Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis
Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis
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DOI：
10.1186/s12913-018-3331-3
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发表时间：
2018-07-11
影响因子：
2.8
通讯作者：
McAuliffe, E.
中科院分区：
文献类型：
--
作者：
Cunningham, U.;Ward, M. E.;McAuliffe, E.
背景资料：关于医疗保健团队有效性的研究重点是有效的团队是否能为患者带来积极的结果，以及团队干预措施对提高绩效的有效性。对于在一个有效的团队中什么对谁有效，或者团队运作的环境如何以及为什么能够使团队成员作为个人和集体制定促进积极成果的行为，人们的理解有限。方法：这种现实主义的文献综合探讨了团队干预之间的关系，这些干预产生的潜在团队合作机制，以及在急性医院环境中对患者结果的最终影响。对五个医疗保健和医疗保健管理学术数据库：PubMed，PsychINFO，CINAHL，ABInform，Emerald Management和三个灰色文献数据库：ERIC，OpenDOAR和Open Grey进行了系统检索。还联系了该领域的五位专家，以获取相关文献。使用PRISMA指南，由三人组成的团队系统检索了2006年1月至2017年1月期间发表的相关研究。借鉴现实主义的方法，数据进行了综合使用的背景下，机制和结果配置作为分析单元，以确定有效的团队interventions.Results的使能因素和障碍：出检索到的3347篇论文，18被列入最后的综合。从这些，五个上下文使能因素被确定为：跨学科的重点和扁平化的层次结构;有效的沟通;领导支持和团队目标与组织目标的一致性;干预的可信度;和适当的团队组成与医生的参与。确定了10个经常性的机制，其中最常见的是共同responsibility.Conclusions：使用现实主义的合成，从文献中推断数据的优点是，它认为的背景和机制，将影响医疗团队干预的有效性。这种方法论的方法提供了一个不同的视角，以其他类型的综合，并提供洞察力，为什么某些上下文元素可能会产生比其他人更成功。因此，调查结果往往具有更实际的意义。在提取用于分析的文章中，外部驱动因素如何影响医疗团队干预措施的详细信息的特异性有限。因此，这种更广泛的视角是未来研究的一个重要考虑因素。
Background: Research on team effectiveness in healthcare has focussed on whether effective teams yield positive outcomes for patients and on the effectiveness of team interventions to improve performance. Limited understanding exists of what works for whom within an effective team, or how and why the context in which the team operates enables team members both as individuals and as a collective to enact behaviours that promote positive outcomes.Methods: This realist synthesis of the literature explores the relationship between team interventions, underlying teamwork mechanisms generated by those interventions, and the resultant impact on patient outcomes in an acute hospital context. A systematic search of five healthcare and healthcare management academic databases: PubMed, PsychINFO, CINAHL, ABInform, Emerald Management and three grey literature databases: ERIC, OpenDOAR and Open Grey was undertaken. Five experts in the field were also contacted to source relevant literature. Using PRISMA guidelines, relevant studies published between January 2006 and January 2017 were systematically searched by a team of three people. Drawing on realist methodology, data were synthesised using context, mechanism and outcome configurations as the unit of analysis to identify enablers and barriers to effective team interventions.Results: Out of 3347 papers retrieved, 18 were included in the final synthesis. From these, five contextual enablers were identified: an inter-disciplinary focus and flattened hierarchy; effective communication; leadership support and alignment of team goals with organisational goals; credibility of intervention; and appropriate team composition with physician involvement. Ten recurring mechanisms were identified, the most frequently occurring of which was shared responsibility.Conclusions: The advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.