Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies.

Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care.

PURPOSE: To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. METHODS: Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. RESULTS: The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078-0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. CONCLUSIONS: The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.

Early identification of at-risk patients and team-based rehabilitation within primary care to prevent sickness absence and long-term problems due to acute/subacute musculoskeletal disorders has been scarcely studied.The PREVSAM model provides a framework for team-based interventions in primary care rehabilitation.The PREVSAM model may be used in the management of acute/subacute musculoskeletal disorders in the prevention of sickness absence.

Interprofessional Collaboration in the OR: A Qualitative Study of Nurses' Perspectives.

Interprofessional collaboration (IPC) in the OR enhances safe and effective patient care. The aim of this qualitative study was to explore perioperative nurses' perspectives on their contributions to IPC. We conducted a secondary analysis of 19 semistructured interviews with perioperative RNs and completed inductive thematic analysis with subsequent categorization of the themes into the Interprofessional Education for Collaborative Patient-Centred Practice Framework. Nurses expressed the importance of being heard through effective communication, feeling confident in their role, being aware of interdependent roles, and sharing a common understanding. From nurses' perspectives, use of structured processes enabled organization of interdisciplinary patient care. Nurses showed leadership skills when they anticipated the needs of the team and recognized they needed support to develop these skills. They contributed to IPC through their shared understanding of common goals, leadership skills in the OR, and active involvement in delivering structured processes.

What palliative care physicians wish neurologists knew.

This chapter describes several features of palliative care that we believe can assist neurologists in caring for patients with serious illness. These features include the importance of recognizing suffering, the central of total pain (including physical, emotional, spiritual, and existential aspects), structural features of palliative care such as the distinction been palliative care and hospice, and the concept of primary and specialty palliative care. Structural features of palliative care such as interdisciplinary teamwork, approaches to self-care, and a perspective on prognostic uncertainty are also considered. Throughout this chapter, the focus is on ways in which neurologists can integrate these approaches in caring for patients and their families.

[Teamwork and stress in routine interventions: an observational study of multiprofessional OR teams]. / Teamarbeit und Stress bei Routineeingriffen: eine Beobachtungsstudie multiprofessioneller OP-Teams.

BACKGROUND: Effective interprofessional teamwork and stress are important factors for quality of care and patient safety in the operating room (OR); however, there are just a few systematic investigations into the relationship of OR teamwork and occupational stress. OBJECTIVE: Determination of the relationship between interdisciplinary OR teamwork and stress in routine procedures, for the whole OR team as well as individual professions. METHODS: Multimethod study with expert observations using a standardized observation tool (OTAS-D) and systematic self-reports of the entire OR team. A total of 64 elective interventions across different surgical departments were observed. Relationships were calculated using mixed-effects regression models with control of procedural and provider characteristics. RESULTS: The quality of the intraoperative teamwork was at a medium level. Reported stress during interventions was at comparatively low levels, with significant differences between the professions of surgery, nursing and anesthesiology. Members of the surgical team reported the highest stress levels. An association between teamwork and perceived stress could not be determined for the entire OR team; however, within the surgical sub-team there were significant positive correlations for the quality of teamwork and stress (as well as for the teamwork dimensions of collaboration and leadership). For the nursing sub-team, we observed significant negative correlations with overall teamwork as well as with the dimension team monitoring. CONCLUSION: The findings suggest a profession-specific relationship between OR teamwork and occupational stress. Further research is necessary to investigate to what extent successful OR teamwork during routine procedures contributes to intraoperative stress.

Interdisciplinary teamwork for chest tube insertion and management: an integrative review.

Thoracostomy requires interdisciplinary teamwork. Even though thoracic drainage is a technical surgical procedure, nurses play an important role with major responsibilities during the procedure. This literature review aimed to identify articles related to the interdisciplinary management of thoracostomy. An integrative literature analysis between 2012 and 2019 with a qualitative approach was conducted. An analysis of articles written in English, French, Portuguese, and Spanish was conducted. A search of the PubMed and SCIELO databases was performed using combinations of the terms "Chest Tube; Nursing; Care; Drainage; Insertion". The search terms were included in 11,277 articles. After excluding articles that did not meet the objective of our study, 475 abstracts were analysed. Finally, 19 articles were selected with content focused on nursing care, content related to surgical procedures, and interdisciplinary content. Themes included the following: description of the procedure, interdisciplinary action, quality of the procedure, use of protocols for patient safety, and new technologies. In conclusion, interdisciplinary courses should be encouraged to improve interprofessional teamwork organization. Notwithstanding all these publications, the literature was fragmented into disciplines and isolated analyses. Each medical or nursing discipline addressed the aspects that pertain to its own responsibilities in the execution of the procedure. This review highlighted the need to develop interdisciplinary research and brought a source of rich information that can instrumentalize the creation of optimized processes for the interdisciplinary chest tube insertion.

Implementing an internet-based capacity building program for interdisciplinary midwifery-lead teams in Ethiopia, Kenya Malawi and Somalia.

The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020-21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. OBJECTIVE: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. METHODS: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. RESULTS: Participants believed the internet-based programme was appropriate for their countries' contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. CONCLUSION: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health.

PennDemic Simulation Framework: An Innovative Approach to Increase Student Interest and Confidence in Disasters Preparedness/Response and Interdisciplinary Teamwork.

An interdisciplinary group from two higher-education institutions in Philadelphia developed a novel framework for interprofessional education. This framework was applied to two different scenarios disease outbreak and natural disaster, which were used in simulations in 2018 and 2020. By design, these simulations included students from a broad range of disciplines, beyond the typical healthcare fields. Students were first grouped by discipline and were then placed in interdisciplinary teams for the rest of the scenario. Students were administered four surveys throughout which included 10 point-Likert scale and free response items. A statistically significant post-simulation increase in student interest and confidence was found. Survey analysis also revealed higher scores of positive group behaviors among interdisciplinary teams when compared to discipline groups. Importantly, students realized the importance of broad representation of disciplines for disaster preparedness. The PennDemic framework may be helpful for teams looking to develop simulations to build interest and confidence in disaster preparedness/response and interdisciplinary teamwork.

Effectiveness of Interdisciplinary Leadership Training for Early Career Professionals in the Field of Developmental Disabilities.

INTRODUCTION: The purpose of this paper is to describe the curriculum and self-reported outcomes on measures of interdisciplinary leadership skills for work within the field of developmental disabilities from trainees in one interprofessional training program. METHODS: The paper highlights one program's curriculum and strategy for capturing self-report survey measures from trainees in cohorts from 2014-2018 (n = 86) on two surveys (Interdisciplinary Attitudes and Skills and Leadership Self-Evaluation Form) and three time points across the training year: before training (T1), mid-year (T2), and after training (T3). RESULTS: Data from 86 trainees are reported including demographics (nearly 80% white, 92% female), non-descriptive statistics due to non-normative samples, and tertiles demonstrating changes between time points. Significant differences between medians are reported between T1-T3 specifically related to utilizing interdisciplinary skills and gains in leadership competencies. Specific utilization of skills was reported to be 'Greatly' attributable to the LEND program related to sharing ideas and asking for help across disciplines. DISCUSSION: Trainees' self-report from before training to after training indicates an increase in competence and utilization of interdisciplinary skills to be expected from participation in the curriculum. Self-report measures are.

Enhancing Team Learning through Leader Inclusiveness: A One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team.

PHENOMENON: Developing modern medical curricula requires collaboration between different scientific and clinical disciplines. Consequently, institutions face the daunting task to engage colleagues from different disciplines in effective team collaboration. Two aspects that are vital to the success of such teamwork are "team learning behavior" by all team members and "leader inclusiveness behavior" by the team leader. Team members display team learning behavior when they share information, build upon and integrate each other's viewpoints. The team leader can promote such team learning by exhibiting inclusiveness behavior, which aims to encourage diversity and preserve individual differences for an inclusive workplace, nurturing engagement in teamwork. There is a paucity of in-depth research on leader inclusiveness behavior in the field of medical education. This case study aimed to offer unique insight into how leader inclusiveness behavior manifests itself in a successful interdisciplinary teacher team, demonstrating team learning behavior in undergraduate medical education. APPROACH: We conducted a qualitative, ethnographic case study using different but complementary methods, including observations, interviews and a documentary analysis of email communication. By means of purposive sampling, we selected an existing interdisciplinary teacher team that was responsible for an undergraduate medical course at Maastricht University, the Netherlands, and that was known to be successful. Chaired by a physician, the team included planning group members and tutors with medical, biomedical, and social sciences backgrounds as well as student-representatives. In the course of one academic year, 23 meetings were observed and recorded, informal interviews were conducted, and over 100 email conversations were collected. All data were submitted to a directed content analysis based on team learning and leader inclusiveness concepts. FINDINGS: Leader inclusiveness behavior became evident from verbal and non-verbal interactions between the team leader and team members. Leader inclusiveness behavior that facilitated team learning behavior manifested itself in five actions undertaken by the team leader: coordinating, explicating, inviting, connecting, and reflecting. Similarly, team members facilitated team learning behavior by participating actively, speaking up behavior, and mimicking leader inclusiveness behavior. These behaviors demonstrated engagement and feelings of inclusion, and reinforced leader inclusiveness behavior by creating additional opportunities for the leader to exhibit such behavior. INSIGHTS: This case study responds to the need for inclusive leadership approaches in medical education. Our findings build upon theoretical knowledge on team learning and leader inclusiveness concepts. By studying behaviors, interactions and documents we obtained in-depth information on leader inclusiveness. Our findings are unique in that they demonstrate how leader inclusiveness behavior manifests itself when leaders interact with their team members. This study provides health professionals who are active in education with practical suggestions on how to act as a successful and inclusive leader. Finally, the behaviors identified open up avenues for future professional development initiatives and future research on team leadership.Supplemental data for this article is available online at here.

Patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs: An importance-performance analysis.

PURPOSE: To analyse the importance and performance of key elements in patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs. METHOD: In four Belgian non-academic hospitals, the importance and performance of a set of 82 key elements was cross-sectionally evaluated by primary and secondary healthcare professionals and by patients. These key elements were divided in 6 themes: coordination of care, style and content of patient contacts, medication counseling at treatment initiation, follow-up of treatment, psychosocial support, and involvement of family and friends. Participants were asked to indicate for each key element if it was implemented in the current care process for patients on oral anticancer drugs ('yes', 'no', 'I don't know') and if they considered it important that the component was implemented or would be in the future ('yes' or 'no'). Three levels of performance were defined, based on the number of participants who had answered 'yes' or 'no': 'systematically performed' (≥90% of participants), 'not systematically performed' (≥75% and <90%) and 'not performed' (<75%). Importance-rates were based on the number of 'yes' or 'no'. RESULTS: In total, 85 participants evaluated the key elements. More than half of key elements, 13/82 (15.9%) and 35/82 (42.6%) respectively, were considered as 'not' or 'not systematically performed'. The majority of these elements concerned coordination of care, medication counseling at treatment initiation and follow-up of treatment. Especially key elements on involving primary care and on discussing adherence had low performance rates. Nearly all key elements were assigned an importance score of ≥90%. CONCLUSIONS: Performance of key elements of patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs proved moderate. Our findings suggest that strategies are needed to prioritize and operationalize key elements to coordinate transmural care and to provide effective education and counseling.

Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial.

Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs;

Perceived Effectiveness of Home-Based Primary Care Teams in Veterans Health Administration.

BACKGROUND AND OBJECTIVES: Previous studies have shown that staff perception of team effectiveness is related to better health outcomes in various care settings. This study focused on the Veterans Health Administration's Home-Based Primary Care (HBPC) program. We examined variations in HBPC interdisciplinary teamwork (IDT) and identified modifiable team and program characteristics that may influence staff perceptions of team effectiveness. RESEARCH DESIGN: We used a broadly validated survey instrument to measure perceived team effectiveness, workplace conditions/resources, group culture, and respondents' characteristics. Surveys were initiated in January and completed in July, 2016. METHODS: Team membership rosters (n = 249) included 2,852 IDT members. The final analytical data set included 1,403 surveys (49%) from 221 (89%) teams. A generalized estimating equation model with logit link function, weighted by survey response rates, was used to examine factors associated with perceived team effectiveness. RESULTS: Respondents who served as primary care providers (PCPs) were 8% more likely (p = .0044) to view team's performance as highly effective compared to other team members. Teams with nurse practitioners serving as team leader reported 6% higher likelihood of high-perceived team effectiveness (p = .0234). High team effectiveness was 13% more likely in sites where the predominant culture was characterized as group/developmental, and 7%-8% more likely in sites with lower environmental stress and better resources and staffing, respectively. CONCLUSIONS AND IMPLICATIONS: Team effectiveness is an important indirect measure of HBPC teams' function. HBPC teams should examine their predominant culture, workplace stress, resources and staffing, and PCP leadership model as part of their quality improvement efforts.

A pragmatic randomised controlled trial (RCT) and realist evaluation of the interdisciplinary home-bAsed Reablement program (I-HARP) for improving functional independence of community dwelling older people with dementia: an effectiveness-implementation hybrid design.

BACKGROUND: A major gap exists internationally in providing support to maintain functional and social independence of older people with dementia living at home. This project evaluates a model of care that integrates evidence-based strategies into a person-centred interdisciplinary rehabilitation package: Interdisciplinary Home-bAsed Reablement Program (I-HARP). Two central aims are: 1) to determine the effectiveness of I-HARP on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I-HARP cost-effectiveness; and 2) to evaluate the processes, outcomes and influencing factors of the I-HARP implementation. METHODS: I-HARP is a 4-month model of care, integrated in community aged care services and hospital-based community geriatric services, and consists of: 1) 8-12 home visits, tailored to the individual client's needs, by an occupational therapist, registered nurse, and other allied health staff; 2) minor home modifications/assistive devices to the value of 60 years with mild to moderate dementia and his/her carer). During Phase I, I-HARP advisory group is established and training of I-HARP interventionists is completed, and the effectiveness of I-HARP is examined using a pragmatic RCT. Phase II, conducted concurrently with Phase I, focuses on the process evaluation of the I-HARP implementation using a realist approach. Semi-structured interviews with participants and focus groups with I-HARP interventionists and participating site managers will provide insights into the contexts, mechanisms and outcomes of I-HARP. DISCUSSION: I-HARP is being evaluated within the real-world systems of hospital-based and community-based aged care services in Australia. Future directions and strategies for reablement approaches to care for community dwelling people living with dementia, will be developed. The study will provide evidence to inform key stakeholders in their decision making and the use/delivery of the program, as well as influence future systems-thinking and changes for dementia care. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTR N12618000600246 (approved 18/04/2018).

Educating the next generation of family caregivers through the use of dynamic case studies.

Between 2008 and 2016, students in an Introduction to Gerontology course were required to complete a dynamic case study project simulating caregiving arrangement decision making. Students were divided into groups representing typical multigenerational families and were required to determine how to develop caregiving arrangements to respond to an older family member' s changing levels of need. The assignment concluded with students writing a final paper summarizing what they learned. This study examined the themes emerging from student group case study papers to gain an understanding of the challenges students face in understanding the dynamics of making family-based caregiving decisions. This is of particular importance as many students were seeking careers in human services and would be assisting clients in such decision-making processes, as well as involvement in decision making for their own family members. Themes that emerged from group papers and the implications related to gerontology education and policy are discussed.

An interprofessional team simulation exercise about a complex geriatric patient.

Interprofessional collaboration is an essential skill to optimize the care of older adults with complex problems. We successfully developed and evaluated an interprofessional teamwork simulation exercise for medical, nursing, pharmacy, and social work students. Pharmacy students participated via video conferencing. Before the simulation, students watched a teamwork video and reviewed the patient case. Following an icebreaker exercise, interdisciplinary faculty facilitated a discussion highlighting effective teamwork strategies. Students then collaborated to develop a discharge plan, followed by a simulated family meeting with a theater student. Interdisciplinary faculty again provided structured debriefing highlighting principles of effective teamwork. Students self-rated interprofessional practice core competencies were evaluated using a retrospective pre/post survey and analyzed using paired t-tests. We qualitatively examined the use of distance technology and assessed learner's satisfaction with the project. All core competency categories for all disciplines demonstrated significant improvements in mean scores. Students' qualitative comments demonstrated positive impact on learning interprofessional core competencies.

Assessing Perceptions of Teamwork Quality Among Perioperative Team Members.

Successful surgery depends on collaboration and mutual trust among interdisciplinary team members. We compared teamwork quality as perceived by surgeons, anesthesia care providers, and perioperative nurses using two surveys in the same hospital. The general survey sent to the homes of the OR personnel revealed teamwork climate scores in the medium to high range. Attending surgeons were significantly more satisfied than perioperative nurses and resident surgeons; anesthesiologists were significantly more satisfied than perioperative nurses. A second single-item survey administered immediately after elective open abdominal surgical procedures also showed relatively high satisfaction with teamwork. Results of the second survey, however, showed that attending surgeons were significantly less satisfied than the members of all the other professions, and perioperative nurses were significantly more satisfied than the members of all the other professions. We conclude that general surveys about teamwork quality among members of surgical teams may not necessarily reflect teamwork quality during actual surgical procedures.

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees.

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

A Concept Analysis of Patient Participation in Intermediate Care.

OBJECTIVE: Although the concept of patient participation has been discussed for a number of years, there is still no clear definition of what constitutes the multidimensional concept, and the application of the concept in an intermediate care (IC) context lacks clarity. Therefore this paper seeks to identify and explore the attributes of the concept, to elaborate ways of understanding the concept of patient participation for geriatric patients in the context of IC. METHODS: Walker and Avant's model of Concept analysis [1] based on a literature review. RESULTS: Patient participation in the context of IC can be defined as a dynamic process emphasizing the person as a whole, focusing on the establishment of multiple alliances that facilitate individualized information and knowledge exchange, and ensuring a reciprocal engagement in activities within flexible and interactive/dynamic organizational structures. CONCLUSION: Patient participation in IC means involving patients and their relatives in holistic interdisciplinary collaborative decision-making. The results highlight the complexity of patient participation and contribute to a greater understanding of the influence of organizational structure and management. PRACTICAL IMPLICATIONS: The present study may provide a practical framework for researchers, policy makers and health professionals to facilitate patient participation in IC services.

Improving the social health of community-dwelling older people living with dementia through a reablement program.

ABSTRACTPsychological, neurological, and social impairments caused by dementia may limit the person's everyday living and experiences, but their capacity to enjoy a meaningful life is still retained. Increasingly, evidence has been shown the importance of reablement approaches to care in maximizing the older person's independence, health, and well-being through increased engagement in their daily, physical, social, and community activities. However, there is a major knowledge gap in providing reablement for people living with dementia. We describe one case of a client with moderate dementia and her daughter carer who participated as a dyad in a person centered, interdisciplinary, and reablement program called I-HARP (Interdisciplinary home-based reablement program). I-HARP is designed to improve functional capacity of those community dwelling, older people living with dementia, and other health conditions. In this paper, we discussed key contributions that such a reablement approach to care can make to optimizing the social health of people living with dementia.