Improving patient safety through leadership and team performance in simulations

描述(由申请人提供)：背景：有效的团队合作和团队表现对临床环境中的差错减少和安全至关重要。团队科学文献确定了提高团队绩效的三个目标：团队设计(组成)、团队培训和团队领导力。到目前为止，努力的重点是团队训练。然而，与这些计划的可行性、可持续性和有效性相关的挑战已经确定。此外，作为一个单位的培训团队，虽然需要有效的培训结果，但对于成员跨学科、高度可变、在复杂、动态和时间紧迫的临床环境下运作的特设应急团队来说，几乎是不可能的。本研究将团队领导力和团队组成作为医疗急救团队绩效的两个重要中介变量，这两个变量在患者安全性研究中尚未被研究。目的：本研究的总体目标是：(1)开发一种新颖的、基于证据的领导力培训方案；(2)利用基于模拟的研究平台，评估领导力培训和团队成员组成(陌生团队与熟悉团队)对医疗急救团队绩效的影响。这将通过以下方式推进AHRQ的患者安全使命：(1)提供额外的机制(领导力培训)来提高团队绩效和患者安全，以克服当前团队培训计划所带来的挑战；(2)提供可靠的诊断方法来评估团队绩效，直接评估基于证据的团队流程(协调、后备行为等)；以及(3)调查团队组成对团队绩效和患者安全关键行为的影响。方法：本项目建立在前人工作的基础上，分为三个具体目标：目标1：评估医疗团队组成(陌生成员与熟悉成员)对医疗急救团队绩效的影响目标2：开发和实施基于自适应学习系统理论启发式系统的团队领导力培训计划目标2a：评估团队领导培训对医疗急救团队绩效的影响目标3：评估团队领导培训对陌生与熟悉医疗急救团队的差异影响本项目采用2(陌生与熟悉)×2(领导力培训与控制)完全交叉设计，以评估领导力培训和团队组成(陌生与熟悉)对特别医疗急救团队绩效的影响。特别医疗应急小组将由来自多个医院机构的紧急医疗护士和医生组成。主要结果衡量标准是团队绩效，使用经过验证的模拟平台(场景+团队流程衡量标准+患者护理衡量标准)进行评估。这些措施将共同代表团队合作和任务工作的准确、可靠的表现。 公共卫生相关性：拟议的项目旨在通过使用基于模拟的评估来评估团队成员熟悉度和领导力培训对医疗团队绩效的影响，从而改善紧急医疗团队的团队合作。医疗急救队由于其固有的设计、任务的性质以及他们所处的环境，对患者的安全构成了巨大的风险。这项研究中使用的基于证据的模拟评估方法可以应用于解决医疗团队文献中报告的一些评估和结果挑战。此外，以领导力为目标的培训解决了大规模团队培训计划(例如，TEAMSTEPPS)中存在的许多可行性和可持续性问题。最后，使用理论和经验支持的领导和团队流程意味着这项工作与当前的团队合作和患者安全干预是兼容和协同的。

DESCRIPTION (provided by applicant): Background: Effective teamwork and team performance are critical to error mitigation and safety in the clinical environment. The team science literature identifies three targets for improving team performance: team design (composition), team training, and team leadership. To date, efforts have focused on team training. However, challenges associated with the feasibility, sustainability, and effectiveness of these programs have been identified. Additionally, training teams as a unit, while required for effective training outcomes, is nearly impossible for ad hoc emergency teams characterized by an interdisciplinary, highly variable membership that operates under complex, dynamic and time pressured conditions in a clinical setting. This proposed research focuses on team leadership and team composition as two important mediators of medical emergency team performance that have not been studied in patient safety research. Objective: The overall objective of the proposed research is to (1) develop a novel, evidence-based leadership training program and (2) evaluate the impact of both leadership training and team member composition (unfamiliar vs. familiar teams) on medical emergency team performance using a simulation-based research platform. This will advance the patient safety mission of AHRQ by (1) providing an additional mechanism (leadership training) for improving team performance and patient safety that overcomes challenges associated with current team training programs, (2) providing a robust, diagnostic method of evaluating team performance that directly assesses evidence-based team processes (coordination, back-up behavior, etc), and (3) investigating the impact of team composition on team performance and patient safety critical behaviors. Methods: This project builds upon previous work and is structured into three specific aims: Aim 1: To assess the impact of healthcare team composition (unfamiliar vs. familiar members) on medical emergency team performance Aim 2: To develop and implement a team leadership training program based on an Adaptive Learning System theoretical heuristic Aim 2a: To assess the impact of team leadership training on medical emergency team performance Aim 3: To assess the differential impact of team leadership training on unfamiliar vs. familiar medical emergency teams This project uses a 2 (unfamiliar vs. familiar) X 2 (leadership training vs. control) fully crossed design to evaluate impact of leadership training and team composition (unfamiliar vs. familiar) on ad hoc medical emergency team performance. Ad hoc medical emergency teams will be comprised of emergency medical nurses and physicians from multiple hospital institutions. The primary outcome measure is team performance, assessed using a validated simulation platform (scenario + team process measures + patient care measures). These measures will collectively represent an accurate, reliable representation of both teamwork and taskwork. PUBLIC HEALTH RELEVANCE: The proposed project seeks to improve teamwork in emergency healthcare teams by evaluating the impact of team member familiarity and leadership training on healthcare team performance using simulation-based assessment. Medical emergency teams present significant risks to patient safety due to their inherent design, the nature of their tasks, and the environment in which they function. The evidence-based simulation-based assessment approach used in this research can be applied to address some of the assessment and outcomes challenges reported in the healthcare team literature. Additionally, the leadership-targeted training addresses many of the feasibility and sustainability issues present in large-scale team training programs (e.g., TeamSTEPPS). Finally, the use of theoretically and empirically supported leadership and team processes means this work is compatible and synergistic with currently existing teamwork and patient safety interventions.