a count of the number of disciplines present. For a performance measure, we draw on the industry-used measurement of perceived care quality and safety. We conduct moderated mediation analysis testing (1) the main effect of JPS on performance, (2) mediation through MVR, and (3) EV as a moderator.

Results

Our results affirm a moderated mediation model wherein JPS enhances performance, both directly and through MVR; EV serves as a moderator in the JPS-MVR relationship. JPS positively influences MVR, irrespective of whether EV is high or low. When JPS is lower, greater EV is associated with lower MVR, whereas amid high JPS, greater EV is associated with higher MVR, as compared to lower EV.

Discussion

Our findings lend further evidence to the value of JPS in fluid teamwork environments for enabling performance, and we document for the first time its relevance for within-organization work. Our results suggest that one vital pathway for JPS to improve performance is through enhancing recognition of the value that others offer, especially in environments where expertise variety is high.

Debriefing Methods for Simulation in Healthcare: A Systematic Review

ABSTRACT

Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.

Sequential Behavioral Analysis: A Novel Approach to Help Understand Clinical Decision-Making Patterns in Extended Reality Simulated Scenarios

SUMMARY STATEMENT

Extended reality (XR)-based simulation training offers unique features that facilitate collection of dynamic behavioral data and increased immersion/realism while providing opportunities for training health care professionals on critical events that are difficult to recreate in real life. Sequential analysis can be used to summarize learning behaviors by discovering hidden learning patterns in terms of common learning or clinical decision-making sequences. This project describes the use of sequential analysis to examine differential patterns of clinical decision-making behaviors in observed XR scenarios, allowing for new insights when using XR as a method to train for critical events and to trace clinical decision making.

"Asking for help is a strength"-how to promote undergraduate medical students' teamwork through simulation training and interprofessional faculty

The ability to team up and safely work in any kind of healthcare team is a critical asset and should be taught early on in medical education. Medical students should be given the chance to "walk the talk" of teamwork by training and reflecting in teams. Our goal was to design, implement and evaluate the feasibility of a simulation-based teamwork training (TeamSIM) for undergraduate medical students that puts generic teamwork skills centerstage. We designed TeamSIM to include 12 learning objectives. For this pre-post, mixed-methods feasibility study, third-year medical students, organized in teams of 11-12 students, participated and observed each other in eight simulations of different clinical situation with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; resuscitation). Guided by an interprofessional clinical faculty with simulation-based instructor training, student teams reflected on their shared experience in structured team debriefings. Using published instruments, we measured (a) students' reactions to TeamSIM and their perceptions of psychological safety via self-report, (b) their ongoing reflections via experience sampling, and (c) their teamwork skills via behavior observation. Ninety four students participated. They reported positive reactions to TeamSIM (M = 5.23, SD = 0.5). Their mean initial reported level of psychological safety was M = 3.8 (SD = 0.4) which rose to M = 4.3 (SD = 0.5) toward the end of the course [T(21) = -2.8, 95% CI -0.78 to-0.12, p = 0.011 (two-tailed)]. We obtained n = 314 headline reflections from the students and n = 95 from the faculty. For the students, the most frequent theme assigned to their headlines involved the concepts taught in the course such as "10 s for 10 min." For the faculty, the most frequent theme assigned to their headlines were reflections on how their simulation session worked for the students. The faculty rated students' teamwork skills higher after the last compared to the first debriefing. Undergraduate medical students can learn crucial teamwork skills in simulations supported by an experienced faculty and with a high degree of psychological safety. Both students and faculty appreciate the learning possibilities of simulation. At the same time, this learning can be challenging, intense and overwhelming. It takes a team to teach teamwork.

How to enrich team research in healthcare by considering five theoretical perspectives

The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.

Human-AI teaming: leveraging transactive memory and speaking up for enhanced team effectiveness

In this prospective observational study, we investigate the role of transactive memory and speaking up in human-AI teams comprising 180 intensive care (ICU) physicians and nurses working with AI in a simulated clinical environment. Our findings indicate that interactions with AI agents differ significantly from human interactions, as accessing information from AI agents is positively linked to a team's ability to generate novel hypotheses and demonstrate speaking-up behavior, but only in higher-performing teams. Conversely, accessing information from human team members is negatively associated with these aspects, regardless of team performance. This study is a valuable contribution to the expanding field of research on human-AI teams and team science in general, as it emphasizes the necessity of incorporating AI agents as knowledge sources in a team's transactive memory system, as well as highlighting their role as catalysts for speaking up. Practical implications include suggestions for the design of future AI systems and human-AI team training in healthcare and beyond.

Measuring teamwork for training in healthcare using eye tracking and pose estimation

Teamwork is critical for safe patient care. Healthcare teams typically train teamwork in simulated clinical situations, which require the ability to measure teamwork via behavior observation. However, the required observations are prone to human biases and include significant cognitive load even for trained instructors. In this observational study we explored how eye tracking and pose estimation as two minimal invasive video-based technologies may measure teamwork during simulation-based teamwork training in healthcare. Mobile eye tracking, measuring where participants look, and multi-person pose estimation, measuring 3D human body and joint position, were used to record 64 third-year medical students who completed a simulated handover case in teams of four. On one hand, we processed the recorded data into the eye contact metric, based on eye tracking and relevant for situational awareness and communication patterns. On the other hand, the distance to patient metric was processed, based on multi-person pose estimation and relevant for team positioning and coordination. After successful data recording, we successfully processed the raw videos to specific teamwork metrics. The average eye contact time was 6.46 s [min 0 s - max 28.01 s], while the average distance to the patient resulted in 1.01 m [min 0.32 m - max 1.6 m]. Both metrics varied significantly between teams and simulated roles of participants (p < 0.001). With the objective, continuous, and reliable metrics we created visualizations illustrating the teams' interactions. Future research is necessary to generalize our findings and how they may complement existing methods, support instructors, and contribute to the quality of teamwork training in healthcare.

Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings

BACKGROUND

Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings.

METHODS

In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection.

RESULTS

The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.

CONCLUSION

When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.

Development of trauma team cognition can be explained by "split vision": A grounded theory study

The aim of this study was to explore interaction of interprofessional hospital trauma teams. A theory about how team cognition is developed through a dynamical process was established using grounded theory methodology. Video recordings of in-real-life resuscitations performed in the emergency ward of a Scandinavian mid-size urban hospital were collected and eligible for inclusion using theoretical sampling. By analyzing interactions during seven trauma resuscitations, the theory that trauma teams perform patient assessment and resuscitation by alternating between two process modes, the two main categories "team positioning" and "sensitivity to the patient," was generated. The core category "working with split vision" explicates how the teams interplay between the two modes to coordinate team focus with an emergent mental model of the specific situation. Split vision ensures that deeper aspects of the team, such as culture, knowledge, empathy, and patient needs are absorbed to continuously adapt team positioning and create precision in care for the specific patient.

What factors affect team members' evaluation of collaboration in medical teams?

Introduction

Perceived teamwork quality is associated with numerous work-related outcomes, ranging from team effectiveness to job satisfaction. This study explored what situational and stable factors affect the perceived quality of teamwork during a specific team task: when a medical team comprising a senior (supervisor) and a junior (trainee) physician diagnoses a patient.

Methods

During a field study in an emergency department, multisource data describing the patients, the diagnosing physicians, and the context were collected, including physicians' ratings of their teamwork. The relationships between perceived teamwork quality and situational (e.g., workload) and stable (e.g., seniority) factors were estimated in a latent regression model using the structural equation modeling (SEM) approach.

Results

Across the N = 495 patients included, SEM analyses revealed that the patient-specific case clarity and urgency influenced the perceived teamwork quality positively, whereas the work experience of the supervisor influenced the perceived teamwork quality of both supervisor and trainee negatively, albeit to different degrees.

Discussion

Our findings shed light on the complex underpinnings of perceived teamwork quality, a performance-relevant factor that may influence work and organizational effectiveness in healthcare settings.

Moving from tangibility toward digitalization: investigating team dynamics and facilitator support among medical students in conventional and digital small-group tutorials

BACKGROUND

Small group tutorials (SGT) promotes self-directed learning and is widely used in medical education. The coronavirus pandemic (COVID-19) has accelerated the trend toward SGT digitalization, with unclear effect. We hypothesize that team dynamics and facilitator support influence SGT satisfaction in digital versus conventional SGT.

METHODS

During the spring semester of year 2021, medical students (the second, third, and fourth year; n = 433) participating in conventional face-to-face and digital SGT curricula were enrolled. Participating students completed the collaborative learning attitude scale (including team dynamics, team acquaintance, and facilitator support dimensions) and teamwork satisfaction scale, previously validated for small-group collaborative learning, and chose preference between conventional or digital SGT in future curricula. Exploratory factor analysis (EFA) was performed to extract the essential structural factors of these scales. Paired t-tests were conducted to compare differences in different dimensions and satisfaction between the conventional and digital SGT settings. Two sets of multiple regression analyses were done; one with team satisfaction scale results and the other with preference for digital SGT as the dependent variable were used to evaluate determinants of these two variables.

RESULTS

The EFA results revealed that the original collaborative learning attitude scale was concentrated on two dimensions: team dynamics and facilitator support. No significant differences were noted between the SGT settings for the two dimensions and teamwork satisfaction. Regression analyses showed that teamwork dynamics was independently correlated with teamwork satisfaction in both conventional and digital SGT. Facilitator support was positively correlated with teamwork satisfaction in conventional, but not digital SGT. Higher teamwork satisfaction was an important determinant of preference for digital SGT among medical students.

CONCLUSIONS

Team dynamics were closely linked to teamwork satisfaction among medical students in both conventional and digital SGT, while the role of facilitator support became less obvious during digital SGT.

Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees

Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.

Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an

Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,

This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.

Debriefing interaction patterns and learning outcomes in simulation: an observational mixed-methods network study

BACKGROUND

Debriefing is effective and inexpensive to increase learning benefits of participants in simulation-based medical education. However, suitable communication patterns during debriefings remain to be defined. This study aimed to explore interaction patterns during debriefings and to link these to participants' satisfaction, perceived usefulness, and self-reported learning outcomes.

METHODS

We assessed interaction patterns during debriefings of simulation sessions for residents, specialists, and nurses from the local anaesthesia department at the Bern University Hospital, Bern, Switzerland. Network analysis was applied to establish distinctive interaction pattern categories based on recorded interaction links. We used multilevel modelling to assess relationships between interaction patterns and self-reported learning outcomes.

RESULTS

Out of 57 debriefings that involved 111 participants, discriminatory analyses revealed three distinctive interaction patterns: 'fan', 'triangle', and 'net'. Participants reported significantly higher self-reported learning effects in debriefings with a net pattern, compared to debriefings with a fan pattern. No effects were observed for participant satisfaction, learning effects after 1 month, and perceived usefulness of simulation sessions.

CONCLUSIONS

A learner-centred interaction pattern (i.e. net) was significantly associated with improved short-term self-reported individual learning and team learning. This supports good-practice debriefing guidelines, which stated that participants should have a high activity in debriefings, guided by debriefers, who facilitate discussions to maximize the development for the learners.

Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts

Background

Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact.

Methods

This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis.

Results

Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams.

Conclusion

This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-021-00980-5.

How collective reward structure impedes group decision making: An experimental study using the HoneyComb paradigm

This study investigates if and under which conditions humans are able to identify and follow the most advantageous leader who will them provide with the most resources. In an iterated economic game with the aim of earning monetary reward, 150 participants were asked to repeatedly choose one out of four leaders. Unbeknownst to participants, the leaders were computer-controlled and programmed to yield different expected payout values that participants had to infer from repeated interaction over 30 rounds. Additionally, participants were randomly assigned to one of three conditions: single, independent, or cohesion. The conditions were designed to investigate the ideal circumstances that lead to identifying the most advantageous leader: when participants are alone (single condition), in a group that lets individuals sample information about leaders independently (independent condition), or in a group that is rewarded for cohesive behavior (cohesion condition). Our results show that participants are generally able to identify the most advantageous leader. However, participants who were incentivized to act cohesively in a group were more likely to settle on a less advantageous leader. This suggests that cohesion might have a detrimental effect on group decision making. To test the validity of this finding, we explore possible explanations for this pattern, such as the length of exploration and exploitation phases, and present techniques to check for confounding factors in group experiments in order to identify or exclude them as alternative explanations. Finally, we show that the chosen reward structure of the game strongly affects the observed following behavior in the group and possibly occludes other effects. We conclude with a recommendation to carefully choose reward structures and evaluate possible alternative explanations in experimental group research that should further pursue the study of exploration/exploitation phases and the influence of group cohesion on group decision making as promising topics for further research.

Capturing Workplace Gossip as Dynamic Conversational Events: First Insights From Care Team Meetings

Even though gossip is a ubiquitous organizational behavior that fulfils important social functions (e.g., social bonding or emotion venting), little is known about how workplace gossip and its functions unfold in situ. To explore the dynamic nature and social embeddedness of workplace gossip, we develop a behavioral annotation system that captures the manifold characteristics of verbal gossip behavior, including its valence and underlying functions. We apply this system to eight elderly care team meetings audio- and videotaped in the field, yielding a sample of N = 4,804 annotated behaviors. On this empirical basis, we provide first insights into the different facets and functions of workplace gossip in real-life team interactions. By means of lag sequential analysis, we quantify gossip patterns that point to the temporal and structural embeddedness of different types of workplace gossip expressions. Though exploratory, these findings help establish workplace gossip as a dynamic conversational event. We discuss future interdisciplinary research collaborations that behavioral observation approaches offer.

Team functioning across different tumour types: Insights from a Swiss cancer center using qualitative and quantitative methods

Background

Multidisciplinary care is pivotal in cancer centres and the interaction of all cancer disease specialists in decision making processes is state‐of‐the‐art.

Aim

To describe differences of MDTMs by tumour type.

Methods

Twelve multidisciplinary team meetings (MDTMs) with participation of different cancer disease specialists at a tertiary hospital were assessed by an exploratory sequential mixed method approach with interviews, observations and a survey to address the following five topics: organisational structure and supporting technology; leadership; teamwork; decision‐making, perceived value and motivation. Thirteen persons with different tumour specialities and levels of seniority were interviewed. The 12 MDTMs were observed twice by uninvolved persons and evaluated by the participating physicians with a survey.

Results

There were no systematic differences between MDTMs for different tumour types with the exception of the non‐disease specific type MDTM, which was the only one for which the organisational structure was not driven by an electronic tool. However, several factors could be identified that generally influenced the functioning of the MDTMs. In particular, the quality of decision‐making was highly dependent on the availability of case‐based information and the presence of relevant cancer disease specialists. Leadership and teamwork were rated as important and were comparable across the MDTM. Team participants' motivation and perceived value of MDTMs was high across all meetings.

Conclusion

MDTM at a single institution did not demonstrate disease specific characteristics. An effective MDTM, irrespective of the tumour type, can be successfully structured by technical means and a chairperson coordinating the interaction of cancer disease specialists to improve the decision‐making process.

Associations of form and function of speaking up in anaesthesia: a prospective observational study

BACKGROUND

Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up.

METHODS

Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding.

RESULTS

Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018).

CONCLUSION

Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.

Teams in Transition: A Three-Wave Longitudinal Study of Reflection, Implicit and Explicit Coordination and Performance Improvements

Research has shown that team reflection is a critical transition process for coordination processes and team performance, but our understanding of its dynamics and relationship to action processes and performance is incomplete. The goal of the present study was to examine the long-term change in reflection in teams over time and explore whether these changes are related to implicit and explicit coordination processes and performance improvement. Drawing on the recurring phase model of team processes and team reflexivity theory, we hypothesized that team reflection is at least stable or increases over time for dissimilar tasks, that reflection trajectories are positively associated with implicit and negatively associated with explicit coordination in the later phases, and that implicit coordination mediates the relationship between team reflection and performance improvement. This model was tested in a three-wave longitudinal study (N = 175 teams) over a 2-months period. Results from growth curve modeling and structural equation modeling provided support for our hypotheses.

Affective Neuroscience: The Suitability of a Web App to Monitor Affective States at Work

This work describes in detail the use of a new tool, a web-app, based on the conceptual framework of affective neuroscience, in particular on Panksepp’s 7 basic emotional systems. Affective neuroscience has been used effectively in many areas, but there have been very few applications in the workplace, due to the lack of a smart implementation tool. The novelty of this work does not lie in the new information, but in a new “clinical” approach. There is a theoretical framework that allows data to be interpreted rather than simply described. Furthermore, the knowledge of working realities through the web app is specific and longitudinal. Finally, emotions are detected in hic et nunc, so the role of reflexive-cognitive mediation and recall bias are minor. This “more situated” knowledge can then guide specific leadership strategies. This paper presents the results of the tool’s application in a company in Northern Italy. The findings of our project, which recorded basic affective states and the functioning of several working teams, are detailed herein. The project’s 488 web-app records are summarized in this report, alongside our examination of related mood tags. Through this project, our analysis has enabled to determine affective neuroscience profiles of the teams analyzed, allowing the researchers to identify areas of possible interventions. The data appear very encouraging.

Understanding how team process-sequences emerge over time and their relationship to team performance

Purpose

The purpose of this study was to explore the team process-sequences executed within and across performance episodes and their relation to team performance. In doing so, this effort responds to the call for examining the temporal and dynamic aspects of teams.

Design/methodology/approach

Data (i.e. observations and audio recordings) was collected from the stand-up meetings of three high-performing Scrum teams across six points in time during two consecutive performance episodes (i.e. beginning, midpoint, end). After content coding the data, lag sequential analyses was used to examine patterns of executed team processes to determine whether particular process-sequences occurred significantly different from others.

Findings

Teams shifted between transition and action phase processes during performance episodes. During and across performance episodes, process-sequences primarily consisted of transition processes. When teams executed process-sequences consisting solely of action phase processes, their focus was on monitoring processes.

Research limitations/implications

This study hopes that the findings here will serve to spur researchers to more fully investigate the relationship between process-sequences and team performance across various team types. However, limitations (e.g. small sample size, unknown point of teams’ life cycle and focus on explicit team processes) should be taken into account when building on the present findings.

Originality/value

This study contributes to a better understanding of the temporal and dynamic nature of team processes by analyzing how the team process and process-sequences occur across time. In addition, this study moves beyond most studies that assess team processes as static retrospective perceptions and consider their natural ordering.

Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses

BACKGROUND

Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario.

METHODS

Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most.

RESULTS

All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course.

CONCLUSIONS

Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.

Investigating voice in action teams: a critical review

Team communication is considered a key factor for team performance. Importantly, voicing concerns and suggestions regarding work-related topics-also termed speaking up-represents an essential part of team communication. Particularly in action teams in high-reliability organizations such as healthcare, military, or aviation, voice is crucial for error prevention. Although research on voice has become more important recently, there are inconsistencies in the literature. This includes methodological issues, such as how voice should be measured in different team contexts, and conceptual issues, such as uncertainty regarding the role of the voice recipient. We tried to address these issues of voice research in action teams in the current literature review. We identified 26 quantitative empirical studies that measured voice as a distinct construct. Results showed that only two-thirds of the articles provided a definition for voice. Voice was assessed via behavioral observation or via self-report. Behavioral observation includes two main approaches (i.e., event-focused and language-focused) that are methodologically consistent. In contrast, studies using self-reports showed significant methodological inconsistencies regarding measurement instruments (i.e., self-constructed single items versus validated scales). The contents of instruments that assessed voice via self-report varied considerably. The recipient of voice was poorly operationalized (i.e., discrepancy between definitions and measurements). In sum, our findings provide a comprehensive overview of how voice is treated in action teams. There seems to be no common understanding of what constitutes voice in action teams, which is associated with several conceptual as well as methodological issues. This suggests that a stronger consensus is needed to improve validity and comparability of research findings.

Time to go wild: How to conceptualize and measure process dynamics in real teams with high-resolution

Team processes are interdependent activities among team members that transform inputs into outputs, vary over time, and are critical for team effectiveness. Understanding the temporal dynamics of team processes and related team phenomena with a high-resolution lens (i.e., methods with high sampling rates) is particularly challenging when going “into the wild” (i.e., studying teams operating in their full situated context). We review quantitative field studies using high-resolution methods (e.g., video, chat/text data, archival, wearables) and map out the various temporal lenses for studying team dynamics. We synthesize these different lenses and present an integrated temporal framework that is of help in theorizing about team dynamics. We also provide readers with a “how to” guide that summarizes four essential steps along with analytical methods (e.g., sequential and pattern analyses, mixed-methods research, abductive reasoning) that are applicable to the broad scope of high-resolution methods.