Errors in the heat of battle: taking a closer look at shared cognition breakdowns through teamwork.

OBJECTIVE: We developed a theoretically based taxonomy for classifying shared cognition breakdowns related to teamwork which contribute to fratricide incidents. BACKGROUND: Fratricide on the battlefield is an inescapable cost of war. A number of technological advancements have been made in terms of combat identification systems to reduce the risk of these incidents. However, fratricide continues to occur at alarming rates. METHOD: We take a human-centered approach to understanding errors leading to fratricide incidents by focusing on shared cognition. We turn to the literature and provide the theoretical foundations for an error classification taxonomy to improve understanding of why fratricide incidents occur. RESULTS: Based on our review of the literature, we identified a number of problem areas leading to fratricide incidents. However, many of the cited contributing factors were broad terms (e.g., poor coordination) and did little to tell us why the breakdown occurred and where improvements are needed. Therefore, we chose to focus on one specific area--teamwork breakdowns--and discuss in depth how these breakdowns contribute to fratricide. CONCLUSION: In this paper, we take a first step toward proposing a taxonomy that allows for the diagnostic assessment of what causes teamwork breakdowns in fratricide. We understand that a taxonomy is only as good as the data available and encourage richer case studies from which to learn. APPLICATION: To apply this taxonomy in an operational setting, we provide a set of behavioral markers that can be used to identify teamwork breakdowns on the battlefield.

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.