Primary health care team faultlines and team performance: the mediating role of knowledge sharing.

Family doctor teams, serving as health gatekeepers, are extensively advocated in China. Their composition, comprising a heterogeneous mix of professionals, contributes to a more comprehensive service, but also poses challenges. Consequently, scholarly interest has arisen in comprehending how these compositions, known as faultlines, influence team dynamics and outcomes. However, there is a lack of comprehensive exploration into how faultlines influence team members' communication processes and knowledge sharing. This study aims to provide insights into the associations between faultlines in primary care teams and team performance, specifically exploring how knowledge sharing may mediate these effects, with the goal of revealing key insights to optimize contracted family doctor services. Survey data from 291 family doctor teams in China was utilized to test hypotheses, revealing a negative association between (social-category and information-based) faultlines and knowledge sharing. Team knowledge sharing acts as a mediator in the relationship between these faultlines and team performance. Our findings advance faultlines theory and emphasize the mediating role of knowledge sharing in elucidating the interplay between faultlines and team performance. These insights are crucial for fostering collaboration, managing faultlines, and enhancing healthcare team performance.

Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation.

BACKGROUND: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. METHODS: This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. RESULTS: An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. CONCLUSIONS: Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes.

Securing success: Exploring attachment dynamics and psychological safety for adaptive behaviors in a military context.

Providing safety is a key function for leaders for those under their command in a military context, and research to date has focused on various aspects of leaders' personalities and leadership styles to investigate the outcomes for their followers. The present research aims to complement this view by adopting a follower-centric approach and exploring the individual and team-level effects of attachment and psychological safety. Drawing on attachment theory, we developed and tested a model that explicates how employees' attachment projections are mediated by psychological safety to influence adaptive behaviors and team performance positively. We collected multi-source survey data from a Navy department to test our model. Our findings suggest that attachment to leaders can indirectly enhance adaptive behaviors through individual psychological safety. This research underscores the critical role of attachment dynamics and resulting safety perceptions in shaping adaptive behaviors among military personnel, emphasizing their significance as social resources.

Automation function and malfunction: effects on human performance in accident handling tasks.

By conducting a mixed-design experiment using simplified accident handling tasks performed by two-person teams, this study examined the effects of automation function and condition (before, during, and after malfunction) on human performance. Five different and non-overlapping functions related to human information processing model were considered and their malfunctions were set in a first-failure way. The results showed that while the automation malfunction impaired task performance, the performance degradation for information analysis was more severe than response planning. Contrary to other functions, the situation awareness for response planning and response implementation tended to increase during malfunctioning and decrease after. In addition, decreased task performance reduced trust in automation, and malfunctions in earlier stages of information processing resulted in lower trust. Suggestions provided for the design and training related to automation emphasise the importance of high-level cognitive support and the benefit of involving automation error handling in training.

The effects of automation function and malfunction on human performance are important for design and training. The experimental results in this study revealed the significance of high-level cognitive support. Also, introducing automation error handling in training can be helpful in improving situation awareness of the teams.

Unveiling the Impact of Communication Network on Engineering Project Team Performance: The Interplay of Centralization and Tie Strength.

Purpose: Recent research has focused on the impact of communication networks on the performance of construction project teams, attempting empirical exploration from various social network analysis perspectives. However, there is still a significant gap in understanding the variations in performance and the mechanisms for teams using different communication networks. Drawing from organizational learning theory and social network theory, this study, based on the Input-Mediator-Output (IMO) model, explores the effects of the interaction between centralization and tie strength in communication networks on team performance, as well as the mediating mechanisms of knowledge sharing behavior and team resilience performance in engineering project teams. Methods: Drawing on classic group communication experiment, we design an online communication and collaboration platform to simulate the execution of a construction engineering project. Finally, data was collected through the communication experiment with 720 participants, and hypotheses were tested using ANOVA and PROCESS. Results: The results indicate that under conditions of weak tie strength, centralized communication networks yield higher performance. Conversely, under conditions of strong tie strength, decentralized communication networks demonstrate superior performance. Furthermore, this study also verifies the mediating role of knowledge sharing behavior and team resilience performance when tie strength is strong. Conclusion: This study focuses on engineering project team, exploring the evolutionary development of knowledge sharing behavior and team resilience performance from the perspective of the interaction of communication network structural characteristics, as well as the paths to enhancing team performance. Our research results highlight the interactive effects of structural indicators and relational indicators of communication networks, revealing the mechanism by which the structure of communication networks impacts team performance. Additionally, from the perspectives of forming and timely adjusting team communication models, and motivating and supporting employee communication behavior, our study provides practical insights for project managers and relevant administrators.

Composition considerations for fluid teams: a review.

The need exists to better understand how to comprise fluid teams-teams that are assembled on short notice, from members with little to no familiarity, who come together to carry out a time-limited task, and then disband. Due to the ever-increasing complexity of the modern workplace, the demand for these types of fluid teams is growing in task domains such as the military, aviation, healthcare, and industry. The aim of this paper is to review the team composition literature to shed light on composition considerations for forming fluid teams.

Value-based healthcare implementation in the Netherlands: a quantitative analysis of multidisciplinary team performance.

BACKGROUND: Many hospitals worldwide have set up multidisciplinary Value Improvement (VI) teams that use the Value-Based Health Care (VBHC) theory to improve patient value. However, it remains unclear what the level of VBHC implementation is within these teams. We therefore studied the current level of VBHC implementation in VI teams. METHODS: A questionnaire was developed based on the strategic agenda for value transformation and real-world experiences with VBHC implementation. The questionnaire consisted of 21 questions, mapped to seven domains, and was sent out to 25 multidisciplinary VI teams. Median scores for individual questions (scale = 1-5) and average scores per domain were calculated. RESULTS: One hundred forty VI team members completed the questionnaire. The overall average score is 3.49. The 'culture and responsibility' domain obtained the highest average score (µ = 4.11). The domain 'measure and improve outcomes' and the domain 'multidisciplinary team' obtained average scores that are slightly higher than the overall average (µ = 3.78 and µ = 3.76 respectively), and the domains 'strategy and organizational policy,' 'collaboration and sharing,' and 'IT and data' scored a little below the overall average (µ = 3.41, µ = 3.32, and µ = 3.29 respectively). The domain 'costs and reimbursement' obtained the lowest average score (µ = 2.42) of all domains, indicating that the implementation of this particular aspect of VBHC remains lagging behind. CONCLUSIONS: Our results indicate activity in each of the questionnaire domains. To bring VBHC implementation to the next level, more attention should be given to the financial aspects. Our questionnaire can be used in future studies to identify improvements or differences within VI teams.

Translation and psychometric validation of the Thai version of TeamSTEPPS® team performance observation tool.

In healthcare, effective communication and teamwork are pivotal in reducing medical errors. Integrating team training into health professions education is crucial. Accurate measurement of team performance during training requires reliable assessment tools. The TeamSTEPPS® Team Performance Observation Tool (TPOT), recently updated by the Agency for Healthcare Research and Quality, serves this purpose. However, it had not been translated and validated for use in Thailand. We aimed to translate and assess the psychometric properties of the Thai version of TPOT. Employing a back-translation process, TPOT was adapted to the Thai context. The resulting Thai TPOT instrument was administered to 518 healthcare professionals who had undergone TeamSTEPPS® training. Participants were asked to evaluate two prerecorded, 7-minute simulated team emergency scenarios using the Thai TPOT instrument. Results exhibited high internal consistency (Cronbach's alpha = .96) and inter-rater reliability (ICC = .98). Confirmatory factor analysis affirmed the construct validity of the Thai TPOT. These findings establish the Thai TPOT as useful for evaluating teamwork within healthcare teams.

The association between team cohesion and performance: A network analysis of nurses.

Team cohesion, as a necessary condition for the cooperation and development of a team, has been shown to have a strong association with team performance. However, the mechanism of this internal correlation is unclear and more in-depth studies are lacking. The study aimed to explore the complex links between the dimensions of team cohesion and performance in nurses. A total of 1639 practice nurses from 118 nursing teams were included in this cross-sectional study. Data were collected using the Team Cohesion Scale (including consistency of affection, behavior, and cognition) and the Team Effectiveness Scale (including cooperation satisfaction, and task performance). Using network analysis, the team cohesion and performance network was constructed, and the strength and bridge strength of nodes were calculated. The results showed that the edges between team cohesion and performance dimensions were all positively correlated. Cooperation satisfaction and consistency of affection are the core variables in the network. Interventions targeting cooperation satisfaction and consistency of affection need to be developed at the team level to maximize team cohesion and performance among nurses.

Supporting fluid teams: a research agenda.

Fluid teams are teams that are rapidly assembled from across disciplines or areas of expertise to address a near-term problem. They are typically composed of individuals who have no prior familiarity with one another, who as a team must begin work immediately, and who disband at the completion of the task. Prior research has noted the challenges posed by this unique type of team context. To date, fluid teams have been understudied, yet their relevance and application in the modern workplace is expanding. This Perspective article presents a concise overview of critical research gaps and opportunities to support selection, training, and workplace design for fluid teams.

Evidence for a new model of the complex interrelationship of ball possession, physical intensity and performance in elite soccer.

BACKGROUND: How the physical metrics, especially physical intensity, and possession interact with each other, and subsequently combine to influence performance remains opaque. Therefore, we investigated the interrelationship of possession, physical metrics, and team performance in elite soccer. METHODS: Four seasons of a top European league were used to derive 80 team league performances (points), together with possession and physical data. Physical metrics were absolute distances (m) during the whole match and ball-in-play, and rates of distance covered (m⋅min-1 ) as the index of physical intensity, notably when in-possession/out-of-possession, in total and within five speed categories. Interrelationships of possession, physical metrics, possession, and performance were assessed with Pearson's correlations and mediation analysis. RESULTS: Overall possession (r = 0.794) and time out-of-possession within the defensive third (r = -0.797) were most strongly correlated with performance. The strong relationships between in-possession distances and performance appeared coincidental due to greater time in-possession. Physical intensity had a complex relationship with possession and performance, with opposite relationships according to possession status: lower physical intensity when in-possession and higher physical intensity when out-of-possession were associated with possession and performance. Mediation analysis revealed the direct, independent importance of possession for team performance; however, the association of physical intensity with performance was largely (>79%) mediated by possession. CONCLUSION: Based on these findings, we propose a novel model of the interrelationships between possession, physical intensity, and performance, whereby higher possession is the largest, direct contributor toward enhanced team performance, with lower physical intensity in-possession a consequence of higher possession, but greater physical intensity when out-of-possession a cause of increased possession.

Increased team familiarity for surgical time savings: Effective primarily in complex surgical cases.

BACKGROUND: Cohesion between team members is critical for surgical performance. Our previous study has shown that the experience of working together (measured by Team Familiarity Score, TFS) helps reduce procedure time (PT). However, that conclusion was found in a relatively small sample size. With a large dataset including mixed general surgical procedures, we hypothesize that team familiarity makes a significant contribution to the improvement of team performance in complex cases, rather than in medium or basic surgical cases, measured by the procedure time, length of hospital stays (LOS), and surgical cost (COST). STUDY DESIGN: Patient demographics, operation, and patient outcome data of 922 general surgery cases were included. The cases were divided into three subgroups, including basic, medium, and complex surgical procedures. TFS and an Index of Difficulty of Surgery (IDS) were calculated for each procedure. Simple linear regression and random forest regressions were performed to analyze the association between surgical outcomes and all included independent variables (TFS, IDS, patient age, patient weight, and team size). RESULTS: When applied to complex cases, procedure time (r = -0.21) and cost (r = -0.23) dropped as TFS increases. In basic and medium surgical cases, increasing team familiarity failed to shorten the procedure time on average. CONCLUSION: Team familiarity is more important in complex cases because there is greater potential for improvement through team collaboration compared to basic and medium cases. Caution will be needed when applying team familiarity scores for examining surgical team performance in large databases with skewed to basic surgical cases.

What can we learn from COVID-19?: examining the resilience of primary care teams.

Introduction: The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience. Methods: Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19. Results: Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing. Discussion: These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.

"If you work alone on this project, you can't reach your target": unpacking the leader's role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19.

The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants' experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders' attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members' mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.

Exploring objective measures for assessing team performance in healthcare: an interview study.

Introduction: Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach. Methods: A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question. Results: The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures. Discussion: The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

Women's wheelchair basketball lineup analysis at the Tokyo 2020 paralympic games: game related statistics explaining team sport performance.

Introduction: Performance analysis through game-related statistics in wheelchair basketball (WB) has focused mainly on the study of the individual efficiency of players according to their functional classification. However, there is little evidence focusing on lineup performances (five players on court) and their composition. Thus, the objective of present study was to analyze the efficiency of the women's WB lineups used during the Tokyo 2020 Paralympic Games (PG) and to determine the variables that best discriminated the lineup performances according to the final point differential. Methods: The sample comprised 507 lineups used in the 31 games by the 10 national teams during the competition. Fifty-one different lineup types (LTs) were categorized. A discriminant analysis was carried out to compare the lineups with a positive and negative point difference according to the game type (balanced and unbalanced games). Results: It was found that LTs 16 (1-1.5-2.5-4-4.5), 47 (1-2-2.5-4-4.5) and 14 (1-1.5-2.5-4.5-4.5) had the best means of efficiency in field goals (LT 16 = 52%; LT 47 = 44% and LT = 40%), while LT 50 (1-2-3-4-4) obtained the highest mean difference in points (3.67 ± 10.67). The variables that best discriminated winner teams in balanced games were field goal efficiency (SC = 0.55), assists (SC = 0.50) and turnovers (SC = -0.41). Discussion: Field goal efficiency, assists, turnovers and steals are the game-related statistics most associated with the success of a lineup used in balanced games in WB in PG competition; this could be taken into account by coaches when deciding how to compose a given lineup in a moment of the game, to adequately select players from different functional classifications for the final squad and to choose training content related to the indicated game-related statistics, as they explain success at this competition level.

Team Dynamics in the Operating Room: How Is Team Performance Optimized?

Health care requires the effort of a team, and nowhere is this more evident than in the care of the surgical patient. No single clinician can perform all aspects of the continuum of surgical care. The basic operating room (OR) team consists of nurses, technicians, surgeons, and anesthesiologists with unique and well-defined roles and expertise in perioperative care. The modern OR team continues to grow and evolve in size, diversity, and complexity to meet the needs of growing patient and procedural complexity. This growing complexity makes achieving optimal team performance paramount and challenging.