A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the “evidence base” levels of the research. Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.

/pdf/interventions-to-improve-team-effectiveness-within-health-3yn9dvno5m.pdf

Interventions to improve team effectiveness within health care: a systematic review of the past decade

Simulation has an established role in the education and training of healthcare professionals, but its function as a healthcare quality improvement (QI) tool is more emergent. In this edition of the journal, Ajmi and colleagues report on a simulation-based intervention that improved door-to-needle times and patient outcomes in acute ischaemic stroke.1 This prompts reflection on the positioning of simulation-based methods within QI programmes, the role of trained simulation experts as part of QI-focused teams and the directions for future scholarly enquiry that supports integration of these fields.

The improvement report by Ajmi et al is a comprehensive and thoughtful example among many reports of simulation-based interventions to improve care processes and patient outcomes. Improved time-based targets in trauma,2 stroke and cardiac care are frequently cited in the literature, as are better resuscitation outcomes3 and compliance with practice guidelines.4 The identification of latent safety threats in clinical environments,5 6 including testing of new facilities prior to opening,7 is also well described. Such research is usually positioned as providing ‘proof’ that simulation ‘works’ for improving patient care. However, confounders and balancing measures may not be rigorously examined in this enthusiasm to demonstrate cause and effect.

Team training using simulation can enable improvements in provider behaviours ,8 including those described by Ajmi et al ,1 where sequential tasks in time-critical patient journeys can be replaced by ‘parallel processing’. Location is also relevant, as ‘in situ simulation’—“taking place in the actual patient care setting/environment”9—affords a closer connexion to the physical environment for ‘real’, often ad hoc teams, to identify enablers or barriers for QI interventions.10 However, the effect could also lie in simulation shaping the culture and relationships 11 12 that underpin and support structural or process specific interventions.

Most reported simulation-based improvement …

https://qualitysafety.bmj.com/content/qhc/28/11/862.full.pdf

Connecting simulation and quality improvement: how can healthcare simulation really improve patient care?

Poor teamwork results in preventable morbidity and mortality for mothers and babies. Suboptimal communication and lack of leadership cost not only lives but also money that is diverted from clinical care to insurance and litigation. Avoidable harm is usually not the result of staff failing their duty of care, it is the result of poor training failing hard-worked staff. This article describes simple yet evidence-based methods to improve teams and leaders.

Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies (Journal article)

Simulation-based training used to train healthcare teams' skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams' human factor skills.A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies.The search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result.Simulation-based training is a successful learning tool to improve qualified healthcare teams' human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety. 

/pdf/the-effectiveness-of-improving-healthcare-teams-human-factor-cxxaqdqq.pdf

The effectiveness of improving healthcare teams’ human factor skills using simulation-based training: a systematic review

Simulation-based teaching in critical care, anaesthesia and emergency medicine.

Objectives The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick’s framework. We explored participants’ acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants’ perception of usefulness of PROMPT in their clinical practice. Study design Mixed methods approach with a pre-test/post-test design. Setting Healthcare network providing obstetric care in Victoria, Australia. Participants Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011–2012 (n=15 361 births) and 2014–2015 (n=12 388 births). Intervention Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills. Main outcome measure Clinical outcomes compared before and after embedding PROMPT in educational practice. Secondary outcome measure Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice. Results There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies. Conclusion Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes.

pdf/evaluation-of-learning-from-practical-obstetric-multi-593g5d3xf0.pdf

Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study.

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Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study.