Improving patient safety through leadership and team performance in simulations

项目摘要 背景：有效的团队合作和团队绩效对于临床中的错误缓解和安全性至关重要 环境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。迄今为止，工作重点是团队培训。但挑战 与这些方案的可行性、可持续性和有效性有关的问题已经确定。此外，本发明的目的是， 培训小组作为一个单位，虽然需要有效的培训成果，但对于特设应急小组来说几乎是不可能的 其特点是在复杂、动态和时间的环境下运作的跨学科、高度可变的成员 在临床环境中的压力条件。本研究将团队领导与团队构成作为两个研究重点 医疗急救团队绩效的重要介质，尚未在患者安全研究中进行研究。 目的：本研究的总体目标是（1）开发一种新的、基于证据的领导力培训 计划和（2）评估领导力培训和团队成员组成（不熟悉与熟悉）的影响 医疗急救队的表现，使用基于模拟的研究平台。这将推动 AHRQ的患者安全使命：（1）提供额外的机制（领导力培训），以改善团队 克服与当前团队培训计划相关的挑战，（2）提供 一种评估团队绩效的强大诊断方法，直接评估基于证据的团队流程 （协调，备份行为等），（3）调查团队组成对团队绩效的影响， 患者安全关键行为。 方法：该项目建立在以前的工作基础上，分为三个具体目标： 目的1：评估医疗团队组成（不熟悉与熟悉的成员）对医疗服务的影响。 应急团队绩效 目标2：开发和实施基于自适应学习的团队领导力培训计划 系统理论启发式 目标2a：评估团队领导力培训对医疗急救团队绩效的影响 目的3：评估团队领导力培训对不熟悉与熟悉的医疗服务的不同影响。 应急队伍 这个项目使用了2（不熟悉与熟悉）X2（领导力培训与控制）完全交叉的设计来评估影响 领导力培训和团队组成（不熟悉与熟悉）对特设医疗应急团队绩效的影响。Ad 临时医疗应急小组将由来自多家医院的急救护士和医生组成 机构职能体系主要的结果测量是团队绩效，使用经过验证的模拟平台进行评估 （方案+团队流程措施+患者护理措施）。这些措施将共同代表一个准确的， 团队合作和任务工作的可靠代表。 !

PROJECT SUMMARY 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. !