Creating a Culture of Teamwork to Save - PowerPoint Presentation

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Creating a Culture of Teamwork to Save Lives: What Does it Take?

Eduardo Salas, Ph.D.Department of Psychology &Institute of Simulation & TrainingUniversity of Central Floridaesalas@ist.ucf.edu

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This Morning…We are taking “

a trip”…Why you should care about teamwork…What team science tells us about teamwork…Give you some advice…What does it take…

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Going to Mars…2035

…An expert team

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Long Duration…Confine Environment…

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This Team Needs To Be…Reliable

, no errors…Resilient, deal with novel events…Adaptive, change due to conditions…Self-correcting, no time for outside intervention…

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This Team Needs To Be…Decisive

, make quick & robust decisions…Cohesive, get along…Safe, errors could cost their lives…Teamwork, coordinate, cooperate & communicate…

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And So Does Patient Care!!!!

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What is the State of the Science?

What Matters in Teams?

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What is the State of the Science?

How Do We Turn a Team of Experts into an Expert Team?

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What is the State of the Science?

Theoretically-driven (170+ models!)“Nothing more practical than a good theory.”It’s a multi-disciplinary fieldExplosion of empirical work!Studying real teams; performing real tasks“Teams in the Wild”SimulationsExperts as participants

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What is the State of the Science?

Hundreds of teams!AviationHealthcareMilitaryCorporate worldTeams definedTask interdependencyDistributed expertiseHierarchical organized

Member Fluidity

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What is Teamwork?It is the

actions, events and behaviors, cognition, feelings taken to accomplish a team goal.It is about……taskwork skills (i.e., own task).…teamwork skills (i.e., how to work together).

…

building

and

maintaining

both.

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What Matters…

The 7 C’s of Teamwork…

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C

OMMU

N

I

C

A

T

I

O

N

TEAMWORK

Organizational

&

Individual Outcomes

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Cooperation…Attitudes & Beliefs:

Team OrientationCollective EfficacyMutual TrustOpenness to ExperienceGood Teams…Develop collective efficacyHave strong team orientation

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Coordination…Behavioral Mechanisms:

Mutual Performance MonitoringBack-up Behavior/SupportiveAdaptability/ FlexibilityGood Teams…Self-correctEmploy huddle, debriefs

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Communication…Information exchange protocols:

Close-loop communicationPrecise, Timely, ClarityAppropriate terminologyGood Teams…Share unique information

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Cognition…Shared understanding:

Roles & ResponsibilitiesKnowledge of team mission; Objectives, Norms, & ResourcesFamiliarity with TeammatesGood Teams…Have clear rolesTeam norms are clear

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Coaching…Leadership:

Team LeadershipPromotes teamworkCares about team membersSets ground rulesGood Teams…Have coachesSet expectationsClarify roles

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Conflict…Conflict resolution strategies:

Interpersonal skillsPsychological safetyGood Teams…Deal with conflict, confront itCoaches create psychological safety

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Conditions…Supportive context

Good performance recognized & reinforcedAccess to resourcesInformation needed availablePolicies, procedures & incentives alignsLeadership sends “signals” that teamwork matters

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Ten Characteristics of Effective Teams…

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Ten characteristics of effective teams…

Clear roles & responsibilities…have members who understand each others’ roles and how they fit together.Compelling purpose – goal, vision…have a clear common purpose.…energized by their shared mission.

…can evaluate current status in terms of a destination

.

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Ten characteristics of effective teams…Team

coach (leader) – promotes, develops, reinforces…leaders that directly intervene to enact teamwork processes.…have team members who believe the leaders care about them.…provide situation updates.…set expectations.…self-correct first.…clarify roles.…solicit ideas and observations from team members.…seek out opportunities to reinforce effective teamwork.

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Ten characteristics of effective teams…Mutual

trust – familiarity …manage conflict well—team members confront each other effectively.…have a strong sense of team orientation.…trust other team members’ “intentions”.…strongly believe in the team’s collective capability to succeed.…develop collective efficacy.

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Ten characteristics of effective teams…Team

norms – clear, known & appropriate…what is acceptable “around here”.​Shared understanding of task, mission & goals – hold shared mental model…have members who anticipate each other.…can coordinate without overt communication.

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Ten characteristics of effective teams…​

Self-correct – huddles, debriefs…regularly provide feedback to each other, both individually and as a team (“de-brief”).…establish and revise team goals and plans.…differentiate between higher and lower priorities.…have mechanisms for anticipating and reviewing issues/problems of members.…periodically diagnose team "effectiveness”, including its results, its processes, and its vitality (morale, retention, energy).

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Ten characteristics of effective teams…

Set expectations (and are managed) – clear, understoodShared unique information – efficient information protocols…huddles, debriefs can help.​Launched correctlyKick-off meeting

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Seven Pieces of Advice…

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Some Advice…

Ensure all team members are trained on team-based KSA’s…around six of the C’s…Team training ≠ Team buildingInformation, demonstration, practice & feedback, key elementsScenario carefully craftedEvent-based approach

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Does Team Training Work?

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YES!!!

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Team Training Works!Compared with current training, enhanced training resulted in

(see Cannon-Bowers & Salas, 19981):45% improvement in Mission Performance.33% improvement in Tactical Decision Making Performance.25% improvement in Communication Efficiency.10-34% improvement in Team Coordination.In the aviation environment (Salas et al., 19992):6-20% improvement in Teamwork Behaviors.

1

Cannon-Bowers, J. A., & Salas, E. 1998

2

Salas, E. et al 1999

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Does Team Training Work?Team training significantly improves team3

:Cognition (ρ = .42)Shared mental modelsBehavioral process (ρ = .44)Communication, coordination, collaborationAffect (ρ = .35)Mutual trust, collective efficacyPerformance outcomes (ρ

= .37)

Task outcomes, satisfaction, viability

3

Salas et al., 2008

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Does Medical Team Training Impact

Clinical Outcomes?

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State of the Science of Medical Team Training…106

Independent Samples, 93 studies were included in the meta-analysisMilitary clinicians-3Nonmilitary clinicians-79Students-20

Mix-4

Most team training programs were developed in house (38.68%)

Most teams trained are

interprofessional

(72.64%) but

interdisciplinary

teams were minority

(26.42%)

Communication

was the competency

most commonly trained

(31.66%)

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What Did We Find?

OutcomeK1N2

Corrected

d

RM

3

Variance

accounted for

Overall

106

19700

.65*

9.5%

Reactions

3

66

0.65*

9.6%

Learning

58

5489

.83*

14.67%

Behaviors

47

7727

0.58*

7.29%

Organizational

Outcomes

29

5591

0.30*

2.19%

Patient Outcomes

16

9350

0.43*

4.42%

K is the number of effect studies analyzed for this outcome

N is the number of individuals evaluated in this outcome

Corrected

d

Rm

is the corrected effect size estimate*Statistically significant; confidence interval excludes zero

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What Do the Data Mean?Team training

improves overall outcomes by 9.5%Team training is well-liked and perceived as useful 9.5%.Team Training accounts for 14.67% of

learning

7.29%

of improvement of

on-the-job performance -

This includes both

task

and team performance

Team training accounts for

2.19%

of

improvement in organizational outcomes

(e.g., culture, turnover, financial)

Team training accounts for

4.42%

of improvement in

patient outcomes

(e.g., infection, mortality, complications)

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Some Advice…

​Teach how to Debrief and Huddle!- Simple, Powerful, & UnderutilizedWhat worked?What can be improved?Focus on as many C’s as possible.Debriefing works! (Tannenbaum & Cerasoli, 2012)25% Performance improvement

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Some Advice…

3. Use Simulation!Games, role playsAccelerates expertiseEmbedded instructional features

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Some Advice… Develop team

coaches, leaders…​Measure & Reinforce teamwork!​​For sustainability…create conditions needed……continuous process…seek supervisory support…not an event, journey…physicians must

engage

…CFO/CEO/CMO must see value, business case

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Some Advice… See if you can use this statement:

“Am Dr. ____, I am a good surgeon but I am vulnerable to error so you are here to help me take care of this patient– we are a team.”

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What Does It Take…

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Success Factors

​Leverage pre-existing team training programs (e.g., TeamSTEPPS, CRM)…Adapt to needs!Need to understand the coordination demands

in your units…Not all teams created equal…Task interdependence matters…

Need to focus on

teamwork

-related

KSAs…

​

Prepare

the organization,

supervisors

,

leaders

and

trainees

for team training…

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Success Factors

Create conditions - A support system that facilitates the application of the trained skills back on the job……Supervisory support

…

…Opportunity to practice…

…Providing

tools

for teamwork & collaboration -- checklists, debriefs, huddles, teamwork aids…

… Team

coaching

…

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Success Factors…An

organizational commitment (CEO, CFO, CMO)– leadership support to do things differently…Long-term culture change efforts…Resources allocated……A cadre of organizational mechanisms to promote & reinforce teamwork…creating the conditions

for sustainability

…

Measure

&

reinforce

teamwork…

A

journey, not an event…

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Success Factors…Continuous

learning & educating…Support IPE…Start early……Discipline in using performance support tools – debriefing, huddles, simulation……Physicians on-board, supporting…champions…

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Final Thoughts…

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Final Thoughts…Effective teamwork is the foundation for

effective patient care.Teams can learn to be more effective and save lives.The science of teamworkRemember the 7 C’s of teamwork and the patterns of effective teams.

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As of July 1, 2015

Eduardo

S

alas,

P

h.D.

Professor of Psychology

Department of Psychology

Rice University

H

ouston, TX

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How Can I Help?