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Experienced and expressed tensions in acute care teams: Dynamics of tension triggers, escalation and reparation processes and impact on team climate and performance

English title Experienced and expressed tensions in acute care teams: Dynamics of tension triggers, escalation and reparation processes and impact on team climate and performance
Applicant Keller Sandra
Number 178574
Funding scheme Early Postdoc.Mobility
Research institution
Institution of higher education Institution abroad - IACH
Main discipline Psychology
Start/End 01.02.2018 - 31.07.2019
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Keywords (8)

travail d'équipe; dynamiques d'équipe; tensions; incivilité; conflit; émotions; équipes de soins aigus; chirurgie

Lay Summary (French)

Lead
Les conséquences des conflits et tensions durant le travail de groupe, aussi bien sur la qualité du travail que sur les membres du groupe, sont connues. Cependant, les facteurs déclencheurs des tensions ainsi que les facteurs à la base d’une escalade ou au contraire d’une réduction de la tension restent encore largement inexplorés.
Lay summary

Les conflits sont la plupart du temps étudiés à long ou moyen-terme en psychologie, et des facteurs tels que des désaccords sur la tâche, comment effectuer la tâche ainsi que des problèmes relationnels ont été trouvés être à la base de conflits. Dans le domaine de la médecine en particulier, les facteurs souvent cités comme responsables de conflits sont généralement des facteurs stables, typiquement des personnalités difficiles ou la culture organisationnelle.

Le projet de recherche a pour objectif d’investiguer les déclencheurs et les processus d’escalade ou de résorption de la tension au cours de l’interaction. Ces aspects n’ont fait l’objet que de peu d’études empiriques ; ils sont cependant cruciaux pour comprendre la dynamique des tensions au travail et les stratégies développées par les membres d’une équipe lors de tensions.

Une première étude prévoit d’investiguer les déclencheurs des tensions dans le contexte du bloc opératoire. Il s’agira d’examiner par des observations et des entretiens situationnels les tensions exprimées ainsi que les tensions ressenties. Une deuxième étude se focalisera sur les processus d’escalade et de résorption des tensions et leurs effets positifs ou négatifs sur la performance de l’équipes de soins aigus.

Le projet a été conçu à l’intersection entre le domaine de la psychologie du travail, des sciences affectives et celui plus récent de la sécurité des patients. Bien que le projet s’inscrive dans une perspective de recherche fondamentale, il a pour objectif de contribuer à une meilleure connaissance des processus émotionnels au travail, et ainsi à l’identification des aspects émotionnels à prendre en compte lors de futures recherches appliquées ou interventions au travail.

Direct link to Lay Summary Last update: 26.01.2018

Responsible applicant and co-applicants

Publications

Publication
Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation
Keller Sandra, Yule Steven, Smink Douglas S., Zagarese Vivian, Safford Shawn, Parker Sarah Henrickson (2020), Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation, in BMC Surgery, 20(1), 318-318.
Predictors and triggers of incivility within healthcare teams: A systematic review of the literature
Keller Sandra, Yule Steven, Zagarese Vivian, Parker Sarah (2020), Predictors and triggers of incivility within healthcare teams: A systematic review of the literature, in BMJ Open, 10, e035471.

Collaboration

Group / person Country
Types of collaboration
Harvard Medical School United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Virginia Tech United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Scientific conference Talk given at a conference Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation 09.10.2020 Planned loation: Stockholm - Due to the COVID-19 pandemic, participants met online, Sweden Keller Sandra;
14th annual INGRoup Conference Poster Experienced and expressed tensions in the operating room: are all team members on the same emotional page? 18.07.2019 Lisbon, Portugal Keller Sandra;
SIOP Talk given at a conference Tensions in surgical teams and their association with perceived quality of cooperation 04.04.2019 National Harbor, United States of America Keller Sandra;
12th international meeting on behavioral science applied to surgery and acute care settings Talk given at a conference Triggers of incivilities in acute care teams: a systematic review of the literature 19.10.2018 Munich, Germany Keller Sandra;


Self-organised

Title Date Place
Symposium at the SPS Conference 09.09.2019 Bern, Switzerland
Symposium at the 13th INGRoup conference 18.07.2018 Washington DC, United States of America

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Gynecology and obstetrics residents meeting Talk 03.05.2019 Roanoke (VA), United States of America Keller Sandra;
General surgery residents and surgeons meeting Talk 01.05.2019 Roanoke (VA), United States of America Keller Sandra;
Anesthetists team meeting Talk 01.05.2019 Roanoke (VA), United States of America Keller Sandra;
Quality and Safety meeting for nurses Talk 01.05.2019 Roanoke (VA), United States of America Keller Sandra;


Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) The Challenge of Giving and Receiving Feedback in the Operating Room (in press) Harvard Macy Institute Blog International 2019

Awards

Title Year
Best Poster Award at the 14th annual INGRoup Conference, July 18-20; Lisbon, Portugal 2019

Abstract

Aim. I plan to investigate dynamics of tensions in acute care teams. I structure the research project based on two research questions. (1) The first research question addresses the processes underlying the emergence of tensions and tension escalation in surgery. I consider emotional and regulation processes in the perspective of initiators, targets and witnesses of tensions (2). The second research question relates to behavioral markers of dynamic handling of tensions at the team level, after the tension is expressed. I hypothesize that teams, including tensions’ initiators, engaging in reparation processes (e.g. small talk, thankfulness) decrease the negative effects of tension on team climate and performance.State of research in the field. Previous research brought to light tensions as an important issue in organizations, both affecting employees and patient safety in the medical domain. However, dynamics of tensions remained largely unexplored: (1) many scholars pointed to surgeons' difficult (stable) personalities and neglected situative and regulation aspects as tension triggers. Conflict theories focused on stable teams, without studying conflict in the interaction. (2) Traditional theoretical models on effects of tensions do not conceptualize team members’ active strategies to handle tensions. I intent to contribute bridging these gaps by combining different research approaches: affective event theories that stress the role of situational tension triggers, research on emotional regulation mechanisms as predictor of emotion expression and research on interactional conflict handling in relationships and negotiations. Methods. I plan two studies. (1) The first study is a field study that aims at investigating tension triggers in surgical settings. The method consists in structured observations and a short event based survey interview conducted directly after pediatric surgeries with all team members. Questions relate to tensed situations, emotions and regulation processes (e.g. attribution of the tension). I will use mixed methods, implying the coding of qualitative material to perform statistical analyses. (2) The second study bases on videos of trauma simulations to test hypothesis 2 (handling tensions at the team level). I plan to use video process coding to assess handling with tensions and team processes and relate these aspects to team performance as measured by medical specialists.
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