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Speaking Up for patient safety: Investigating the social dynamics of voice behavior in healthcare

English title Speaking Up for patient safety: Investigating the social dynamics of voice behavior in healthcare
Applicant Kolbe Michaela
Number 169785
Funding scheme Project funding (Div. I-III)
Research institution Simulationszentrum Universitätsspital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Psychology
Start/End 01.12.2016 - 31.12.2019
Approved amount 436'484.00
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All Disciplines (2)

Discipline
Psychology
Surgery

Keywords (5)

Patient safety; Social sensors; Voice; Teamwork; Ad-hoc teams

Lay Summary (German)

Lead
In der Medizin ist die Verbesserung der Patientensicherheit ein zentrales Anliegen. Ein besonderes Anliegen dabei ist die Förderung von Speaking Up - das offene Äussern von Bedenken, Vorschlägen und Ideen und das Nachfragen bei Zweifeln. Ohne Speaking Up können potentielle Fehler am Patienten weniger gut vermieden werden. In diesem Projekt untersuchen wir die sozialen Dynamiken von Speaking Up in der Medizin. Basierend auf aktuellen Entwicklungen in sensoren-basierter Messmethodik ist das Ziel des Projekts, mehr über die Prozessdynamiken und sozialen und Verhaltenskorrelate von Speaking Up zu erfahren. Dadurch sollen wirksame und nachhaltige Interventionen zur Förderung von Speaking Up entwickelt werden können.
Lay summary

In der Medizin ist die Verbesserung der Patientensicherheit ein zentrales Anliegen. Ein besonderes Anliegen dabei ist Speaking Up – das offene Äussern von Bedenken, Vorschlägen und Ideen und das Nachfragen bei Zweifeln. Die Forschung hat gezeigt, dass Speaking Up wesentlich seltener als erwünscht geschieht. Das ist problematisch, denn ohne Speaking Up können potentielle Fehler am Patienten weniger gut vermieden werden. In komplexen Disziplinen wie im Operationsaal oder Schockraum ist das besonders relevant, da dort schlechte Teamarbeit schnell zum Verlust von Menschenleben führen kann. In diesen Disziplinen arbeiten anstatt stabilen, traditionellen Teams vor allem ad-hoc zusammengesetzte, dynamische Teams (Acute Care Teams). Diese Teams können sich nicht auf Speaking Up-Teamnormen verlassen.

In diesem Projekt untersuchen wir die sozialen Dynamiken von Speaking Up in Acute Care Teams. Basierend auf aktuellen Entwicklungen in sensoren-basierter Messmethodik ist das Ziel des Projekts, mehr über die Prozessdynamiken und sozialen und Verhaltenskorrelaten von Speaking Up zu erfahren. Dadurch sollen wirksame und nachhaltige Interventionen zur Förderung von Speaking Up entwickelt werden können.

Das Projekt besteht aus 4 Studien. Studie 1 ist ein Laborexperiment, dort werden wir den Einfluss der Reaktionen auf Speaking Up und der wahrgenommenen Erfahrung der Teammitglieder auf Speaking Up-Interaktionsmuster untersuchen. Studien 2 und 3 sind simulationsbasierte Quasi-Experimente, in denen wir verschiedene Reaktionen auf Speaking Up, soziale Empfindsamkeit und Cognitive Load im Zusammenhang mit physiologischen Markern und Speaking Up-Interaktionsmustern untersuchen werden. Basierend auf Studien 1-3 werden wir in Studie 4 physiologische Marker und Teaminteraktionsmuster in Relation zu Speaking Up im klinischen Spitalsetting untersuchen. 

Direct link to Lay Summary Last update: 26.09.2016

Responsible applicant and co-applicants

Employees

Publications

Publication
“Not only hard to make but also hard to take:” Team leaders’ reactions to voice
KrenzHanna, BurtscherMichael, KolbeMichaela (2019), “Not only hard to make but also hard to take:” Team leaders’ reactions to voice, in Gruppe. Interaktion. Organisation. Zeitschrift für Angewandte Organisationspsychologie (GIO), 1.
Observing group interaction: The benefits of taking group dynamics seriously
Kolbe Michaela, Boos Margarete (2018), Observing group interaction: The benefits of taking group dynamics seriously, in Brauner Elisabeth, Boos Margarete, Kolbe Michaela (ed.), Cambridge University Press, Cambridge, UK, 68.
„Speaking Up“ statt tödlichem Schweigen im Krankenhaus: Die entscheidende Rolle der Gruppenprozesse und Organisationskultur
Kolbe Michaela, Grande Bastian (2016), „Speaking Up“ statt tödlichem Schweigen im Krankenhaus: Die entscheidende Rolle der Gruppenprozesse und Organisationskultur, in Gruppe.Interaktion.Organisation, 47(4), 299-311.

Collaboration

Group / person Country
Types of collaboration
Valentin Neuhaus, Division of Trauma, University Hospital Zurich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Sebastian Feese, Electronics Laboratory - Wearable Computing, ETH Zurich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
Nadine Bienefeld, ZHAW School of Applied Psychology Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
The Center for Medical Simulation (CMS) United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
12th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Talk given at a conference Changes in lead-taking = changes in voice-making?: Variation in team composition and its impact on communication in healthcare teams 19.10.2018 Munich, Germany Krenz Hanna Lea; Burtscher Michael Josef; Förster Sonja; Kolbe Michaela; Grande Bastian;
SGI - Jahrestagung Schweizerische Gesellschaft für Intensivmedizin Talk given at a conference Speak up: reagieren und sich gegenseitig ansprechen, wenn die Patientensicherheit gefährdet ist 19.09.2018 Interlaken, Switzerland Grande Bastian;
Organization Science Winter Conference Talk given at a conference Pass on the Baton: Technological Advocacy and Its Effects on Routine Interfaces and Employee Voice 03.03.2018 Park City, United States of America Brusoni Stefano; Förster Sonja;
Research Meeting, Institute of Anesthesiology, University Hospital Zurich Talk given at a conference Pass on the Baton: Technological Advocacy and Its Effects on Routine Interfaces and Employee Voice 24.01.2018 Zurich, Switzerland Förster Sonja; Brusoni Stefano;
BSAS 11th International Meeting for Behavioural Sciences Applied to Surgery and Acute Care Settings Poster Speaking Up After The Deed: A Quasi-Experimental Study on Postoperative Handovers 20.10.2017 Zurich, Switzerland Brusoni Stefano; Förster Sonja;
Research Meeting Department of Management, Technology and Economics, ETH Zurich Talk given at a conference Speaking Up After The Deed: A Quasi-Experimental Study on Postoperative Handovers 19.10.2017 Zurich, Switzerland Förster Sonja; Brusoni Stefano;
Gemeinsame Jahrestagung SGI | GSASA Talk given at a conference CRM in Healthcare 13.09.2017 St. Gallen, Switzerland Grande Bastian;


Knowledge transfer events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Anästhesiologisches Kolloquium Talk 08.01.2019 Universitätsklinik Regensburg, Germany
Safety, Risk & Quality - von den Besten lernen, Workshop- und Vortragsreihe zu Themen der Patientensicherheit Workshop 20.11.2018 Zurich, University Hospital, Switzerland
2nd Zurich-Harvard Intensive Clinical Bioethics Course Workshop 09.11.2018 Univesity Hospital Zurich, Switzerland
Faculty development workshop for simulation-based educators Workshop 09.11.2018 REA 2000, St. Gallen, Switzerland
2nd Zurich-Harvard Intensive Clinical Bioethics Course Talk 09.11.2018 University Hospital Zurich, Switzerland
Nationalt PKL-seminar Talk 28.05.2018 Sørup Herregård, Denmark
EMS 2018 Talk 15.04.2018 Kopenhagen, Denmark
EMS 2018 Talk 15.04.2018 Kopenhagen, Denmark
Safety, Risk & Quality - von den Besten lernen, Workshop- und Vortragsreihe zu Themen der Patientensicherheit Workshop 14.11.2017 UniversitätsSpital Zürich, Switzerland
SGI | SSMI - Postgraduate Course | Simulation Workshop 13.09.2017 St. Gallen, Switzerland
Gemeinsames Weiterbildungsprogramm der Intensivstationen USZ Talk 09.05.2017 UniversitätsSpital Zürich, Switzerland


Associated projects

Number Title Start Funding scheme
177069 Advancing team science by social sensor-based measurement 01.04.2018 R'EQUIP

Abstract

Improving patient safety is a major challenge in healthcare. Of particular concern is the scarcity of Speaking Up, also called “voice”, which refers to explicit communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or team functioning. Without Speaking Up, potential harm for patients will not be prevented. This is particularly important in complex environments such as operating and emergency rooms, where errors can quickly lead to adverse consequences?for patients. Teams in these settings are mostly organized as Acute Care Teams (ACTs; i.e., ad hoc, fluid action teams of highly skilled specialists working together for brief performance events). They cannot rely on established norms to Speak Up, their performance is safety-critical at most times, and their work cannot be revised at a later point. As such, Speaking Up is rare, in healthcare as well as in other domains. Whereas many barriers to Speaking Up have been studied, potentially enabling social dynamics of actual Speaking-Up behavior are still poorly understood. Moreover, due to static research mainly relying on self-report data, little is known about how actual Speaking Up unfolds within teams. Within the proposed project, we will extend current knowledge on Speaking Up by studying the social dynamics of voice behavior in ACTs. Building on recent developments in sensor-based measurement (SBM) as high-frequency, low-cost, and unobtrusive measurement of behavioral data in teams, we will address some of the shortcomings of extant studies of voice in teams. By examining the suitability of SBM for this purpose, investigating actual Speaking-Up behavior, and focusing on enabling social dynamics we will contribute to the science of voice in teams. The proposed project will consist of four studies. In study 1, we will examine voice interaction patterns with respect to perceived team member experience and response to voice in the laboratory setting. In study 2, we will test the effects of different forms of civil responses to Speaking Up on the occurrence of further Speaking Up and explore related interaction patterns in real ACTs in the simulated setting. In study 3, we will examine voice patterns in relation to social perceptiveness and cognitive load, also in real ACTs in the simulated setting. Building on the results of studies 1 to 3, in study 4 we will further examine team members’ physiological markers and interaction patterns in relation to voice over a two-month period in the clinical setting. The interdisciplinary team of applicants builds on expertise in psychology, medicine, and technology and innovation management, allowing for synergistic approaches throughout the proposed project. From the results we expect to extend our understanding regarding the social dynamics of voice within ACTs. Specifically, we expect to learn (a) how the dynamics of voice unfold, (b) what meaningful behavioral and social correlates can be obtained via SBM, and c) how to design and better target more powerful interventions for promoting Speaking Up. With the results from the four proposed studies we aim to (a) help embedding Speaking Up into healthcare practice, education, and training, (b) advance research methods capturing team dynamics, and (c) contribute to evidence-based patient safety research. As ACTs represent a prototypical example of the fluid, dynamic teams that can be found in an increasing number of organizations, we consider the enhanced understanding of their Speaking-Up dynamics not limited to healthcare but applicable to many of contemporary teamwork settings.
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