Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

Background: Effective teams are essential to high-quality healthcare. However, teams, team-level constructs, and team effectiveness strategies are poorly delineated in implementation science theories, models, and frameworks (TMFs), hindering our understanding of how teams may influence implementation. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework is a flexible and accommodating framework that can facilitate the application of team effectiveness approaches in implementation science. Main Text: We define teams and provide an overview of key constructs in team effectiveness research. We describe ways to conceptualize different types of teams and team constructs relevant to implementation within the EPIS framework. Three case examples illustrate the application of EPIS to implementation studies involving teams. Within each study, we describe the structure of the team and how team constructs influenced implementation processes and outcomes. Conclusions: Integrating teams and team constructs into the EPIS framework demonstrates how TMFs can be applied to advance our understanding of teams and implementation. Implementation strategies that target team effectiveness may improve implementation outcomes in team-based settings. Incorporation of teams into implementation TMFs is necessary to facilitate application of team effectiveness research in implementation science.

Teams and team-level constructs are neglected in implementation theories, models, and frameworks (TMFs). This paper calls attention to the importance of teams in implementation research and practice and provides an overview of team effectiveness research for implementation science. We illustrate how the EPIS framework can be applied to advance our understanding of how teams influence implementation processes and outcomes. We identify future directions for research on teams and implementation, including developing and testing implementation strategies that focus on team effectiveness.

A Lexical Approach to Assessing Stress: Development and Proof-of-Concept.

OBJECTIVE: We describe a methodology that provides a nonobtrusive means of detecting stress and related deficits through the assessment of spontaneous verbal output in ongoing communications. BACKGROUND: In high-demand environments, operational personnel are exposed to an array of environmental, task, and interpersonal stressors that can negatively impact performance as well as jeopardize safety and well-being. In these settings, the requirement exists to assess cognitive and emotional state "at a distance" and without interfering with ongoing performance. METHOD: We describe a lexical approach to assessing stress effects from ongoing or spontaneous verbal output. This approach is examined in a spaceflight analog setting. RESULTS: We assess stress effects in terms of five core dimensions and develop lexical indicators of these core stress dimensions and relevant sub-facets. We establish the proof-of-concept of this approach by presenting representative data from a spaceflight analog. CONCLUSION: This approach provides an unobtrusive means to evaluate ongoing task communications at the individual and team level in order to assess cognitive/emotional states such as workload, negative affect, attentional focus, anxiety, and team orientation. APPLICATION: There are many high-demand settings in which it is valuable to monitor the potential negative effects of stress on operational personnel. These environments include spaceflight, the military, aviation, law enforcement, and medicine.

Understanding Team Learning Dynamics Over Time.

Organizations depend on the learning capabilities of teams in order to be competitive in today's information-laden business landscape. Hence, it is not surprising that there have been tremendous efforts made to understand team learning within the past two decades. These efforts, however, have produced a cluttered literature-base that overlooks a fundamental aspect of team learning: How do teams learn over time? In this paper, we first synthesize the literature to develop a shared vocabulary to understand team learning dynamics. We then leverage research investigating how teams operate within the context of time (e.g., team development, performance cycles, emergent state development) and combine it with the extant team learning literature in developing an unfolding model of team learning. This comprehensive model addresses a noticeable gap in the extant literature by illustrating how teams learn over time. Finally, we put forth three grand challenges for the future of team learning research.

A Bottom Up Perspective to Understanding the Dynamics of Team Roles in Mission Critical Teams.

There is a long history, dating back to the 50 s, which examines the manner in which team roles contribute to effective team performance. However, much of this work has been built on ad hoc teams working together for short periods of time under conditions of minimal stress. Additionally, research has been conducted with little attention paid to the importance of temporal factors, despite repeated calls for the importance of considering time in team research (e.g., Mohammed et al., 2009). To begin to understand team roles and how temporal aspects may impact the types of team roles employed when teams are working in extreme mission critical environments, the current manuscript uses a data-driven, bottom-up approach. Specifically, we employ the use of retrospective historical data as our input and a historiometric approach (Simonton, 2003). Source documents consist primarily of autobiographies, memoires, biographies, and first-hand accounts of crew interaction during spaceflight. Critical incidents regarding team interaction were extracted from these source documents and independently coded for team roles by two trained raters. Results of the study speak to the importance of task and social roles within teams that are predominantly intact and operating in extreme environments where mistakes can be life threatening. Evidence for the following task (i.e., coordinator, boundary spanner, team leader, evaluator, critic, information provider, team player, and innovator) and social roles (i.e., team builder, nurturer, harmonizer, entertainer, jokester, and the negative roles of attention seeker and negativist) were found. While it is often task roles that receive the greatest attention, results point to the importance of not neglecting the socioemotional health of the team (and the corresponding roles). Results also indicated that while some roles were consistently enacted independent of temporal considerations (e.g., mission length), the degree to which others were enacted varied across missions of differing lengths. Additionally, based on the current sample we see the following trends: (1) increased enactment of the team builder role as mission duration increases, (2) prominence of the entertainer role, and (3) increased emphasis on the visionary/problem solver role on missions over 2 years.

Total Force Fitness in units part 1: military demand-resource model.

The military unit is a critical center of gravity in the military's efforts to enhance resilience and the health of the force. The purpose of this article is to augment the military's Total Force Fitness (TFF) guidance with a framework of TFF in units. The framework is based on a Military Demand-Resource model that highlights the dynamic interactions across demands, resources, and outcomes. A joint team of subject-matter experts identified key variables representing unit fitness demands, resources, and outcomes. The resulting framework informs and supports leaders, support agencies, and enterprise efforts to strengthen TFF in units by (1) identifying TFF unit variables aligned with current evidence and operational practices, (2) standardizing communication about TFF in units across the Department of Defense enterprise in a variety of military organizational contexts, (3) improving current resources including evidence-based actions for leaders, (4) identifying and addressing of gaps, and (5) directing future research for enhancing TFF in units. These goals are intended to inform and enhance Service efforts to develop Service-specific TFF models, as well as provide the conceptual foundation for a follow-on article about TFF metrics for units.

Does team training improve team performance? A meta-analysis.

OBJECTIVE: This research effort leveraged the science of training to guide a taxonomic integration and a series of meta-analyses to gauge the effectiveness and boundary conditions of team training interventions for enhancing team outcomes. BACKGROUND: Disparate effect sizes across primary studies have made it difficult to determine the true strength of the relationships between team training techniques and team outcomes. METHOD: Several meta-analytic integrations were conducted to examine the relationships between team training interventions and team functioning. Specifically, we assessed the relative effectiveness of these interventions on team cognitive, affective, process, and performance outcomes. Training content, team membership stability, and team size were investigated as potential moderators of the relationship between team training and outcomes. In total, the database consisted of 93 effect sizes representing 2650 teams. RESULTS: The results suggested that moderate, positive relationships exist between team training interventions and each of the outcome types. The findings of moderator analyses indicated that training content, team membership stability, and team size moderate the effectiveness of these interventions. CONCLUSION: Our findings suggest that team training interventions are a viable approach organizations can take in order to enhance team outcomes. They are useful for improving cognitive outcomes, affective outcomes, teamwork processes, and performance outcomes. Moreover, results suggest that training content, team membership stability, and team size moderate the effectiveness of team training interventions. APPLICATION: Applications of the results from this research are numerous. Those who design and administer training can benefit from these findings in order to improve the effectiveness of their team training interventions.

Markers for enhancing team cognition in complex environments: the power of team performance diagnosis.

Team cognition has been identified as a key component to achieve mission goals in dynamic, team-based, stressful, distributed and multicultural operations. Effective team performance in complex environments requires that team members hold a shared understanding of the task, their equipment, and their teammates. So, many of the simulation-based training (SBT) systems and programs have been designed (partly) to enhance shared/team cognition. However, these simulation systems lack the sufficient robustness in their performance assessment tools or capabilities (if they have any) to allow for a rich and deep understanding of team cognition. Therefore, the purpose of this article is fourfold: I) to present a brief account of team cognition; 2) to develop the concept of performance diagnosis and present SBT as an approach to the performance diagnosis of team cognition; 3) to present a set of illustrative behavioral markers of team cognition; and 4) to explicate how these elements (performance diagnosis, team cognition, and SBT) can be leveraged to increase training effectiveness through the development of performance profiles--a rich, detailed, and informative set of metrics--and cognitive and behavioral indicators or illustrative markers of team cognition. Research needs are discussed in terms of realizing the potential of this approach in operational and embedded training contexts.

Understanding team adaptation: a conceptual analysis and model.

This endeavor provides a multidisciplinary, multilevel, and multiphasic conceptualization of team adaptation with theoretical roots in the cognitive, human factors, and industrial-organizational psychology literature. Team adaptation and the emergent nature of adaptive team performance are defined from a multilevel, theoretical standpoint. An input-throughput-output model is advanced to illustrate a series of phases unfolding over time that constitute the core processes and emergent states underlying adaptive team performance and contributing to team adaptation. The cross-level mixed-determinants model highlights team adaptation in a nomological network of lawful relations. Testable propositions, practical implications, and directions for further research in this area are also advanced.

Does crew resource management training work? An update, an extension, and some critical needs.

OBJECTIVE: This review provides the state of crew resource management (CRM) training evaluations since the E. Salas, C. S. Burke, C. A. Bowers, and K. A. Wilson (2001) review and extends it to areas beyond aviation cockpits. Some critical evaluation needs in CRM training are also covered. BACKGROUND: Because of the purported success of CRM training in aviation, other high-consequence domains have begun to implement CRM training for their workforces. However, the true impact of CRM training in aviation and these other domains has yet to be determined. METHOD: Using D. L. Kirkpatrick's (1976) framework for evaluating training (i.e., reactions, learning, behavior, and organizational impact), we reviewed 28 published accounts of CRM training to determine its effectiveness within aviation, medicine, offshore oil production and maintenance, shipping/maritime, and nuclear power domains. RESULTS: Findings indicate that CRM training generally produced positive reactions from trainees; however, the impact of training on learning and behavioral changes suggest mixed results across and within domains. Furthermore, and as was found by Salas, Burke, et al. in 2001, we cannot ascertain whether CRM has had an impact on the organization's bottom line (i.e., safety). CONCLUSION: Based on the results, there are several critical needs that the CRM training community must address before CRM training can have the desired impact on safety: a mandate, access to data, and resources. APPLICATION: As CRM training expands to organizations beyond aviation, it is critical that its impact be understood such that it can be improved and achieve the intended results.

Using simulation-based training to improve patient safety: what does it take?

BACKGROUND: Through simulations health care workers can learn by practicing skills taught and experiencing mistakes before interacting with an actual patient. A number of areas within the health care industry are currently using simulation-based training to help individuals and teams improve patient safety. WHAT IS SIMULATION-BASED TRAINING? The key components of simulation-based training are as follows: performance history/skill inventory, tasks/competencies, training objectives, events/exercises, measures/metrics, performance diagnosis, and feedback and debrief. WHAT DOES IT TAKE FOR SIMULATION-BASED TRAINING TO BE EFFECTIVE? To be effective, simulation-based training must be implemented appropriately. The guidelines are as follows: understand the training needs and requirements; instructional features, such as performance measurement and feedback, must be embedded within the simulation; craft scenarios based on guidance from the learning outcomes; create opportunities for assessing and diagnosing individual and/or team performance within the simulation; guide the learning; focus on cognitive/psychological simulation fidelity; form a mutual partnership between subject matter experts and learning experts; and ensure that the training program worked. CONCLUSION: The health care community can gain significantly from using simulation-based training to reduce errors and improve patient safety when it is designed and delivered appropriately.

The impact of cross-training on team effectiveness.

The authors examined the role of cross-training in developing shared team-interaction mental models, coordination, and performance in a 2-experiment study using computer simulation methodology (for Experiment 1, N = 45 teams; for Experiment 2, N = 49 teams). Similar findings emerged across the 2 experiments. First, cross-training enhanced the development of shared team-interaction models. Second, coordination mediated the relationship between shared mental models and team performance. However, there was some inconsistency in the findings concerning the depth of cross-training necessary for improving shared mental models. Results are discussed in terms of the impact of different levels of cross-training on team effectiveness.