Targeted On-Demand Team Performance App Development

Background: Effective teamwork optimizes the completion of complex tasks in any domain, but it is essential for patient safety and quality of care in healthcare. Effective healthcare teams increase the diagnostic power applied to challenging medical problems by incorporating input from multiple sources and are more likely to develop new procedures, methods, and tools to improve the provision of patient care. Proficient healthcare teams contribute to the financial stability of healthcare institutions by reducing high staff turnover rates, incidences of infection, untreated pain, and poor clinical outcomes that extend hospital stays and recovery periods. Healthcare team performance is affected by the individual capabilities of each team member, as well as the contextual complexities of the patient care environment, itself set within a complex system. A comprehensive analysis of healthcare teams revealed four distinct types of teams with variable compositions, environments, and team practices that may not readily adapt to a generalized performance model. Training that does not consider the critical factors associated with the type of team may not optimize team performance. To best inform the development of a substantive, technology-supported team training and evaluation resource, we must adequately characterize the individual and team factors that most impact healthcare team performance.

Objective/Hypothesis: A regression analysis evaluating the relative importance of individual and team factors on team performance in an Emergency Medicine context will provide a framework developing targeted computer-based, smart-technology training solutions. The resulting solutions will be adaptable for applicability to all types of military and civilian healthcare teams.

Specific Aims: The primary aim is to define the individual and team factors that best inform the development of a targeted smart-technology team-training solution. Secondary aims will determine the relative impacts of individual and collective (team) factors on team performance in the provision of emergent, urgent clinical care, including clinical accuracy of team performance, team cohesiveness, and team morale after the management of an emergency medicine patient, and the extent to which clinical accuracy of team performance in the management of an emergency medicine patient correlates with team cohesiveness and team morale.

Study Design: Data will be collected from six sites to characterize the influence of institutional culture on team performance. The sample will be comprised of Emergency Medicine personnel from each site randomly assigned to teams comprised of clinicians from each professional discipline. Other individual factors within each team will be controlled through randomization. Multiple regression analysis will be used to predict the value of continuous dependent (criterion) variables (Y1 = team performance, Y2 = team cohesiveness, Y3 = team morale) from the known values of individual and team predictor variables.

Teams will work through three different simulated Emergency Medicine patient scenarios. Each scenario will be designed to be emergent and urgent, with symptomologies that could indicate multiple etiologies: septic shock; pediatric exposure to neurotoxin; and diverticulitis. The purpose is to challenge the teams through stressful clinical situations that could occur in Emergency Medicine contexts. Independent assessors will use a customized version of the CareAssess performance assessment app to capture all data for predictor and criterion variables. Customization will allow for real-time data capture during the case scenarios and will support the eventual translation of real-time assessment metrics into real-time performance feedback when used in conjunction with future training applications.

Impact: Team training programs designed to reduce errors, increase patient safety, and improve quality of care in clinical settings have been effected in both military and civilian contexts. Although costly to develop and implement, the relative and sustained effectiveness of these programs remains limited. The proposed study will produce an evidence-based model for determining the relative importance of both individual and team factors on team performance. The results of this work will inform the development of effective, smart-technology centered, portable training solutions that provide real-time performance feedback and may be tailored for applicability across variable civilian and military healthcare teams.