Project

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Debriefings as Enabler for Learning in Ad-hoc Action Teams in Healthcare

English title Debriefings as Enabler for Learning in Ad-hoc Action Teams in Healthcare
Applicant Kolbe Michaela
Number 152822
Funding scheme Project funding (Div. I-III)
Research institution Abteilung Qualitätsmanagement und Patientensicherheit USZ UniversitätsSpital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Psychology
Start/End 01.09.2014 - 31.08.2017
Approved amount 355'472.00
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All Disciplines (2)

Discipline
Psychology
Surgery

Keywords (5)

Teamwork; Patient safety; Ad-hoc teams; Learning; Anesthesia

Lay Summary (German)

Lead
Improving patient safety is a major concern in healthcare, especially in high-risk medical domains such as anesthesia or surgery where poor teamwork can result in the loss of life. In these disciplines, work is performed by ad-hoc, action teams which are fluid and dynamic rather than definite and stable. Despite the growing presence of these so-called acute care teams (ACT), not much is known of what drives their effectiveness and enables their learning. Within the project we will extend current knowledge on ACT learning and performance by examining how structured debriefings-also called after action reviews (AARs)-can provide a suitable learning infrastructure.
Lay summary

 

Die Verbesserung der Patientensicherheit ist ein zentrales Anliegen in der Medizin. Dies gilt besonders für risikoreiche Disziplinen wie Anästhesie oder Chirurgie, wo schlechte Teamarbeit schnell zum Verlust von Menschenleben führen kann. In diesen Disziplinen arbeiten anstatt stabilen, traditionellen Teams eher ad-hoc zusammengesetzte, dynamische Teams. Bisher ist nicht viel darüber bekannt, wie diese Teams effektiv und sicher arbeiten können. In diesem Projekt untersuchen wir, wie regelmässige, strukturierte Debriefings—auch After Action Reviews genannt—diesen ad-hoc Teams nach komplexen Operationen, Zwischenfällen und Notfalleinsätzen helfen können, kurz aber systematisch über die Zusammenarbeit zu reflektieren und Verbesserungspotentiale zu identifizieren. Dazu werden verschiedene After Action Review-Methoden miteinander verglichen. Ziel ist, Bedingungen zu identifizieren, die solche After Action Reviews nicht nur effektiv und effizient sondern auch leicht anwendbar machen.

Das Projekt besteht aus 3 Phasen. In Phase 1 vergleichen wir mit einem Prä-Post-Kontrollgruppen-Design im Rahmen simulations-basierter Trainings ein neu entwickeltes Debriefingtool mit einer konventionellen Debriefingmethode. In Phase 2 werden wir u.a. mit den Teilnehmenden aus Phase 1 Interviews durchführen, um sowohl die subjektive Perspektive beim Debriefen als auch nötige Voraussetzungen zum Anwenden des Debriefingtools zu untersuchen. Darauf aufbauend werden wir in Phase 3 mit einem Prä-Post-Design die Anwendung des strukturierten Debriefingtools im klinischen Alltag untersuchen.

Da ad-hoc Teams zunehmend in vielen Organisationen eingesetzt werden, halten wir die Ergebnisse des Projektes auch relevant für gegenwärtige Teams ausserhalb des Spitalkontextes.

 

Direct link to Lay Summary Last update: 16.04.2014

Responsible applicant and co-applicants

Employees

Publications

Publication
Implizite Führungstheorien in Akutsituationen im Gesundheitswesen„Kobra, übernehmen Sie!“
Seelandt Julia, Grande Bastian, Kolbe Michaela (2017), Implizite Führungstheorien in Akutsituationen im Gesundheitswesen„Kobra, übernehmen Sie!“, in Gruppe. Interaktion. Organisation. Zeitschrift für Angewandte Organisationspsychologie (GIO), 48(1), 69-78.
How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns
Kolbe Michaela, Marty Adrian, Seelandt Julia, Grande Bastian (2016), How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns, in Advances in Simulation, 1(29), 1.
Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude, and setting
Kolbe Michaela, Grande Bastian, Spahn Donat R. (2015), Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude, and setting, in Best Practice & Research: Clinical Anaesthesiology, 29(1), 87-96.
DE-CODE: A coding scheme for assessing debriefing interactions
Seelandt Julia, Grande Bastian, Kriech Sarah, Kolbe Michaela, DE-CODE: A coding scheme for assessing debriefing interactions, in BMJ Simulation and Technology Enhanced Learning, in press.
Observing Group Interaction: The Benefits of Taking Group Dynamics Seriously
Michaela Kolbe, Margarete Boos, Observing Group Interaction: The Benefits of Taking Group Dynamics Seriously, in Brauner Elisabeth, Kolbe Michaela, Boos Margarete (ed.), Cambridge University Press, Cambridge, UK, in press.
Quality Control: Assessing Reliability and Validity
Seelandt Julia, Quality Control: Assessing Reliability and Validity, in Brauner Elisabeth, Kolbe Michaela, Boos Margarete (ed.), Cambridge University Press, Cambridge, UK, in press.
Simulation und Forschung
Kolbe Michaela, Seelandt Julia, Nef Andrina, Grande Bastian, Simulation und Forschung, in Breuer Georg, St.Pierre Michael (ed.), in press.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
CareArt 2017 Talk given at a conference Worüber sollen wir jetzt sprechen? Debriefings & Patientensicherheit 09.06.2017 Basel, Switzerland Kolbe Michaela;
ESA Conference Talk given at a conference Simulation for learning team dynamics - systemic debriefing methods. 03.06.2017 Genf, Switzerland Kolbe Michaela;
Update Refresher Anesthesia and Intensive Care 2017 Talk given at a conference CRM - Gute Kommunikation zur Verbesserung der Team Performance 31.05.2017 Zürich, Switzerland Grande Bastian;
APS-Tagung Talk given at a conference Nachbesprechungen herausfordernder Behandlungssituationen 05.05.2017 Berlin, Germany Kolbe Michaela;
European Symposium on Ambulatory Anesthesia and Analgesia Talk given at a conference Simulation based team trainings 10.03.2017 Zürich, Switzerland Grande Bastian;
IMSH 2017 Talk given at a conference Measuring Teamwork - Transformative Teams 28.01.2017 Orlando, United States of America Grande Bastian;
InSim 2016 Poster "Debriefing-Mythen" - Eine systemische Interviewstudie über Hindernisse und Erfolgsfaktoren bei der Durchführung von Debriefings im klinischen Alltag 13.10.2016 Dresden, Germany Kolbe Michaela; Seelandt Julia; Grande Bastian;
SESAM 2016 Poster Assessing debriefing interactions with DE-CODE - a coding scheme for assessing debriefing interactions 15.06.2016 Lissabon, Portugal Kolbe Michaela; Seelandt Julia; Grande Bastian;
SESAM 2016 Poster Enhancing team learning in acute care teams by using debriefings 15.06.2016 Lissabon, Portugal Grande Bastian; Seelandt Julia; Kolbe Michaela;
IMSH 2016 Poster DE-CODE - A coding scheme for assessing debriefing interactions 16.01.2016 San Diego, United States of America Seelandt Julia; Grande Bastian; Kolbe Michaela;
InSim 2015 Poster Was wirkt wie in Debriefings? Eine Mikroanalyse von Debriefing-Interaktionen 17.10.2015 München, Germany Grande Bastian; Seelandt Julia; Kolbe Michaela;
InSim 2015 Poster DE-CODE: Ein Kodiersystem zur Messung von Debriefing-Interaktionen 17.10.2015 München, Germany Seelandt Julia; Kolbe Michaela; Grande Bastian;
9th International Workshop on Behavioral Sciences Applied to Surgery and Acute Care Settings Poster Debriefings for enhanced learning in acute care teams 09.10.2015 Bonn, Germany Grande Bastian; Seelandt Julia; Kolbe Michaela;
6th International Conference of Applied Human Factors and Ergonomics Poster Using debriefings to enhance learning in acute care teams 17.07.2015 Las Vegas, United States of America Seelandt Julia; Kolbe Michaela; Grande Bastian;
Conference of the European Society of Anesthesiologists Talk given at a conference Communication barriers: Does better communication reduce the risks 30.05.2015 Berlin, Germany Kolbe Michaela;
Dreiländerkongress 2015 Talk given at a conference Debriefings-Wozu, weshalb, warum? 20.03.2015 Karlsruhe, Germany Kolbe Michaela; Grande Bastian; Seelandt Julia;
IMSH 2015 Poster From simulation to reality 10.01.2015 New Orleans, United States of America Kolbe Michaela; Grande Bastian;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Kommunikation im Behandlungsteam Talk 09.05.2017 Zürich, Switzerland Kolbe Michaela;
InSim Workshop 13.10.2016 Dresden, Germany Seelandt Julia; Grande Bastian; Kolbe Michaela;
OP-Symposium Talk 29.09.2016 St.Gallen, Switzerland Kolbe Michaela;
OP-Management Symposium Talk 16.09.2016 Davos, Switzerland Kolbe Michaela;
Mythen und Fakten zur Teamarbeit Talk 15.09.2016 Zürich, Switzerland Kolbe Michaela;
SESAM Workshop 15.06.2016 Lissabon, Portugal Grande Bastian; Kolbe Michaela; Seelandt Julia;
EMS 2016 Talk 30.05.2016 Kopenhagen, Denmark Kolbe Michaela;
PädSim Weiterbildung Workshop 23.04.2016 Tübingen, Germany Kolbe Michaela;
Gesundheitstagung des Kantons Nidwalden Talk 21.04.2016 Nidwalden, Switzerland Kolbe Michaela;
IMSH 2016 Workshop 16.01.2016 San Diego, United States of America Kolbe Michaela; Grande Bastian; Seelandt Julia;
InSim Workshop 17.10.2015 München, Germany Kolbe Michaela; Grande Bastian; Seelandt Julia;
European Safety Course Talk 18.09.2015 Männedorf, Switzerland Kolbe Michaela; Grande Bastian;
Internationaler Tag der Patientensicherheit Talk 17.09.2015 Zürich, Switzerland Seelandt Julia; Grande Bastian; Kolbe Michaela;
Annual SIDOPS/SIGOP Meeting Talk 06.03.2015 Yverdon les Bain, Switzerland Grande Bastian; Kolbe Michaela;
IMSH 2015 Workshop 10.01.2015 New Orleans, United States of America Kolbe Michaela; Grande Bastian;


Self-organised

Title Date Place
Debriefing team interactions using circular questions 15.06.2017 Paris, France
Simulation and research 11.03.2017 New York City, United States of America

Communication with the public

Communication Title Media Place Year
Media relations: radio, television Notfall im Notfall SRF German-speaking Switzerland 2017
Media relations: radio, television Wenn Fehler tödlich enden SRF German-speaking Switzerland 2017
Media relations: radio, television Wenn ein falscher Entscheid zum Tod führen kann SRF - 10 vor 10 Western Switzerland 2016
Media relations: radio, television Wie Teamarbeit funktioniert ARD - Planet Wissen International 2016
New media (web, blogs, podcasts, news feeds etc.) Reducing healthcare cost by investing in safety: safety management examples from the U.S. Swiss Re Risk Dialogue International 2014
Media relations: radio, television Teamwork kann Leben retten ARD - W Wie Wissen International 2014

Abstract

Improving patient safety is a major concern in healthcare, especially in high-risk medical domains such as anesthe-sia, surgery, and intensive care where poor teamwork can result in the loss of life. In these disciplines, work is performed by ad-hoc, action teams which are fluid and dynamic rather than definite and stable. Despite the growing presence of these so-called acute care teams (ACT) in today’s organizations, not much is known of what drives their effectiveness and enables their learning. Current team learning theories do not apply to ACTs because they do not factor in their lack of temporal stability. Due to this temporal instability, learning has to be transitional, that is enable team members to use the team experience from participating in one ACT to improve participating in another ACT. However, there is only limited knowledge on what ACTs do and need to learn. Within the project we will extend current knowledge on ACT learning and performance by examining how structured debriefings-also called after action reviews-can provide a suitable learning infrastructure and enhance learning. So far, debrief-ings are underutilized and understudied in healthcare. When not well-structured, they are also at risk to fail because phenomena on the individual and social level such as cognitive biases, preference-consistent information sharing, and a lack of psychological safety that may inhibit explicitness and structured information sharing. By designing a structured ACT debriefing tool that takes these risks into account and by meticulously studying its effectiveness we will contribute to the science of team and organizational learning as well as of debriefings. The project will consist of three phases. In phase one, we will compare the effects of the ACT debriefing tool with the effects of a conventional, unstructured debriefing method (i.e. plus/delta) via simulation-based training applying a pre-post, control group design. In addition, we will perform in-depth analyses of debriefing communications to understand how learners react to different behaviors and communications used by debriefers. In phase two we will conduct semi-structured interviews with some of the participants from phase one to examine the subjective perspectives of ACT members during debriefings. To enhance the generalizability of our results over organizational and cultural contexts, we also intent to interview leading subject matter experts at the Center for Medical Simulation in Boston and the Institute of Medical Simulation and Advanced Learning in New York City. Building on the results of phases one and two, in phase 3 we will examine the effects of the ACT debriefing tool on ACT learning and performance in clinical practice applying a pre-post test design. From the results we expect to extend currently limited knowledge on learning processes within ACTs. Specifically, we expect to learn (a) how learning and performance of ACTs will be effectively enhanced by struc-tured debriefings in clinical practice which could provide a cost-effective and potentially powerful learning infra-structure and (b) how ACT debriefings have to be embedded in organizational learning, set up, and conducted to provide an effective yet feasible and low-threshold learning tool for ACTs. Also, by prospectively evaluating ACT debriefings in clinical practice we hope to contribute to evidence-based patient safety research. As ACTs represent the growing number of fluid, dynamic teams in many organizations, we consider the enhanced understanding of their learning processes neither limited to healthcare nor to high-risk teams but applicable to many of today's con-temporary teams.
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