The cognitive basis of effective team performance: features of failure and success in simulated cardiac resuscitation.

Despite a body of research on teams in other fields relatively little is known about measuring teamwork in healthcare. The aim of this study is to characterize the qualitative dimensions of team performance during cardiac resuscitation that results in good and bad outcomes. We studied each team's adherence to Advanced Cardiac Life Support (ACLS) protocol for ventricular fibrillation/tachycardia and identified team behaviors during simulated critical events that affected their performance. The process was captured by a developed task checklist and a validated team work coding system. Results suggest that deviation from the sequence suggested by the ACLS protocol had no impact on the outcome as the successful team deviated more from this sequence than the unsuccessful team. It isn't the deviation from the protocol per se that appears to be important, but how the leadership flexibly adapts to the situational changes with deviations is the crucial factor in team competency.