Presentation
PS3 - Enhancing Team Competencies in Healthcare: Lessons from Extreme Environments Literature
DescriptionThe research surrounding extreme environments typically focuses on domains such as spaceflight, aviation, and military operations. However, the concept of an extreme environment transcends these specific contexts and is defined as an environment characterized by unpredictability, high stress, and increased demands, where ineffective performance can result in life-threatening consequences (Driskell et al., 2017). Hence, while they may not be experiencing microgravity, healthcare contexts such as surgical operating rooms (ORs) or emergency departments can thus also be considered extreme environments. The healthcare sector can learn from the literature surrounding expert performance in extreme environments, as they share similarities with these safety-critical domains. It would therefore be advantageous for the healthcare industry to draw insights from the extensive literature surrounding expert performance in extreme environments. This body of knowledge has the potential to offer valuable lessons which can help to inform the development of training programs aimed at enhancing effective teamwork within healthcare settings.
Training has been a critical part of medical education for many decades (Lateef, 2010; King et al., 2008), and training experts recommend consistent development and innovation of training frameworks in order to remain competitive (Salas et al., 2012). Programs like Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS; Guimond et al., 2009) have been developed to enhance healthcare teams’ efficiency and effectiveness, ultimately aimed to improve patient outcomes (Guimond et al., 2009). TeamSTEPPS includes five major principles: team structure, communication, team leadership, situation monitoring, and mutual support (Parker et al., 2019). This program has been shown to be widely effective in the healthcare industry (Brooks et al., 2022); however, other industries can help to inform updates and enhancements to this training program to consistently align the program with current team science findings and practices.
The extreme environments literature indicates that training intact teams is vital to developing essential teamwork elements like team cohesion and norms (Landon & O’Keefe, 2018). However, this is challenging in healthcare, as many teams often form spontaneously as needs arise (Eppich et al., 2011), and thus may not have practiced together before (Clancy & Tornberg, 2007). To address this issue, TeamSTEPPS should be enhanced using knowledge from extreme environments literature, which emphasizes the importance of team adaptation (Driskell et al., 2017) and resilience (Landon et al., 2018; Vanhove et al., 2015), cross-training to promote the development of shared mental models (Driskell et al., 2017; Gorman et al., 2010), and enhancing psychological safety (Salas et al., 2018; Edmonson, 1999) through inclusivity and open communication. These recommendations enhance the tools, strategies, and key principles comprising the TeamSTEPPs program.
Team Adaptability & Resilience. The extreme environments literature indicates that it is especially important for safety-critical teams to understand the factors necessary to promote team adaptability and resilience (Maynard et al., 2020). Adaptability has been considered a potential outcome of TeamSTEPPS, however, the extreme environments literature suggests that team adaptability is an indispensable competency for achieving optimal team performance in these environments (Driskell et al., 2017; Smith-Jentsch et al., 2015; Landon et al., 2017). Often conceptually linked to adaptation (Kennedy et al., 2016; Maynard et al., 2020), resilience is another element necessary to train within teams (Maynard et al., 2020). Resilience has been a subject of study within the extreme environments literature (Maynard et al., 2020), with findings suggesting that resilience can be developed through training prior to actual performance (Maynard et al., 2020), as well as through ‘resilience check-ins’, debriefs, and a crew assistant system that assesses adaptation triggers and obtains feedback to create alternative strategies for adaptation (Maynard et al., 2020; Alliger et al., 2015). The absence of team resilience can compromise team performance (Alliger et al., 2015), rendering it an indispensable component to integrate into training.
Consequently, concrete actions need to be enacted to foster healthcare teams that are adaptive and resilient. The literature recommends the implementation of tools and strategies to cultivate flexibility and adaptability amongst a team (Smith-Jentsch et al., 2015). This approach allows for teams to utilize their resources in times of uncertainty, ultimately resulting in increased team effectiveness (Smith-Jentsch et al., 2015). Team adaptability and resilience should not be considered mere training outcomes; they should be fundamental principles of training and development in extreme environments like healthcare. Traditional training programs, like TeamSTEPPS, should be updated to include team adaptability & resilience as a sixth key principle, allowing for enhancements in the tools and strategies to foster improved patient outcomes.
Implementing Cross-Training to Develop Shared Mental Models (SMMs). The incorporation of cross-training within healthcare has been shown to have a positive impact on team performance (Hedges et al., 2019), as it allows a deeper understanding of the roles and responsibilities held by fellow team members (Cannon-Bowers & Salas, 1998). This heightened awareness contributes to the cultivation of shared knowledge amongst the team, which ultimately has been shown to improve team performance (Marks et al., 2002). Extreme environments literature indicates that the implementation of cross-training allows for team members to maintain expectations amongst their fellow team members in addition to shared role knowledge (Driskell et al., 2017), which contributes to a deeper understanding regarding how their specific responsibilities align with those of their fellow team members, termed interpositional knowledge (IPK; Cannon-Bowers & Salas, 1998). Together, this awareness ultimately fosters the key competency of shared mental models. TeamSTEPPs suggests that all individuals within the team develop knowledge regarding the workload of other team members, however, currently it does not list cross-training as a tool or strategy to promote the development of SMMs. The development of SMMs can allow for team members to offer task assistance, feedback, and other support to their fellow team members, ultimately leading to improved patient outcomes (Marks et al., 2002).
Enhancing Psychological Safety Through Inclusivity & Open Communication. The concept of psychological safety, which has garnished increased attention in extreme environments (Landon et al., 2015) and medical education literature (Hsiang-Te Tsuei et al., 2019), is intrinsically linked to improved team performance (Edmonson et al., 2014; Newman et al., 2017) and learning (Edmonson, 1999; O’donovan & Mcauliffe, 2020). Psychological safety enables team members to “speak up” and report errors, ultimately enhancing patient safety (Han & Roh, 2020). Consequently, there is a need for proper development of psychological safety within teams, as it has shown to be critical for success in uncertain environments (Delizonna, 2017). TeamSTEPPS currently discusses the concept of “advocacy and assertion” as a key strategy for developing mutual support within a team, however, psychological safety encompasses more than just this notion. Concepts such as inclusivity and openness to communication are both vital to the creation of psychological safety within a team (Cho et al., 2023). Fortunately, fostering an inclusive culture as well as encouraging open communication within the healthcare industry can be done regardless of familiarity with your teammates. The TeamSTEPPS framework needs to be updated to consider these factors when training individuals on ways to develop psychological safety. This update can ultimately lead to better patient outcomes as well as increased job satisfaction among medical staff (Cho et al., 2023).
TeamSTEPPS training should be intentionally designed with the awareness that medical teams often form ad hoc in response to emerging needs, and should therefore emphasize these three components to help mitigate the problems resulting from healthcare teams’ lack of ability to consistently train together as a team. The purpose of this poster is to expand on the three recommendations provided by extreme environments literature in the context of healthcare TeamSTEPPS training, ultimately helping to update training protocols to include necessary teamwork competencies.
Training has been a critical part of medical education for many decades (Lateef, 2010; King et al., 2008), and training experts recommend consistent development and innovation of training frameworks in order to remain competitive (Salas et al., 2012). Programs like Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS; Guimond et al., 2009) have been developed to enhance healthcare teams’ efficiency and effectiveness, ultimately aimed to improve patient outcomes (Guimond et al., 2009). TeamSTEPPS includes five major principles: team structure, communication, team leadership, situation monitoring, and mutual support (Parker et al., 2019). This program has been shown to be widely effective in the healthcare industry (Brooks et al., 2022); however, other industries can help to inform updates and enhancements to this training program to consistently align the program with current team science findings and practices.
The extreme environments literature indicates that training intact teams is vital to developing essential teamwork elements like team cohesion and norms (Landon & O’Keefe, 2018). However, this is challenging in healthcare, as many teams often form spontaneously as needs arise (Eppich et al., 2011), and thus may not have practiced together before (Clancy & Tornberg, 2007). To address this issue, TeamSTEPPS should be enhanced using knowledge from extreme environments literature, which emphasizes the importance of team adaptation (Driskell et al., 2017) and resilience (Landon et al., 2018; Vanhove et al., 2015), cross-training to promote the development of shared mental models (Driskell et al., 2017; Gorman et al., 2010), and enhancing psychological safety (Salas et al., 2018; Edmonson, 1999) through inclusivity and open communication. These recommendations enhance the tools, strategies, and key principles comprising the TeamSTEPPs program.
Team Adaptability & Resilience. The extreme environments literature indicates that it is especially important for safety-critical teams to understand the factors necessary to promote team adaptability and resilience (Maynard et al., 2020). Adaptability has been considered a potential outcome of TeamSTEPPS, however, the extreme environments literature suggests that team adaptability is an indispensable competency for achieving optimal team performance in these environments (Driskell et al., 2017; Smith-Jentsch et al., 2015; Landon et al., 2017). Often conceptually linked to adaptation (Kennedy et al., 2016; Maynard et al., 2020), resilience is another element necessary to train within teams (Maynard et al., 2020). Resilience has been a subject of study within the extreme environments literature (Maynard et al., 2020), with findings suggesting that resilience can be developed through training prior to actual performance (Maynard et al., 2020), as well as through ‘resilience check-ins’, debriefs, and a crew assistant system that assesses adaptation triggers and obtains feedback to create alternative strategies for adaptation (Maynard et al., 2020; Alliger et al., 2015). The absence of team resilience can compromise team performance (Alliger et al., 2015), rendering it an indispensable component to integrate into training.
Consequently, concrete actions need to be enacted to foster healthcare teams that are adaptive and resilient. The literature recommends the implementation of tools and strategies to cultivate flexibility and adaptability amongst a team (Smith-Jentsch et al., 2015). This approach allows for teams to utilize their resources in times of uncertainty, ultimately resulting in increased team effectiveness (Smith-Jentsch et al., 2015). Team adaptability and resilience should not be considered mere training outcomes; they should be fundamental principles of training and development in extreme environments like healthcare. Traditional training programs, like TeamSTEPPS, should be updated to include team adaptability & resilience as a sixth key principle, allowing for enhancements in the tools and strategies to foster improved patient outcomes.
Implementing Cross-Training to Develop Shared Mental Models (SMMs). The incorporation of cross-training within healthcare has been shown to have a positive impact on team performance (Hedges et al., 2019), as it allows a deeper understanding of the roles and responsibilities held by fellow team members (Cannon-Bowers & Salas, 1998). This heightened awareness contributes to the cultivation of shared knowledge amongst the team, which ultimately has been shown to improve team performance (Marks et al., 2002). Extreme environments literature indicates that the implementation of cross-training allows for team members to maintain expectations amongst their fellow team members in addition to shared role knowledge (Driskell et al., 2017), which contributes to a deeper understanding regarding how their specific responsibilities align with those of their fellow team members, termed interpositional knowledge (IPK; Cannon-Bowers & Salas, 1998). Together, this awareness ultimately fosters the key competency of shared mental models. TeamSTEPPs suggests that all individuals within the team develop knowledge regarding the workload of other team members, however, currently it does not list cross-training as a tool or strategy to promote the development of SMMs. The development of SMMs can allow for team members to offer task assistance, feedback, and other support to their fellow team members, ultimately leading to improved patient outcomes (Marks et al., 2002).
Enhancing Psychological Safety Through Inclusivity & Open Communication. The concept of psychological safety, which has garnished increased attention in extreme environments (Landon et al., 2015) and medical education literature (Hsiang-Te Tsuei et al., 2019), is intrinsically linked to improved team performance (Edmonson et al., 2014; Newman et al., 2017) and learning (Edmonson, 1999; O’donovan & Mcauliffe, 2020). Psychological safety enables team members to “speak up” and report errors, ultimately enhancing patient safety (Han & Roh, 2020). Consequently, there is a need for proper development of psychological safety within teams, as it has shown to be critical for success in uncertain environments (Delizonna, 2017). TeamSTEPPS currently discusses the concept of “advocacy and assertion” as a key strategy for developing mutual support within a team, however, psychological safety encompasses more than just this notion. Concepts such as inclusivity and openness to communication are both vital to the creation of psychological safety within a team (Cho et al., 2023). Fortunately, fostering an inclusive culture as well as encouraging open communication within the healthcare industry can be done regardless of familiarity with your teammates. The TeamSTEPPS framework needs to be updated to consider these factors when training individuals on ways to develop psychological safety. This update can ultimately lead to better patient outcomes as well as increased job satisfaction among medical staff (Cho et al., 2023).
TeamSTEPPS training should be intentionally designed with the awareness that medical teams often form ad hoc in response to emerging needs, and should therefore emphasize these three components to help mitigate the problems resulting from healthcare teams’ lack of ability to consistently train together as a team. The purpose of this poster is to expand on the three recommendations provided by extreme environments literature in the context of healthcare TeamSTEPPS training, ultimately helping to update training protocols to include necessary teamwork competencies.
Event Type
Poster Presentation
TimeTuesday, March 264:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives