Teamwork and implementation of innovations in healthcare and human service settings: a systematic review.

BACKGROUND: Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings. METHODS: We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence. RESULTS: Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. CONCLUSIONS: Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations. TRIAL REGISTRATION: This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. REGISTRATION NUMBER: CRD42020220168.

Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills.

Importance: Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging. Objective: To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures. Design, Setting, and Participants: This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters. Main Outcomes and Measures: NOTSS overall score, with motion features extracted from surgical videos as measures. Results: A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores. Conclusions and Relevance: This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.

How to Make an Internal Team Coach: An Integration of Research.

Team coaching has been found to increase group effort, improve interpersonal processes, and increase team knowledge and learning. However, the team coaching literature is renowned for its inability to define team coaching itself-making it difficult to solidify its place in the world of team science. So far, there is no consensus on what specific training would serve internal leaders best, and how they would connect to the team coaching literature. We know leadership and team training are effective in improving organizational outcomes, but the gap in the literature lies in identifying what specific competencies internal team coaches need, and what training could fulfill these. In this piece, we seek to (1) identify what competencies internal team leaders need based on the outcomes we know team coaching yields, (2) identify specific behaviors that can fulfill these competencies, and (3) integrate the literature to form an evidence-based guide on what training to provide to internal team coaches. By doing so, we hope to provide a definitive understanding of what internal team coaches need to be successful.

Cumulative risk of future bleaching for the world's coral reefs.

Spatial and temporal patterns of future coral bleaching are uncertain, hampering global conservation efforts to protect coral reefs against climate change. Our analysis of daily projections of ocean warming establishes the severity, annual duration, and onset of severe bleaching risk for global coral reefs this century, pinpointing vital climatic refugia. We show that low-latitude coral regions are most vulnerable to thermal stress and will experience little reprieve from climate mitigation. By 2080, coral bleaching is likely to start on most reefs in spring, rather than late summer, with year-round bleaching risk anticipated to be high for some low-latitude reefs regardless of global efforts to mitigate harmful greenhouse gasses. By identifying Earth's reef regions that are at lowest risk of accelerated bleaching, our results will prioritize efforts to limit future loss of coral reef biodiversity.

Astrocitoma de bajo grado en un teratoma retroperitoneal: reporte de caso / Low-grade astrocytoma within a retroperitoneal teratoma: Case report

Los teratomas son neoplasias que se originan de las células germinales, algunos pueden sufrir una transformación maligna. La Organización Mundial de la Salud (OMS) los clasificó como teratomas con malignidad de tipo somático, los cuales son poco comunes, siendo los sarcomas el tipo histológico con mayor incidencia. Es importante diferenciar esté tipo de tumores ya que influye en el pronóstico y en la supervivencia del paciente. A continuación se presenta el caso de un masculino de 5 meses de edad, que inició su padecimiento al mes de vida con la presencia de estreñimiento y aumento del perímetro abdominal, los estudios de imagen revelaron una lesión abdominal. Se inició tratamiento con quimioterapia y se realizó tumorectomía retroperitoneal. El reporte histopatológico reportó teratoma inmaduro grado I con foco de tejido nervioso que muestra características de astrocitoma de bajo grado. (AU)

Teratomas are neoplasms originate from germ cells and can undergo malignant transformation, the World Health Organization (WHO) classified them as teratoma with somatic-type malignancy which is uncommon and sarcomas are the histological type with the highest incidence. It is important to identify this type of tumors because influences the prognosis and survival of the patient. We present the case of a 5-month-old male, who began his condition at one month-old with constipation and increase of the abdominal circumference, imaging studies revealed an abdominal lesion, he was treated with chemotherapy and surgery. The histopathological report was immature teratoma, grade 1, with a focus of nervous tissue showing characteristics of low-grade astrocytoma. (AU)

Astrocitoma de bajo grado en un teratoma retroperitoneal: reporte de caso / Low-grade astrocytoma within a retroperitoneal teratoma: Case report

Los teratomas son neoplasias que se originan de las células germinales, algunos pueden sufrir una transformación maligna. La Organización Mundial de la Salud (OMS) los clasificó como teratomas con malignidad de tipo somático, los cuales son poco comunes, siendo los sarcomas el tipo histológico con mayor incidencia. Es importante diferenciar esté tipo de tumores ya que influye en el pronóstico y en la supervivencia del paciente. A continuación se presenta el caso de un masculino de 5 meses de edad, que inició su padecimiento al mes de vida con la presencia de estreñimiento y aumento del perímetro abdominal, los estudios de imagen revelaron una lesión abdominal. Se inició tratamiento con quimioterapia y se realizó tumorectomía retroperitoneal. El reporte histopatológico reportó teratoma inmaduro grado I con foco de tejido nervioso que muestra características de astrocitoma de bajo grado. (AU)

Teratomas are neoplasms originate from germ cells and can undergo malignant transformation, the World Health Organization (WHO) classified them as teratoma with somatic-type malignancy which is uncommon and sarcomas are the histological type with the highest incidence. It is important to identify this type of tumors because influences the prognosis and survival of the patient. We present the case of a 5-month-old male, who began his condition at one month-old with constipation and increase of the abdominal circumference, imaging studies revealed an abdominal lesion, he was treated with chemotherapy and surgery. The histopathological report was immature teratoma, grade 1, with a focus of nervous tissue showing characteristics of low-grade astrocytoma. (AU)

The development and validation of an Army team resilience measure.

Given the demanding nature of its mission, the collective units of the Army, not just individual Soldiers, need to be able to withstand and adapt to a wide range of challenges. Therefore, it is important to be able to effectively assess resilience at the team-level and to understand the factors that can enable or diminish it. This article describes the development of a construct valid and psychometrically-sound measure of team resilience - the Team Resilience Scale (TRS). A theoretical framework of team resilience and related constructs is introduced. We then summarize the procedures for developing the TRS and related constructs, providing evidence of the content validity of the TRS. Finally, we assess the psychometric soundness and construct validity of the TRS in two Army field studies. Our analyses support the convergent validity of items and indicate that the measure can be used to examine three first-order dimensions of resilience (i.e., physical, affective, and cognitive) or as a single overall resilience composite. Results show the TRS was positively related to team performance in both samples and it co-varied with stressors and team actions. Practical recommendations for use of the measure and suggestions for future research are offered.

[Low-grade astrocytoma within a retroperitoneal teratoma: Case report]. / Astrocitoma de bajo grado en un teratoma retroperitoneal: reporte de caso.

Teratomas are neoplasms originate from germ cells and can undergo malignant transformation, the World Health Organization (WHO) classified them as teratoma with somatic-type malignancy which is uncommon and sarcomas are the histological type with the highest incidence. It is important to identify this type of tumors because influences the prognosis and survival of the patient. We present the case of a 5-month-old male, who began his condition at one month-old with constipation and increase of the abdominal circumference, imaging studies revealed an abdominal lesion, he was treated with chemotherapy and surgery. The histopathological report was immature teratoma, grade 1, with a focus of nervous tissue showing characteristics of low-grade astrocytoma.

Can team coaching provide healthcare the remedy it needs?

The healthcare industry is inadvertently a teamwork industry - and yet - little time is devoted to improving teamwork on the field. As a response to this issue, team development intervention (TDI) tools have flourished. Findings suggest the capability for TDIs to better team competencies, and potentially mitigate prominent healthcare problems. However, team coaching has been excluded as a potential TDI for healthcare. For this reason, we seek to 1) discuss existing team coaching models, integrating findings across the literature, 2) highlight the advantages of Hackman and Wageman (2005)'s model over others, 3) display its empirically-corroborated propositions, and finally, 4) provide general guidance on how to move forward. We move beyond extant literature by providing an outline on what outcomes team coaching can and cannot yield, accumulating evidence from fields outside of healthcare and incorporating team coaching into the TDI literature. By doing so, we hope empirical research on team coaching is incentivized, resulting in an efficient and accessible TDI for healthcare professionals and the field of interprofessional care.

Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams.

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.

Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams.

Background: Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. Methods: A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). Results: The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. Conclusions: TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.

Handoffs and the challenges to implementing teamwork training in the perioperative environment.

Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.

Team FIRST framework: Identifying core teamwork competencies critical to interprofessional healthcare curricula.

Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.

Holistic strategy for promoting effective handoffs.

BACKGROUND: Handoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality. METHODS: This article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments. RESULTS: We examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care). CONCLUSION: We propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals.

The Next Giant Leap for Space Human Factors: The Opportunities.

OBJECTIVE: Propose areas of future space human factors research. BACKGROUND: Deep space, long-duration human spaceflight missions to the Moon and Mars still require advances in space human factors research. Key drivers relate to astronauts living and working in isolation, new novel technologies required to accomplish exploration missions, and the longer durations of these. RESULTS: Three areas of research are proposed for methods and techniques: (1) to enable more autonomous astronauts; (2) to monitor crew and improve ground team situation awareness; and (3) to detect and support changes in long-duration team coordination. CONCLUSIONS: Future human exploration missions will benefit from advances in space human factors research. APPLICATION: Human factors researchers can contribute to human spaceflight by prioritizing these research topics.

Autonomous Vehicle Dataset with Real Multi-Driver Scenes and Biometric Data.

The development of autonomous vehicles is becoming increasingly popular and gathering real-world data is considered a valuable task. Many datasets have been published recently in the autonomous vehicle sector, with synthetic datasets gaining particular interest due to availability and cost. For a real implementation and correct evaluation of vehicles at higher levels of autonomy, it is also necessary to consider human interaction, which is precisely something that lacks in existing datasets. In this article the UPCT dataset is presented, a public dataset containing high quality, multimodal data obtained using state-of-the-art sensors and equipment installed onboard the UPCT's CICar autonomous vehicle. The dataset includes data from a variety of perception sensors including 3D LiDAR, cameras, IMU, GPS, encoders, as well as driver biometric data and driver behaviour questionnaires. In addition to the dataset, the software developed for data synchronisation and processing has been made available. The quality of the dataset was validated using an end-to-end neural network model with multiple inputs to obtain the speed and steering wheel angle and it obtained very promising results.