Cultural diversity in health care teams: A systematic integrative review and research agenda.

BACKGROUND: Although team-based work is deemed key to improving the quality of national health care systems, adverse events related to teamwork account for up to one third of all incidents. Health care teams are typically multiprofessional and diverse in many aspects, but cultural diversity is one of the most challenging. PURPOSES: The objective of this review is to systematically analyze the literature to better understand the impact of cultural diversity in health care teams on team processes as well as team and patient outcomes. This study also explores the conditions that enable or hinder team functioning. METHODOLOGY: Through a systematic integrative literature review, this study builds on the input-process-output-context framework. Multiple searches of the main databases led to identifying 43 relevant articles. FINDINGS: The results suggest that, when not proactively managed, cultural diversity may have a negative effect on team communication and integration, increasing team conflict and thereby negatively influencing team performance, team climate, and patient safety, both directly and indirectly. Yet, when managed properly and in the presence of engaged and culturally sensitive leadership, cultural training, and open and transparent procedures, cultural diversity in health care teams can be an asset to health care organizations. Analyzing and aggregating these findings into an integrative framework, our study identifies several themes and a research agenda for future studies on culturally diverse health care teams. PRACTICE IMPLICATIONS: Our findings suggest that culturally diverse health care teams experience a number of challenges, pointing to the need for action or structures that enable these teams to perform better, such as emphasizing learning and allowing team members time to get to know each other outside work.

Simulation educators in clinical work: the manager's perspective.

PURPOSE: Information is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers' perceptions of the significance of clinically active simulation educators for the organisation. DESIGN/METHODOLOGY/APPROACH: Healthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers' perceptions of simulation educators' impact as co-workers on their healthcare organisations. FINDINGS: The identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators' work. PRACTICAL IMPLICATIONS: The findings might have implications for the implementation and support of simulation training programs. SOCIAL IMPLICATIONS: Healthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff. ORIGINALITY/VALUE: The study provided new insights about how simulation educators as team members affect clinical practice.

Confident but not theoretically grounded - experienced simulation educators' perceptions of their own professional development.

BACKGROUND: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature. OBJECTIVES: To explore changes in experienced simulation educators' perceptions of their own teaching skills, practices, and understanding of teaching over time. METHODS: A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis. RESULTS: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor's pedagogical development. CONCLUSION: Experienced simulation educators' pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.