Creating a Culture of Teamwork to Save Lives:
What Does it Take?Eduardo Salas, Ph.D.Department of Psychology &Institute of Simulation & TrainingUniversity of Central [email protected]
This Morning…
We are taking “a trip”… Why you should care about
teamwork… What team science tells us
about teamwork… Give you some advice… What does it take…
Going to Mars…2035
…An expert team
Long Duration…Confine Environment…
This Team Needs To Be…
Reliable, no errors… Resilient, deal with novel
events… Adaptive, change due to
conditions… Self-correcting, no time for
outside intervention…
This Team Needs To Be…
Decisive, make quick & robust decisions…
Cohesive, get along… Safe, errors could cost their
lives… Teamwork, coordinate,
cooperate & communicate…
And So Does Patient Care!!!!
I. What is the State of the Science? What Matters in Teams?
What is the State of the Science?
How Do We Turn a Team of Experts into an Expert Team?
What is the State of the Science? Theoretically-driven (170+ models!)
“Nothing more practical than a good theory.”
It’s a multi-disciplinary field Explosion of empirical work! Studying real teams; performing real
tasks “Teams in the Wild” Simulations
Experts as participants
What is the State of the Science? Hundreds of teams!
Aviation Healthcare Military Corporate world
Teams defined Task interdependency Distributed expertise Hierarchical organized Member Fluidity
What is Teamwork? It is the actions, events and
behaviors, cognition, feelings taken to accomplish a team goal.
It is about… …taskwork skills (i.e., own task). …teamwork skills (i.e., how to work together). …building and maintaining both.
What Matters…
The 7 C’s of Teamwork…
COMMUNICATION
TEAMWORK
Organizational &
Individual Outcomes
Cooperation… Attitudes & Beliefs:
Team Orientation Collective Efficacy Mutual Trust Openness to Experience
Good Teams… Develop collective efficacy Have strong team orientation
Coordination… Behavioral Mechanisms:
Mutual Performance Monitoring Back-up Behavior/Supportive Adaptability/ Flexibility
Good Teams… Self-correct Employ huddle, debriefs
Communication… Information exchange protocols:
Close-loop communication Precise, Timely, Clarity Appropriate terminology
Good Teams… Share unique information
Cognition… Shared understanding:
Roles & Responsibilities Knowledge of team mission; Objectives,
Norms, & Resources Familiarity with Teammates
Good Teams… Have clear roles Team norms are clear
Coaching… Leadership:
Team Leadership Promotes teamwork Cares about team members Sets ground rules
Good Teams… Have coaches Set expectations Clarify roles
Conflict… Conflict resolution strategies:
Interpersonal skills Psychological safety
Good Teams… Deal with conflict, confront it Coaches create psychological
safety
Conditions… Supportive context
Good performance recognized & reinforced
Access to resources Information needed available
Policies, procedures & incentives aligns
Leadership sends “signals” that teamwork matters
II. Ten Characteristics of Effective Teams…
Ten characteristics of effective teams…1. Clear roles & responsibilities
…have members who understand each others’ roles and how they fit together.
2. Compelling purpose – goal, vision …have a clear common purpose. …energized by their shared mission. …can evaluate current status in terms of a
destination.
Ten characteristics of effective teams…3. Team coach (leader) – promotes,
develops, reinforces …leaders that directly intervene to enact
teamwork processes. …have team members who believe the leaders
care about them. …provide situation updates. …set expectations. …self-correct first. …clarify roles. …solicit ideas and observations from team
members. …seek out opportunities to reinforce effective
teamwork.
Ten characteristics of effective teams…4. Mutual trust – familiarity
…manage conflict well—team members confront each other effectively.
…have a strong sense of team orientation. …trust other team members’ “intentions”. …strongly believe in the team’s collective
capability to succeed. …develop collective efficacy.
Ten characteristics of effective teams…5. Team norms – clear, known &
appropriate …what is acceptable “around here”.
6. Shared understanding of task, mission & goals – hold shared mental model …have members who anticipate each
other. …can coordinate without overt
communication.
Ten characteristics of effective teams…7. Self-correct – huddles, debriefs
…regularly provide feedback to each other, both individually and as a team (“de-brief”).
…establish and revise team goals and plans. …differentiate between higher and lower
priorities. …have mechanisms for anticipating and
reviewing issues/problems of members. …periodically diagnose team "effectiveness”,
including its results, its processes, and its vitality (morale, retention, energy).
Ten characteristics of effective teams…8. Set expectations (and are
managed) – clear, understood9. Shared unique information –
efficient information protocols …huddles, debriefs can help.
10. Launched correctly Kick-off meeting
III. Seven Pieces of Advice…
Some Advice… 1. Ensure all team members are trained
on team-based KSA’s…around six of the C’s… Team training ≠ Team building Information, demonstration, practice &
feedback, key elements Scenario carefully crafted Event-based approach
Does Team Training Work?
YES!!!
Team Training Works! Compared with current training,
enhanced training resulted in (see Cannon-
Bowers & Salas, 19981): 45% improvement in Mission
Performance. 33% improvement in Tactical Decision
Making Performance. 25% improvement in Communication
Efficiency. 10-34% improvement in Team
Coordination. In the aviation environment (Salas et al.,
19992): 6-20% improvement in Teamwork
Behaviors.
1Cannon-Bowers, J. A., & Salas, E. 19982 Salas, E. et al 1999
Does Team Training Work? Team training significantly
improves team3:
Cognition (ρ = .42) Shared mental models
Behavioral process (ρ = .44) Communication, coordination,
collaboration Affect (ρ = .35)
Mutual trust, collective efficacy Performance outcomes (ρ = .37)
Task outcomes, satisfaction, viability 3Salas et al., 2008
Does Medical Team Training Impact Clinical Outcomes?
State of the Science of Medical Team Training… 106 Independent Samples, 93 studies were
included in the meta-analysis Military clinicians-3 Nonmilitary clinicians-79 Students-20 Mix-4
Most team training programs were developed in house (38.68%)
Most teams trained are interprofessional (72.64%) but interdisciplinary teams were minority (26.42%)
Communication was the competency most commonly trained (31.66%)
What Did We Find?
Outcome K1 N2Corrected
dRM3
Variance accounted for
Overall 106 19700 .65* 9.5%
Reactions 3 66 0.65* 9.6%
Learning 58 5489 .83* 14.67%
Behaviors 47 7727 0.58* 7.29%
Organizational Outcomes 29 5591 0.30* 2.19%
Patient Outcomes 16 9350 0.43* 4.42%
1. K is the number of effect studies analyzed for this outcome2. N is the number of individuals evaluated in this outcome3. Corrected dRm is the corrected effect size estimate*Statistically significant; confidence interval excludes zero
What Do the Data Mean? Team training improves overall outcomes by 9.5% Team training is well-liked and perceived as useful
9.5%. Team Training accounts for 14.67% of learning 7.29% of improvement of on-the-job performance
-This includes both task and team performance Team training accounts for 2.19% of improvement
in organizational outcomes (e.g., culture, turnover, financial)
Team training accounts for 4.42% of improvement in patient outcomes (e.g., infection, mortality, complications)
Some Advice… 2. Teach how to Debrief and Huddle!-
Simple, Powerful, & Underutilized What worked? What can be improved? Focus on as many C’s as possible. Debriefing works! (Tannenbaum & Cerasoli,
2012) 25% Performance improvement
Some Advice… 3. Use Simulation!
Games, role plays Accelerates expertise Embedded instructional features
Some Advice…4. Develop team coaches, leaders…5. Measure & Reinforce teamwork!6. For sustainability…create
conditions needed… …continuous process …seek supervisory support …not an event, journey …physicians must engage …CFO/CEO/CMO must see value, business
case
Some Advice… 7. See if you can use this statement:
“Am Dr. ____, I am a good surgeon but I am vulnerable to error so you are here to help me take care of this patient– we are a team.”
IV. What Does It Take…
Success Factors1. Leverage pre-existing team training
programs (e.g., TeamSTEPPS, CRM)…Adapt to needs!
2. Need to understand the coordination
demands in your units…Not all teams created equal…Task interdependence matters…
3. Need to focus on teamwork-related KSAs…
4. Prepare the organization, supervisors, leaders and trainees for team training…
Success Factors5. Create conditions - A support
system that facilitates the application of the trained skills back on the job… …Supervisory support… …Opportunity to practice… …Providing tools for teamwork &
collaboration -- checklists, debriefs, huddles, teamwork aids…
… Team coaching…
Success Factors6. …An organizational commitment
(CEO, CFO, CMO)– leadership support to do things differently… Long-term culture change efforts… Resources allocated…
7. …A cadre of organizational mechanisms to promote & reinforce teamwork…creating the conditions for sustainability… Measure & reinforce teamwork… A journey, not an event…
Success Factors8. …Continuous learning &
educating…Support IPE…Start early…
9. …Discipline in using performance support tools – debriefing, huddles, simulation…
10. …Physicians on-board, supporting…champions…
V. Final Thoughts…
Final Thoughts… Effective teamwork is the foundation
for effective patient care. Teams can learn to be more effective
and save lives. The science of teamwork
Remember the 7 C’s of teamwork and the patterns of effective teams.
As of July 1, 2015
Eduardo Salas, Ph.D.Professor of Psychology
Department of PsychologyRice University
Houston, TX
How Can I Help?
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