The School of Health Sciences, City University of London, London, UK; The Florence Nightingale Faculty of Nursing, Midwifery and PalliativeCare, King's College London, London, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
Appl Ergon. 2020 Jan;82:102915. doi: 10.1016/j.apergo.2019.102915. Epub 2019 Aug 15.
Effective teamwork is critical to patient safety across multiple healthcare settings. However, current observational tools assessing teamwork performance tend to be developed for specific settings or tasks and do not capture temporal features of interaction. This study aimed to develop a valid and reliable observational teamwork behaviour framework, which is based on healthcare practice, applicable across a variety of healthcare contexts and can be used to capture temporal team dynamics.
Team interactions were audio-visually recorded during routine simulation training at two large clinical education centres specialising in physical and mental healthcare. The framework was based on theoretical models of teamwork and was developed in three steps: 1-micro analysis of verbal and nonverbal behaviour during recorded scenarios (n = 20); 2-iterative test and refine cycles; 3-final behavioural framework applied to a cohort of acute emergency scenarios (n = 9) by two raters to assess inter-rater agreement.
The framework contains twenty-three specific verbal and nonverbal behaviours that can be identified during observations. Behaviours are grouped conceptually based on their function resulting in thirteen behavioural functions, which cluster into five overarching teamwork domains. Inter-rater agreement was excellent (Cohen's Kappa = .84, SE = 0.03).
We present a valid and reliable behavioural framework, grounded in teamwork theory and empirical observations of clinical team behaviour. This framework enables analysis of the nuances and temporal features of clinical practice in depth and across a wide range of clinical contexts and settings. Use of this framework will advance our understanding of teamworking in healthcare.
有效的团队合作对于跨多个医疗保健环境的患者安全至关重要。然而，目前评估团队合作绩效的观察工具往往是针对特定环境或任务开发的，并且无法捕捉交互的时间特征。本研究旨在开发一个基于医疗实践、适用于各种医疗保健环境且可用于捕捉团队动态的有效且可靠的观察性团队合作行为框架。
在两个专门从事身心保健的大型临床教育中心的常规模拟培训期间，对团队互动进行了音频视觉记录。该框架基于团队合作的理论模型，并分三个步骤开发：1. 对记录情景中的言语和非言语行为进行微观分析（n=20）；2. 迭代测试和完善周期；3. 最终行为框架由两名评估员应用于一组急性紧急情景（n=9），以评估评估者间的一致性。
该框架包含在观察期间可以识别的二十三种特定的言语和非言语行为。行为根据其功能进行概念分组，产生十三种行为功能，这些功能分为五个总体团队合作领域。评估者间的一致性非常好（Cohen 的 Kappa=0.84，SE=0.03）。
我们提出了一个基于团队合作理论和临床团队行为的实证观察的有效且可靠的行为框架。该框架能够深入分析和广泛的临床背景和环境中的临床实践的细微差别和时间特征。使用该框架将有助于我们加深对医疗保健中团队合作的理解。
