Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine.

BACKGROUND: The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams. PURPOSES: Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem. METHODOLOGY: The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams. FINDINGS: The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices. PRACTICE IMPLICATION: The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.

Job Demands and Resources among Healthcare Professionals during Virus Pandemics: A Review and Examination of Fluctuations in Mental Health Strain during COVID-19.

The present article examines how job demands and resources are related to indices of strain among healthcare professionals during virus pandemics. The article also presents the results of a study examining the relationships between COVID-19 demands (e.g., lack of personal protective equipment, concerns about infecting family members), resources (meaningful work, social support), and mental health strain within a sample of emergency medicine personnel over six consecutive weeks. COVID-19-related demands and hours worked were hypothesized to be positively related to mental health strain, whereas meaningful work and social support were hypothesized to be negatively related to mental health strain. Hours worked the prior week were hypothesized to exacerbate the positive relationships between COVID-19 demands and mental health strain, whereas the resources of meaningful work and social support were expected to buffer the relationships. Multilevel models controlling for mental health strain the prior week revealed that COVID-19 demands, along with hours worked, were each related to higher mental health strain during the week. Hours worked magnified the within-person relationship between personal COVID-19 demands and mental health strain. In contrast to the hypotheses, social support and meaningful work were not related to mental health strain. Discussion focuses on the implications of the findings for healthcare professionals.

Bringing a Multiteam Systems Perspective to the Perioperative Context: Considerations for Future Research of Perioperative Handoffs.

BACKGROUND: Perioperative handoffs entail transferring responsibility for surgical patients from one specialized group or team to another. Multiteam system (MTS) theory has not yet been considered within perioperative handoff literature, even though multiple teams must work within and across the preoperative, intraoperative, and postoperative settings to care for shared patients. METHODS: Using a case study from gynecological oncology, the authors demonstrate the applicability of an MTS taxonomy to the perioperative context. Compositional, linkage, and developmental MTS attributes are defined, along with the concept of boundary spanning, using examples from the case study to illustrate their relevance to the perioperative environment. Key research issues invoked through the application of the MTS taxonomy are discussed alongside overarching recommendations regarding approaches and methods to study these issues. RESULTS: This discussion of perioperative handoffs considers team functional diversity and motivation, between-team interdependence and communication patterns, changes in MTS composition and structure, and boundary spanning. The authors make overarching recommendations for future research that specify mapping perioperative MTSs, identifying weaknesses in MTS functioning and possible handoff design countermeasures, and evaluating handoffs designs' impact on patient care and MTS outcomes using several study designs. CONCLUSION: An MTS perspective can uniquely inform key research questions to advance the practice of perioperative handoffs. Processes that affect complex patient safety and care quality outcomes demand consideration of between-team collaboration quality during perioperative periods. The application of MTS theory in intervention research addressing perioperative handoffs can support MTS functioning for the benefit of safe, high-quality care.

Making Every Meeting Count: A Qualitative Investigation of Multiteam Meeting Events and Their Role in Supporting Coordinated Cancer Care Delivery.

PURPOSE: This research considers how cross-disciplinary cancer care meetings can facilitate coordination within the multiteam systems (MTSs) that provide inpatient hospital care. We conducted a series of interviews and observations with members of a single cancer care MTS to address the following research questions: (1) what are the key characteristics of MTS cancer care meetings (with regard to composition, focus, and structure)? and (2) how is cross-team coordination acknowledged and addressed during these meetings? METHODS: In this single-site case study of a MTS operating to provide gynecologic oncology care within a teaching hospital, two types of meetings, called rounds and huddles, were held consistently. We used qualitative methods, including interviews with health care professional subject matter experts and 30 hours of observations of cancer care meetings, and analyzed the data in three stages of qualitative coding. RESULTS: Our analyses resulted in a thematic framework detailing key processes, and subprocesses, identified as central to the activities of observed cancer care meetings. Key processes include information sharing, gaining clarity, strategizing, and pedagogy. Discussions and explanations of this framework showcase the ways in which MTS meetings can bolster cross-team coordination and facilitate MTS activities. CONCLUSION: Inpatient cancer care meetings provide opportunities to facilitate MTS coordination in several ways, yet doing so does not come without challenges. Considering these results together with insights from meeting science and MTS research, this article concludes by putting forward practical recommendations for leveraging opportunities and overcoming challenges to use cancer care meetings as tools to support cross-team coordination.

"I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19.

During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.

Multiteam Systems in Long Duration Exploration Missions: A Qualitative Analysis of Key Characteristics and Challenges.

Given the unprecedented environment of long duration space exploration (LDSE), success simply cannot occur without the coordinated efforts of multiple teams, both in flight and on the ground. These multiteam systems (MTSs) are needed to achieve the complex and dynamic tasks of spaceflight missions that will be longer and more uncertain than any previously experienced. Accordingly, research is limited in terms of how to best coordinate these teams and their dynamics-and in particular, how to best prepare LDSE teams to work across time and space effectively. To begin to address these critical questions systematically, qualitative data was extracted from a series of ten interviews with experts in spaceflight and long duration analog environments. Using thematic analysis techniques, we identified several consistent themes for affective, behavioral, and cognitive elements of teamwork occurring within and between teams. We examine each of these in detail, to identify the dynamics of what is currently known and where research needs to go to provide guidance for spaceflight organizations as well as others attempting to successfully implement MTSs in novel, complex environments.

An integrative review and practical guide to team development interventions for translational science teams: One size does not fit all.

As the need to tackle complex clinical and societal problems rises, researchers are increasingly taking on a translational approach. This approach, which seeks to integrate theories, methodologies, and frameworks from various disciplines across a team of researchers, places emphasis on translation of findings in order to offer practical solutions to real-world problems. While translational research leads to a number of positive outcomes, there are also a multitude of barriers to conducting effective team science, such as effective coordination and communication across the organizational, disciplinary, and even geographic boundaries of science teams. Given these barriers to success, there is a significant need to establish team interventions that increase science team effectiveness as translational research becomes the new face of science. This review is intended to provide translational scientists with an understanding of barriers to effective team science and equip them with the necessary tools to overcome such barriers. We provide an overview of translational science teams, discuss barriers to science team effectiveness, demonstrate the lacking state of current interventions, and present recommendations for improving interventions in science teams by applying best practices from the teams and groups literature across the four phases of transdisciplinary research.

Enhancing the practice of medicine with embedded multi-disciplinary researchers in a model of change.

Successfully embedding researchers in a health care setting brings unique challenges and opportunities. Through a joint clinical and academic partnership, we have developed a novel approach to problem-solving in the health care context, by employing a model for leading through change to embed researchers in transformative initiatives. Using the model, we have been able to leverage our local environment and resources to engage multi-disciplinary researchers in solving complex issues. An example is our initiative, Enhancing the Practice of Medicine, to address burnout among health care providers. Through this work, we have identified 3 primary factors critical to the successful deployment of embedded researchers. First and foremost, a multi-disciplinary team with diverse expertise is necessary to truly understand the root causes and potential solutions for complex issues. Second, this diverse team of embedded researchers must be involved from the initial stages of project design and have a voice throughout all phases of planning and assessing the initiative. Finally, embedded researchers will be most successful when they are supported to build relationships, navigate the system, and conduct research as part of an integrated and comprehensive effort that aligns with health system priorities.

The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework.

Care coordination challenges for patients with cancer continue to grow as expanding treatment options, multimodality treatment regimens, and an aging population with comorbid conditions intensify demands for multidisciplinary cancer care. Effective teamwork is a critical yet understudied cornerstone of coordinated cancer care delivery. For example, comprehensive lung cancer care involves a clinical "team of teams"-or clinical multiteam system (MTS)-coordinating decisions and care across specialties, providers, and settings. The teamwork processes within and between these teams lay the foundation for coordinated care. Although the need to work as a team and coordinate across disciplinary, organizational, and geographic boundaries increases, evidence identifying and improving the teamwork processes underlying care coordination and delivery among the multiple teams involved remains sparse. This commentary synthesizes MTS structure characteristics and teamwork processes into a conceptual framework called the cancer MTS framework to advance future cancer care delivery research addressing evidence gaps in care coordination. Included constructs were identified from published frameworks, discussions at the 2016 National Cancer Institute-American Society of Clinical Oncology Teams in Cancer Care Workshop, and expert input. A case example in lung cancer provided practical grounding for framework refinement. The cancer MTS framework identifies team structure variables and teamwork processes affecting cancer care delivery, related outcomes, and contextual variables hypothesized to influence coordination within and between the multiple clinical teams involved. We discuss how the framework might be used to identify care delivery research gaps, develop hypothesis-driven research examining clinical team functioning, and support conceptual coherence across studies examining teamwork and care coordination and their impact on cancer outcomes.

To Address Burnout in Oncology, We Must Look to Teams: Reflections on an Organizational Science Approach.

PURPOSE: Despite decades of effort, burnout among physicians remains elevated compared with that of other working populations, and it yields catastrophic consequences, including medical errors and physician suicide. Burnout leaves oncologists feeling like they are alone, but this is not the case-it affects everyone. To effectively address burnout, it is not enough to look only at oncologists; instead, we must include all those involved in the delivery of cancer care. With this aim, we present an overview of the organizational science strategies and initial evidence for the value of a comprehensive, team-focused approach to addressing oncology provider burnout. METHODS: We describe the development of a team-focused burnout intervention approach, implemented for oncology providers, which focuses on the importance of encouraging communication and psychological safety to reduce feelings of isolation and fragmentation. We discuss the initial findings from 1 such team-based initiative currently underway within an academic medical center, presenting data from 409 cancer care providers embedded in 30 oncology units participating in this intervention approach. RESULTS: Preliminary results demonstrate that units that integrated a team-focused intervention for burnout reported significantly higher levels of teamwork and lower levels of burnout. We also describe lessons learned and recommendations for implementing this type of intervention on the basis of best practices from organizational science. CONCLUSION: This approach can positively affect the delivery of cancer care, interprofessional relationships among oncology staff, and the well-being of both patients and providers. Treating physician burnout alone will treat 1 symptom of the overall issue of burnout in oncology. As burnout pulls oncology clinicians apart, our solution must be to bring them together.

Learning From the Past to Advance the Future: The Adaptation and Resilience of NASA's Spaceflight Multiteam Systems Across Four Eras of Spaceflight.

Many important "grand" challenges-such as sending a team of humans on a voyage to Mars-present superordinate goals that require coordinated efforts across "multiteam systems" comprised of multiple uniquely specialized and interdependent component teams. Given their flexibility and resource capacity, multiteam system structures have great potential to perform adaptively in dynamic contexts. However, these systems may fail to achieve their superordinate goals if constituent members or teams do not adapt their collaboration processes to meet the needs of the changing environment. In this case study of the National Aeronautics and Space Administration (NASA)'s Spaceflight Multiteam Systems (SFMTSs), we aim to support the next era of human spaceflight by considering how the history of manned spaceflight might impact a SFMTS's ability to respond adaptively to future challenges. We leverage archival documents, including Oral History interviews with NASA personnel, in order to uncover the key attributes and structural features of NASA's SFMTSs as well as the major goals, critical events, and challenges they have faced over 60 years of operation. The documents reveal three distinct "eras" of spaceflight: (1) Early Exploration, (2) Experimentation, and (3) Habitation, each of which reflected distinct goals, critical events, and challenges. Moreover, we find that within each era, SFMTSs addressed new challenges adaptively by modifying their: (1) technical capabilities; (2) internal collaborative relationships; and/or (3) external partnerships. However, the systems were sometimes slow to implement needed adaptations, and changes were often spurred by initial performance failures. Implications for supporting future SFMTS performance and future directions for MTS theory and research are discussed.

Considerations for Multiteam Systems in Emergency Medical Services.

OBJECTIVE: Despite good intentions, mishaps in teamwork continue to affect patient's lives and plague the medical community at large and Emergency Medical Services (EMS) in particular. Effective and efficient management of patient care necessitates that sets of multiple teams (i.e., multiteam systems [MTSs] - EMS ground crews, EMS air crews, dispatch, and receiving hospital teams) seamlessly work together. Although advances have been made to improve teams, little research has been dedicated to enhancing MTSs especially in the critical yet often under studied domain of EMS. The purpose of this paper is to assist the pre-hospital community in strengthening patient care by presenting considerations unique to multiteam systems. METHODS: We synthesized the literature pertinent to multi-team systems and emergency medical services. RESULTS: From this synthesis, we derived five unique considerations: goals, boundary spanning, adaptation, leadership, and social identity. CONCLUSIONS: MTSs are prevalent in prehospital care, as they define how multiple component healthcare teams work together to intervene in emergency situations. We provided some initial directions regarding considerations for success in EMS MTSs based on existing research, but we also recognize the need for further study on these issues.

Teamwork situated in multiteam systems: Key lessons learned and future opportunities.

Many important contexts requiring teamwork, including health care, space exploration, national defense, and scientific discovery, present important challenges that cannot be addressed by a single team working independently. Instead, the complex goals these contexts present often require effectively coordinated efforts of multiple specialized teams working together as a multiteam system (MTS). For almost 2 decades, researchers have endeavored to understand the novelties and nuances for teamwork and collaboration that ensue when teams operate together as "component teams" in these interdependent systems. In this special issue on the settings of teamwork, we aim to synthesize what is known thus far regarding teamwork situated in MTS contexts and offer new directions and considerations for developing, maintaining, and sustaining effective collaboration in MTSs. Our review of extant research on MTSs reveals 7 key lessons learned regarding teamwork situated in MTSs, but also reveals that much is left to learn about the science and practice of ensuring effective multiteam functioning. We elaborate these lessons and delineate 4 major opportunities for advancing the science of MTSs as a critical embedding context for collaboration and teamwork, now and in the future. (PsycINFO Database Record

DEVELOPING, SUSTAINING, AND MAXIMIZING TEAM EFFECTIVENESS: AN INTEGRATIVE, DYNAMIC PERSPECTIVE OF TEAM DEVELOPMENT INTERVENTIONS.

Organizations regularly make significant investments to ensure their teams will thrive, through interventions intended to support their effectiveness. Such team development interventions (TDIs) have demonstrated their value from both a practical and empirical view, through enabling teams to minimize errors and maximize expertise and thereby advance organizational gains. Yet, on closer examination, the current state of the TDI literature appears so piecemeal that the robustness of extant scientific evidence is often lost. Accordingly, we seek to provide a more cohesive and dynamic integration of the TDI literature, evolving thinking about TDIs toward a system of interventions that can be optimized. Drawing on the existing theoretical and empirical literatures, we first broadly define TDIs. We then offer an in-depth look at the most common types of TDIs, in terms of summarizing the state of the science surrounding each TDI. Based on this review, we distinguish features that make for an effective TDI. We then advance a more integrative framework that seeks to highlight certain interventions that are best served for addressing certain issues within a team. In conclusion, we promote a call for evolving this robust yet disjointed TDI literature into a more holistic, dynamic, and intentional action science with clear empirical as well as practical guidance and direction.