Medical Management Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
Scand J Trauma Resusc Emerg Med. 2011 Nov 15;19:70. doi: 10.1186/1757-7241-19-70.
Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors.
The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors.
We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process.
This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.
团队合作被认为是改善急诊部门（ED）护理流程的一种有前途的方法。然而，为了使团队合作产生预期的结果，实施必须涉及行为改变。本研究的目的是使用行为分析来定性地检查团队合作在实践中是如何发挥作用的，并了解计划行为和实际行为之间的最终差异。
该研究在瑞典一所大学医院 ED 的实施初期进行。干预措施侧重于改变环境和重新设计工作流程以实现团队合作。每个团队负责整个护理过程，即从患者到达 ED 到出院。数据通过围绕观察方案进行的 3 天观察收集。行为分析用于确定关键的团队合作行为，以一致地实施团队合作，并分析减少或增加这些行为可能性的条件。
我们发现计划的团队合作过程与观察到的过程之间存在很大差异。观察到的 44 名患者中有 60%仅由指定的团队成员处理。只有 36%的观察到的患者护理过程按照计划的团队合作过程中的描述开始，即一起进行病史采集。除了这种行为之外，在定义的团队室开会并与团队成员沟通被证明是一致实施团队合作的必要条件。降低这些关键行为可能性的因素包括等待其他团队成员或难以找到彼此。没有延迟地完成工作并全面了解患者护理过程会增加团队行为。此外，关于团队成员何时应该互动和沟通的明确指示会增加对计划过程的遵守。
本研究说明了如何使用行为分析来理解计划行为和观察行为之间的差异。通过检查可能影响行为的背景条件，可以提出改进实施策略的建议。从而可以提高对计划干预措施的遵守率，并/或提出对干预措施的修订。
