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UID:HFESHCS_2024 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess128_POST150@linklings.com
SUMMARY:PS3 - Enhancing Team Competencies in Healthcare: Lessons from Extr
 eme Environments Literature
DESCRIPTION:Poster Presentation\n\nLila Berger, Maha Khalid, and Eduardo S
 alas (Rice University)\n\nThe research surrounding extreme environments ty
 pically focuses on domains such as spaceflight, aviation, and military ope
 rations. However, the concept of an extreme environment transcends these s
 pecific contexts and is defined as an environment characterized by unpredi
 ctability, high stress, and increased demands, where ineffective performan
 ce can result in life-threatening consequences (Driskell et al., 2017). He
 nce, while they may not be experiencing microgravity, healthcare contexts 
 such as surgical operating rooms (ORs) or emergency departments can thus a
 lso be considered extreme environments. The healthcare sector can learn fr
 om the literature surrounding expert performance in extreme environments, 
 as they share similarities with these safety-critical domains. It would th
 erefore be advantageous for the healthcare industry to draw insights from 
 the extensive literature surrounding expert performance in extreme environ
 ments. This body of knowledge has the potential to offer valuable lessons 
 which can help to inform the development of training programs aimed at enh
 ancing effective teamwork within healthcare settings. \nTraining has been 
 a critical part of medical education for many decades (Lateef, 2010; King 
 et al., 2008), and training experts recommend consistent development and i
 nnovation 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 aim
 ed to improve patient outcomes (Guimond et al., 2009). TeamSTEPPS includes
  five major principles: team structure, communication, team leadership, si
 tuation 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 en
 hancements to this training program to consistently align the program with
  current team science findings and practices. \nThe extreme environments l
 iterature indicates that training intact teams is vital to developing esse
 ntial teamwork elements like team cohesion and norms (Landon & O’Keefe, 20
 18).  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 issu
 e, 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 (Driskel
 l et al., 2017; Gorman et al., 2010), and enhancing psychological safety (
 Salas et al., 2018; Edmonson, 1999) through inclusivity and open communica
 tion. These recommendations enhance the tools, strategies, and key princip
 les comprising the TeamSTEPPs program. \n\nTeam Adaptability & Resilience.
  The extreme environments literature indicates that it is especially impor
 tant for safety-critical teams to understand the factors necessary to prom
 ote team adaptability and resilience (Maynard et al., 2020). Adaptability 
 has been considered a potential outcome of TeamSTEPPS, however, the extrem
 e environments literature suggests that team adaptability is an indispensa
 ble competency for achieving optimal team performance in these environment
 s (Driskell et al., 2017; Smith-Jentsch et al., 2015; Landon et al., 2017)
 . Often conceptually linked to adaptation (Kennedy et al., 2016; Maynard e
 t al., 2020), resilience is another element necessary to train within team
 s (Maynard et al., 2020). Resilience has been a subject of study within th
 e extreme environments literature (Maynard et al., 2020), with findings su
 ggesting 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 trigg
 ers and obtains feedback to create alternative strategies for adaptation (
 Maynard et al., 2020; Alliger et al., 2015).  The absence of team resilien
 ce can compromise team performance (Alliger et al., 2015), rendering it an
  indispensable component to integrate into training. \nConsequently, concr
 ete actions need to be enacted to foster healthcare teams that are adaptiv
 e and resilient. The literature recommends the implementation of tools and
  strategies to cultivate flexibility and adaptability amongst a team (Smit
 h-Jentsch et al., 2015). This approach allows for teams to utilize their r
 esources in times of uncertainty, ultimately resulting in increased team e
 ffectiveness (Smith-Jentsch et al., 2015). Team adaptability and resilienc
 e should not be considered mere training outcomes; they should be fundamen
 tal principles of training and development in extreme environments like he
 althcare. Traditional training programs, like TeamSTEPPS, should be update
 d to include team adaptability & resilience as a sixth key principle, allo
 wing for enhancements in the tools and strategies to foster improved patie
 nt outcomes.\n\nImplementing Cross-Training to Develop Shared Mental Model
 s (SMMs). The incorporation of cross-training within healthcare has been s
 hown 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 awa
 reness 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 implementatio
 n of cross-training allows for team members to maintain expectations among
 st their fellow team members in addition to shared role knowledge (Driskel
 l et al., 2017), which contributes to a deeper understanding regarding how
  their specific responsibilities align with those of their fellow team mem
 bers, 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 de
 velop knowledge regarding the workload of other team members, however, cur
 rently it does not list cross-training as a tool or strategy to promote th
 e 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., 2
 002). \n\nEnhancing Psychological Safety Through Inclusivity & Open Commun
 ication. The concept of psychological safety, which has garnished increase
 d attention in extreme environments (Landon et al., 2015) and medical educ
 ation literature (Hsiang-Te Tsuei et al., 2019), is intrinsically linked t
 o improved team performance (Edmonson et al., 2014; Newman et al., 2017) a
 nd learning (Edmonson, 1999; O’donovan & Mcauliffe, 2020). Psychological s
 afety enables team members to “speak up” and report errors, ultimately enh
 ancing 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). Te
 amSTEPPS currently discusses the concept of “advocacy and assertion” as a 
 key strategy for developing mutual support within a team, however, psychol
 ogical safety encompasses more than just this notion. Concepts such as inc
 lusivity and openness to communication are both vital to the creation of p
 sychological safety within a team (Cho et al., 2023). Fortunately, fosteri
 ng an inclusive culture as well as encouraging open communication within t
 he healthcare industry can be done regardless of familiarity with your tea
 mmates. The TeamSTEPPS framework needs to be updated to consider these fac
 tors when training individuals on ways to develop psychological safety. Th
 is update can ultimately lead to better patient outcomes as well as increa
 sed job satisfaction among medical staff (Cho et al., 2023).  \n\nTeamSTEP
 PS training should be intentionally designed with the awareness that medic
 al teams often form ad hoc in response to emerging needs, and should there
 fore emphasize these three components to help mitigate the problems result
 ing from healthcare teams’ lack of ability to consistently train together 
 as a team. The purpose of this poster is to expand on the three recommenda
 tions provided by extreme environments literature in the context of health
 care TeamSTEPPS training, ultimately helping to update training protocols 
 to include necessary teamwork competencies.\n\nTrack: Digital Health, Simu
 lation and Education, Hospital Environments, Medical and Drug Delivery Dev
 ices, Patient Safety Research and Initiatives
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