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RATIONALE & OBJECTIVE: Infection prevention efforts in dialysis centers can avert patient morbidity and mortality but are challenging to implement. The objective of this study was to better understand how the design of the work system might contribute to infection prevention in outpatient dialysis centers. STUDY DESIGN: Mixed methods, observational study. SETTING & PARTICIPANTS: Six dialysis facilities across the United States visited by a multidisciplinary team over 8 months. ANALYTICAL APPROACH: At each facility, structured macroergonomic observations were undertaken by a multidisciplinary team using the SEIPS 1.0 model. Ethnographic observations were collected about staff encounters with dialysis patients including the content of staff conversations. Selective and axial coding were used for qualitative analysis and quantitative data were reported using descriptive statistics. RESULTS: Organizational and sociotechnical barriers and facilitators to infection prevention in the outpatient dialysis setting were identified. Features related to human performance, (eg, alarms, interruptions, and task stacking), work system design (eg, physical space, scheduling, leadership, and culture), and extrinsic factors (eg, patient-related characteristics) were identified. LIMITATIONS: This was an exploratory evaluation with a small sample size. CONCLUSIONS: This study used a systematic macroergonomic approach in multiple outpatient dialysis facilities to identify infection prevention barriers and facilitators related to human performance. Several features common across facilities were identified that may influence infection prevention in outpatient care and warrant further exploration.
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Instituciones de Atención Ambulatoria , Control de Infecciones , Diálisis Renal , Humanos , Control de Infecciones/métodos , Estados Unidos/epidemiología , Ergonomía/métodosRESUMEN
INTRODUCTION: In laparoscopic surgery, looking in the target areas is an indicator of proficiency. However, gaze behaviors revealing feedforward control (i.e., looking ahead) and their importance have been under-investigated in surgery. This study aims to establish the sensitivity and relative importance of different scene-dependent gaze and motion metrics for estimating trainee proficiency levels in surgical skills. METHODS: Medical students performed the Fundamentals of Laparoscopic Surgery peg transfer task while recording their gaze on the monitor and tool activities inside the trainer box. Using computer vision and fixation algorithms, five scene-dependent gaze metrics and one tool speed metric were computed for 499 practice trials. Cluster analysis on the six metrics was used to group the trials into different clusters/proficiency levels, and ANOVAs were conducted to test differences between proficiency levels. A Random Forest model was trained to study metric importance at predicting proficiency levels. RESULTS: Three clusters were identified, corresponding to three proficiency levels. The correspondence between the clusters and proficiency levels was confirmed by differences between completion times (F2,488 = 38.94, p < .001). Further, ANOVAs revealed significant differences between the three levels for all six metrics. The Random Forest model predicted proficiency level with 99% out-of-bag accuracy and revealed that scene-dependent gaze metrics reflecting feedforward behaviors were more important for prediction than the ones reflecting feedback behaviors. CONCLUSION: Scene-dependent gaze metrics revealed skill levels of trainees more precisely than between experts and novices as suggested in the literature. Further, feedforward gaze metrics appeared to be more important than feedback ones at predicting proficiency.
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Fijación Ocular , Laparoscopía , Humanos , Benchmarking , Competencia Clínica , Laparoscopía/educación , AlgoritmosRESUMEN
BACKGROUND: Surgical training includes the development of technical and nontechnical skills. While technical skills are more easily quantified, nontechnical skills such as situation awareness (SA) are more difficult to measure and quantify. This study investigated the relationships between different SA elements and expertise. METHODS: Twenty attending and resident surgeons rated their anticipation of an impending adverse event while watching 20 videos of laparoscopic cholecystectomies with and without adverse events. After watching each video, they assessed surgeon skills and self-assessed their anticipation ratings. All participants answered a general confidence questionnaire before and after the study. RESULTS: Videos with adverse events led to significantly higher anticipation of adverse events (P < 0.001), lower surgeon skill rating (P < 0.001), and higher self-assessment in their anticipation ratings (P < 0.001) across both participant groups. General confidence was significantly lower for residents than that for attending surgeons (P < 0.001). Compared with the residents, attendings exhibited stronger and more stable correlations between measurements of SA. When viewing videos with adverse events, attendings showed significantly higher correlation between anticipation of an impending adverse event and skill assessment of the surgeon (P = 0.005). CONCLUSIONS: This study investigated how different elements of SA and their relationships were influenced by experience. The results indicated that attendings had stronger and more stable correlations between SA elements than residents, demonstrating how measurement correlations could be meaningful and sensitive indicators of expertise and autonomy readiness.
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Colecistectomía Laparoscópica/educación , Competencia Clínica , Internado y Residencia , Cirujanos , Adulto , Anciano , Colecistectomía Laparoscópica/efectos adversos , Evaluación Educacional , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoevaluación (Psicología) , Adulto JovenRESUMEN
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.
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Atención a la Salud , Instituciones de Salud , Servicios de Salud Comunitaria , Cuidados Críticos , Humanos , Grupo de Atención al PacienteRESUMEN
Healthcare providers often perform under significant stress, during which their performance must be optimal, but is known to suffer. Stress management interventions in this context can provide cognitive support to rescue performance. This exploratory study sought to evaluate the effect of stress intervention components on stress and performance while clinicians engaged in two versions of a computer-based task, differing in overall level of demand: one high-stress and one low-stress. Participants (N = 45) were assigned to one of five groups (N = 9 per group), where they each completed both versions of the task, under different conditions of cognitive support. Group 1 received no intervention; Group 2 received biofeedback; and Group 3 received biofeedback and explicit coping instructions. Group 4 received emotional intelligence training, and Group 5 received emotional intelligence training and biofeedback. We hypothesized that Group 3 participants would present the lowest self-reported and physiological measures of stress, and the highest performance. Results reveal that the high-stress task induced significantly higher self-reported and physiological stress/anxiety, and lower task performance. No significant main effects of experimental condition or interaction effects were detected, indicating that intervention components had minimal effect on stress and performance. However, ultra-short term physiological analysis, analyzing <5 min of HRV data, revealed significantly decreased stress (SDNN, the standard deviation of normal-to-normal peaks) following auditory coping instructions. Exploratory study results suggest that although cognitive intervention components had minimal effect on stress and performance, physiological stress may be significantly reduced immediately following adherence to a coping instruction intervention. Future work is needed.Lay summaryThis exploratory study evaluated the potential benefit of providing healthcare practitioners with various stress management components during an acutely stressful task. Our results support the positive effect of following behavioral coping instructions on immediate physiological measures of stress.
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Adaptación Psicológica , Estrés Psicológico , Ansiedad/terapia , Biorretroalimentación Psicológica , Inteligencia Emocional , Humanos , Estrés Psicológico/terapiaRESUMEN
BACKGROUND: Team familiarity has been shown to be important for operative efficiency and number of complications, but it is unclear for which types of operations and for which team members familiarity matters the most. The objective of this study is to further our understanding of familiarity in the OR by quantifying the relative importance of familiarity among all possible core team dyads, and defining the impact of team level familiarity on outcomes. MATERIALS AND METHODS: Using a retrospective chart and administrative data review, five years of data from two health systems (14 hospitals) and across two procedures, (knee arthroplasty and lumbar laminectomy) were included. Multilevel modeling approach and a dominance analysis were conducted. RESULTS: For each previous surgery that any two members of the core surgical team had participated in together, the length of surgery decreased significantly. The familiarity of the scrub and the surgeon was the most significant relationship for knee arthroplasty across the two hospitals, and laminectomies at one hospital. CONCLUSIONS: The relationship between familiarity of the surgical team and surgical efficiency may be more complex than previously articulated. Familiarity may be more important for certain types of procedures. The familiarity of certain dyads may be more important for certain types of procedures.
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Competencia Clínica , Tiempo de Internación , Tempo Operativo , Grupo de Atención al Paciente , Cirujanos , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. METHODS: We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. RESULTS: We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. CONCLUSIONS: Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a "sterile cockpit" phase for all team members.
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Emociones , Quirófanos , Estrés Psicológico , Cirujanos/psicología , Procedimientos Quirúrgicos Operativos/psicología , Lugar de Trabajo/psicología , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Carga de TrabajoRESUMEN
AIM: The objective of this paper is to identify attribute patterns of influential individuals in intensive care units using unsupervised cluster analysis. BACKGROUND: Despite the acknowledgement that culture of an organisation is critical to improving patient safety, specific methods to shift culture have not been explicitly identified. METHODS: A social network analysis survey was conducted and an unsupervised cluster analysis was used. RESULTS: A total of 100 surveys were gathered. Unsupervised cluster analysis was used to group individuals with similar dimensions highlighting three general genres of influencers: well-rounded, knowledge and relational. CONCLUSIONS: Culture is created locally by individual influencers. Cluster analysis is an effective way to identify common characteristics among members of an intensive care unit team that are noted as highly influential by their peers. To change culture, identifying and then integrating the influencers in intervention development and dissemination may create more sustainable and effective culture change. Additional studies are ongoing to test the effectiveness of utilising these influencers to disseminate patient safety interventions. IMPLICATIONS FOR NURSING MANAGEMENT: This study offers an approach that can be helpful in both identifying and understanding influential team members and may be an important aspect of developing methods to change organisational culture.
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Personal de Salud/psicología , Unidades de Cuidados Intensivos , Cultura Organizacional , Influencia de los Compañeros , Apoyo Social , Centros Médicos Académicos/organización & administración , Análisis por Conglomerados , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Administración de la Seguridad/normas , Administración de la Seguridad/estadística & datos numéricos , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
BACKGROUND: The achievement of surgical goals and the successful functioning of operating room (OR) teams are dependent on leadership. The attending surgeon is a team leader during an operation, with responsibility for task accomplishment by the clinical team. This study examined surgeons' leadership behaviors during surgical procedures, with particular reference to the effect of intraoperative events on leadership. METHODS: Videos of operations (n = 29) recorded at three UK teaching hospitals were analyzed to identify and classify surgeons' intraoperative leadership behaviors using the Surgeons' Leadership Inventory. The frequency and type of leadership behaviors were compared before and after the point of no return (PONR) (n = 24), and during an unexpected intraoperative event (n = 5). RESULTS: Most of the surgeons' leadership behaviors were directed toward the resident during an operation. No significant differences were found for the overall number or type of leadership behaviors pre- and post-PONR. The frequency of leadership behaviors classified as "Training" and "Supporting others" significantly decreased during an unanticipated intraoperative event. DISCUSSION: Overall, surgeons engaged in the same leadership behaviors throughout the course of an operation unless they were dealing with an unanticipated event. Surgeons appeared to adopt a "one size fits all" leadership style approach regardless of the team or situation. Additionally, surgeons seemed to limit their intraoperative leadership focus to other surgeons rather than to the wider OR team.
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Cirugía General/normas , Liderazgo , Quirófanos , Humanos , Periodo Intraoperatorio , Grabación en VideoRESUMEN
Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders' behavior, were used to create four example simulations of out-of-hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.
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Sobredosis de Droga , Sobredosis de Opiáceos , Trastornos Relacionados con Opioides , Humanos , Antagonistas de Narcóticos/uso terapéutico , Sobredosis de Opiáceos/tratamiento farmacológico , Naloxona/uso terapéutico , Sobredosis de Droga/tratamiento farmacológico , Investigación Cualitativa , Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológicoRESUMEN
Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees' application of hands-on skills, and conduct formative assessments.
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In recent years, the focus of implementation science (IS) shifted to emphasize the influence of contextual factors on intervention adaptations in clinical, community, and corporate settings. Each of these settings represent a unique work system with varying contexts that influence human capabilities, needs, and performance (otherwise known as "human factors"). The ease of human interaction with a work system or an intervention is imperative to IS outcomes, particularly adoption, implementation, and maintenance. Both scientific approaches consider the "big picture" when designing interventions for users and stakeholders to improve work and health outcomes. IS and human factors are therefore complementary in nature. In this paper, the authors will (1) provide perspective on the synergistic relationship between human factors and IS using two illustrative and applied cases and (2) outline practical considerations for human factors-based strategies to identify contextual factors that influence intervention adoption, implementation, and maintenance dimensions of the RE-AIM framework. This article expands on recent research that developed user- and human-centered design strategies for IS scientists to use. However, defining the complementary relationship between IS and human factors is a necessary and valuable step in maximizing the effectiveness of IS to transform healthcare. While IS can complement practitioners' identification of intervention adaptations, human interaction is a process in the work system often overlooked throughout implementation. Further work is needed to address the influence that organizational endorsement and trust have on intervention adaptations and their translation into the work system.
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BACKGROUND: Simulation-based training (SBT) is often evaluated based on the transfer of specific knowledge and skills. In contrast, the degree to which reflective practice is inculcated by SBT is rarely considered. Because reflection is a pillar of adult learning theories, we sought to examine the degree to which participation in SBT was associated with increased reflective practice. METHOD: Eighty one healthcare professionals completed a survey which included the number of SBTs they participated in during the past two years, content- and administrative-related features of those SBTs, and a key aspect of reflective practice (i.e., self-appraisal). RESULTS: The number of SBTs healthcare professionals participated in during the past two years was positively associated with reflective self-appraisal. This relationship was not moderated by the inclusion of reflection components in SBTs nor by the voluntary/mandatory nature of participation in SBTs. Furthermore, the facilitator was ranked as the most important feature of the overall learning experience in SBTs. Also, no significant differences were found between the number of technical skills-based and non-technical skills-based SBTs. CONCLUSION: These findings demonstrate the importance (of evaluating) SBTs for facilitating reflective learning mindsets that healthcare practitioners can apply beyond the specific skills trained by SBTs.
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The practice of cardiovascular surgery demands daily interface with sophisticated technologies including most commonly the cardiopulmonary bypass (CPB) machine. Although other industries have recognized the importance of considering human factors in the design of machines to reduce operator error, the evolution of the CPB machine over the past half-century has been characterized by incremental modifications of component parts with attention principally to mechanical efficiency and biocompatibility, but with little awareness of the impact of design changes on the human user. As a first step in the redesign of a safer pump, systematic observations of perfusionists during 10 adult and pediatric cases were conducted by staff cardiac surgeons and by human factors experts. Observations were classified according to accepted ergonomics principles. Perfusionists also performed usability evaluations and provided feedback concerning the design and functionality of bypass machines. Problems identified clustered around several usability themes. Issues with displays (8% of total comments) included location, legibility, format, and integration. Multiple problems with controls (11% of total comments) including location, sensitivity, and shape were identified, as were issues with audible alarms (6% of total comments). Component integration (14% of comments) and work-space design (21% of comments) were suboptimal as well. Procedural and communication issues (21% of comments) related to pump utilization, rather than pump design, were also identified, which stemmed from a lack of standardized operating room practices. Clinical issues (14% of comments) surrounding care of the patient were also identified but were not further analyzed, because these comments did not pertain to the design of the perfusion pump. Our observations confirmed the hypothesis that opportunities exist to incorporate usability and ergonomics insights into CPB machine design to optimize the human/technology interface. Such fundamental design considerations may improve the safety of the conduct of CPB and, consequently, outcomes after cardiovascular surgery.
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Puente Cardiopulmonar/instrumentación , Adulto , Niño , Diseño de Equipo , Análisis de Falla de Equipo , Seguridad de Equipos , Humanos , ObservaciónRESUMEN
OBJECTIVE: With recent changes to graduate medical education, the balance between resident autonomy and need for supervision impacts the educational and training experience of residents. The objective of this study was to understand the relationship between the confidence of attendings and residents and their different perspectives of perceived educational experience and autonomy in the operating room (OR). We hypothesized that the attending's confidence in the resident would be an important factor in improving the educational experience and resident's autonomy in the OR. DESIGN: Self-reported confidence-rating and operative experience surveys were administered to teams of post-graduate year (PGY 1) through PGY 5 surgical residents and attendings in two temporal sets (Early: Sept-Dec 2015, nâ¯=â¯20; Late: Jan-Apr 2016, nâ¯=â¯22). A second "end-of-year" survey was distributed to residents (nâ¯=â¯9, 37.5% response) and attendings (nâ¯=â¯10, 35% response) asking questions regarding their educational experience and operative experience during the past year. SETTING: Large rural teaching hospital. PARTICIPANTS: Nineteen general surgery residents (PGY 1 - 5) and 14 general surgery attendings. RESULTS: Resident perception of confidence differs from junior to senior residents, and that there was discordance between resident's confidence and skill as perceived by attendings, particularly in senior residents. Results also showed that attending's confidence in residents was positively correlated with attending's perceived educational experience in the OR. Residents and attendings both indicated attending's confidence in residents as an important factor in increasing resident autonomy in the OR, thus the attending's confidence in residents could have a positive impact on resident autonomy and educational experience in the OR. CONCLUSIONS: We have demonstrated a relationship between self-confidence for residents and improved confidence from attendings in residents' capabilities. Based on these findings, we would propose identifying methods to expand resident's awareness of surgical situations and develop attending's confidence in residents.
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Cirugía General/educación , Internado y Residencia , Relaciones Interprofesionales , Cuerpo Médico de Hospitales/psicología , Autoimagen , Cirujanos/psicología , Actitud , AutoinformeRESUMEN
Individual performance on complex healthcare tasks can be influenced by acutely stressful situations. Real-time biofeedback using passive physiological monitoring may help to better understand an individual's progression towards acute stress-induced performance decrement. Providing biofeedback at an appropriate time may provide learners within an indicator that their current performance is susceptible to a decrement, and offer the opportunity to intervene. We explored the presentation timing of coping instructions during an acutely stressful task. In this pilot study, we recorded and analyzed electrocardiography data surrounding coping instruction presentation on various time schedules while participants played a first-person shooter computer game. Around times of significantly elevated heart rate, an indicator of acute stress, presenting a coping instruction tended to result in an increase in heart rate variability (HRV) following its presentation, with a more marked effect in high-stress conditions; not presenting a coping instruction at this time tended to result in a decrease in HRV in high-stress conditions, and no change in low-stress conditions. HRV following instruction presentation tended to increase in both high- and low-stress conditions when the instruction was presented at times of elevated heart rate; there was very little change in HRV when instruction presentation was not bound to physiology. Performance data showed that better performance was associated with greater adherence to coping instructions, compared to when zero instructions were followed. Implications for healthcare are significant, as acute stress is constant and it is necessary for providers to maintain a high level of performance.
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STATEMENT: Simulation has had a major impact in the advancement of healthcare team training and assessment. To date, most simulation-based training and assessments focus on the teamwork behaviors that impact team performance, often ignoring critical cognitive, motivational, and affective team processes. Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, we synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.
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Competencia Clínica , Cognición , Procesos de Grupo , Grupo de Atención al Paciente/organización & administración , Entrenamiento Simulado/organización & administración , Actitud del Personal de Salud , Comunicación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Liderazgo , Grupo de Atención al Paciente/normasRESUMEN
An alternative to conventional models that treat decisions as open-loop independent choices is presented. The alterative model is based on observations of work situations such as healthcare, where decisionmaking is more typically a closed-loop, dynamic, problem-solving process. The article suggests five important distinctions between the processes assumed by conventional models and the reality of decisionmaking in practice. It is suggested that the logic of abduction in the form of an adaptive, muddling through process is more consistent with the realities of practice in domains such as healthcare. The practical implication is that the design goal should not be to improve consistency with normative models of rationality, but to tune the representations guiding the muddling process to increase functional perspicacity.
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Conducta de Elección , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Solución de Problemas , HumanosRESUMEN
BACKGROUND: The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. STUDY DESIGN: We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. RESULTS: All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (p < 0.0001). Excerpts of representative dialogue are included for illustration. CONCLUSIONS: We provide a framework for evaluating surgeons' leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care.
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Liderazgo , Quirófanos/organización & administración , Grupo de Atención al Paciente/organización & administración , Cirujanos/psicología , Humanos , Variaciones Dependientes del Observador , Seguridad del Paciente , Distribución de Poisson , Cirujanos/organización & administración , Encuestas y Cuestionarios , Grabación en VideoRESUMEN
Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks. Infect Control Hosp Epidemiol 2016;37:867-871.