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