and Teamwork Communication
ISyE 349
Video
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Take home messages
Teams and groups are different.
Teams need to be designed and trained
according to scientific evidence
Good team performance emerges from
good team design and training
Riddle me this...
A team of experts does
not make an expert team.
Why not...what makes a
good team?
Think of teams on which you have participated.
What made some perform well? What made some
perform poorly?
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What is a team?
Individuals (a) who see themselves and who are seen by
others as a social entity, (b) who are interdependent
because of the tasks they perform as members of a
group
Teams generally have
Task interdependence
Distributed expertise and roles
Hierarchically Organized
Common goal
Who uses teams?
Everyone!
Aviation
Sports
Finance
Nuclear power
Healthcare
Consulting
Manufacturing
Why are teams important?
The Industries and Businesses
Keep competitive advantage
Movement toward team-based systems
80% of individuals report belong to
organizational team (Fiore et al., 2001)
Believe teams are better than
individuals
Jobs are more complex, difficult and
dynamic
Groups vs. Teams
In groups performance depends mostly on
individual contributions. People might all
have the same roles and skills
In teams skills are complimentary, roles
are highly defined, members are mutually
accountable to each other and need each
other to succeed. They work toward a
common goal and are interdependent.
Group vs. Team Performance
In groups productivity may be only as
good as the most productive individual
In teams productivity is an emergent
property of teamwork and task work and
therefore total productivity can be greater
than individual parts
Taskwork vs. Teamwork
Taskwork relates to member jobs
Teamwork supports relationships and
functional interactions
Communication, coordination, cooperation
Teamwork supports taskwork
What is required for effective teams?
TEAM REQUIREMENTS
Attitude
Knowledge
Skills
Feelings
Thinking
Doing
TEAM PERFORMANCE
Attitude requirements
Collective efficacy
Shared vision
Team cohesion
Mutual trust
Collective/team orientation
Value of teamwork
Knowledge requirements
Shared Task Models; Situation
Assessment
Teammate Characteristics; Familiarity
Knowledge of Team Mission; Objectives;
Norms; Resources
Roles and expectations
Individual-task proficiency
Skill requirements
Mutual performance monitoring
Supporting/Back-up behavior
Team leadership
Task-related assertiveness
Conflict resolution
Closed-loop communication
Video 1
Video 2
Team leadership
are led by someone with good leadership skills
and
not just technical competence.
have team members who believe the leaders
cares about them.
provides situation updates.
fosters teamwork, coordination and cooperation
self-correct first.
Building Good Teams
Ensure team members know their job
Provide detailed, timely and diagnostic feedback
Ensure members know how their jobs intersect with
team members
Set performance goals that are hard, challenging and
achievable
Set goals at the team-level as well as individual-level
Provide feedback on goals
Set learning goals early in development, performance
goals later
Is teamwork and communication
important?
Breakdowns in teamwork and
communication are one of the
most common problems in the
operating room and other
healthcare settings
Breakdowns in teamwork and
communication are one of the
largest contributors to errors
and patient harm
video
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How do we measure teamwork?
Mayo High Performance
Teamwork Scale (MHPTS)
Observational Teamwork
Assessment for Surgery
(OTAS)
Trauma Team Performance
Observation Tool (TPOT)
Non-technical Skills for
Surgeons (NOTSS) behavior
rating system
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How can teamwork and
communication be improved?
Training
Crew Resource Management (CRM)
TeamSTEPPS
Briefings
Standardization of Communication
Familiarity
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Background of CRM Training
Crew resource management training was
first introduced in 1979.
Purpose is to train crewmembers to utilize
all available resources: information,
people, and equipment within and outside
the cockpit.
Since its inception, has evolved through 5
generations.
History of CRM
1st Generation CRM
Emphasis on changing individual styles and correcting deficiencies
in individual behavior
Aimed at individual attitudes, leadership, and communication
Objective was to prevent accidents due to flawed flight crews
Heavy focus on psychological testing
Individuals had either the right or wrong stuff
It is not surprising that the pilot community did not embrace early CRM
training.
Paries, J. & Amalberti, R. (1995). Recent trends in aviation safety: From individuals to organizational resources
management training. In Risoe National Laboratory Systems Analysis Dept. (Eds.), Technical Report(Risoe
Series 1; pp. 216-228). Roskilde, Denmark: Risoe National Laboratory.
Salas, E., Burke, S., Bowers, C., and Wilson, K. (2001). Team training in the skies: Does crew resource
management (CRM) training work? Human Facotrs, 43, 641-674.
History of CRM
2nd Generation CRM
Still aimed at individual attitudes, leadership, and communication but
expanded to include
situation awareness
the error chain
stress management
decision making
Focus on cockpit group dynamics
Dealt more with specific aviation concepts related to flight operations
Both 1st and 2nd generation CRM training relied heavily on role-playing
and non-aviation related games, and resorted to repetitive accident
case studies.
History of CRM
3rd Generation CRM
Aimed at improving the overall system performance through
improved performance of the systems basic flight operational units
aircraft/crew system
flight/cabin crew system
maintenance
Added concepts of mental models, fatigue management, automation
management, vigilance, and human reliability
Training intended to develop not only skills, but also understanding
and knowledge.
Safety was considered to be proactive rather than reactive
History of CRM
4th Generation CRM
Aim to improve overall system performance through improved
performance of as many as possible of the systems components.
Includes topics such as:
interaction among teams
shared mental models
role and status
organizational synergy
Advance Qualification Program Airlines tailored training to fit their
needs
Required to provide both CRM and line oriented flight training
(LOFT)
History of CRM
5th Generation CRM
CRM being used to manage errors (Threat and Error
Management)
on Emphasis error avoidance, detection, and
minimization of consequences
Teamwork Training in
Healthcare
Crisis Resource
Management
Team Strategies and Tools to
Enhance Performance and
Patient Safety
(TeamSTEPPS)
http://teamstepps.ahrq.gov/index.htm
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Evaluating Teamwork Training
(Kirkpatricks Framework, 1976)
Reactions: Assessment of trainees feelings
toward the program.
Learning: Principles, facts, and skills
understood and absorbed by participants.
Behavior: Assessment of whether knowledge
learned in training transfer to actual behavior on
job or in a simulated environment.
Results: Assessment of impact on organization
as a whole.
Does team training work?
(Cannon-Bowers & Salas, 1998; Salas et al., 1999)
Compared with current training, enhanced
training resulted in
45% Improvement in Mission Performance
33% Improvement in Tactical Decision Making
Performance
25% Improvement in Communication Efficiency
10-34% Improvement in Team Coordination
6-20% Improvement in Teamwork Behaviors
What about Healthcare?
(McCulloch, Rathbone, & Catchpole, 2011)
Conclusion: The evidence for
technical or clinical benefit from
teamwork training in medicine is
weak. There is some evidence of
benefit from studies with more
intensive training programmes
[such as simulation], but better
quality research and cost-benefit
analysis are needed.
Training Guide: Using Simulation in
TeamSTEPPS Training
http://www.ahrq.gov/teamsteppstools/sim
ulation/index.html
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Why doesnt team training
always work?
Eight myths about
CRM training
Salas, Wilson, Burke, & Bowers, 2002
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Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 1: Everyone who has ever learned
anything or has gone to training is a
training expert and therefore can design it.
Training requires knowledge of cognitive and behavior
aspects of learning.
Designers must consider scenario design, guided practice,
feedback, measurement, and supporting technology.
They must also be trained in the necessary knowledge,
skills and attitudes (KSAs).
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 2: Subject matter experts should drive
the design of training.
Subject matter experts are great source of task domain
knowledge and can and should articulate the needs and
requirements to execute a task.
They are necessary but not sufficient to ensure a sound
learning environment.
A such, the design of CRM training (like any other)
requires a partnership between subject matter experts and
training experts.
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 3: The higher the fidelity of the
simulation, the better one learns.
Simulations designed with low physical and functional
fidelity will be as effective as those with high fidelity as
long as the psychological fidelity of the system is
adequate.
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 4: The more one practices, the better
one gets.
Practice alone does not improve performance.
Practice needs to be guided and requires measurement
and feedback.
Practice should accompany training that help trainees
develop appropriate mental representations of the task.
Practice makes permanent, not necessarily perfect!
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 5: If you know how well you did during
training, learning has taken place.
Feedback must provide more than just a rating of good
or bad.
It should be diagnostic and constructive, based on the
process performed during training, specific to the trainees
skill performance, and provide an indication of how the
trainee can improve.
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 6: Positive reactions to what
happened during training leads to learning.
Just because trainees liked training does not mean that
the desired knowledge, skills, and attitudes were learned.
It is important that organizations look at training beyond
reactions to accurately assess, diagnose, and evaluate
the program.
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 7: If one learns during training, this
will lead to behavior change on the job.
Although trainees learn the trained knowledge, skills, and
attitudes, these may not transfer to the job.
Transfer requires that the material learned in training be
generalized to the job setting and that skills be retained
over time.
What affects transfer?
Culture / climate
Opportunities to perform on the job
Delays between training and real performance
Social cues and support
Rewards / punishment
Actual physical design of jobs and technologies
Myths about CRM Training
Salas, Wilson, Burke, & Bowers, 2002
Myth 8: CRM is a stand alone program.
CRM training involves the design and delivery of
instructional strategies and requires the
integration of tools, methods, and content, as
well as organizational support.
How can teamwork and
communication be improved?
Training
Crew Resource Management (CRM)
TeamSTEPPS
Briefings
Standardization of Communication
Familiarity
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Improving Teamwork and
Communication
Pre-operative briefings
The goal of this project was to
...develop, implement, and evaluate a
preoperative briefing for cardiovascular
surgery.
After implementation..., there was a
reduction in total surgical flow disruptions
per case including miscommunication
events ...On average, briefed teams
experienced fewer trips to the core and
spent less time in the core ...and there
was a trend toward decreased waste .
Video 1
Video 2
Improving Teamwork and
Communication
Pre-operative briefings
Standardization of
communication
Intraoperative communication
was assessed before (n =18) and
after (n =16) introduction of a
structured communication
protocol... Frequency of
communication breakdowns per
case decreased significantly after
implementation.
Video 1
Video 2
Improving Teamwork and
Communication
Pre-operative briefings
Standardization of
communication
Team familiarity
Teams made up of members that
were familiar with the operating
surgeon had significantly fewer...
total teamwork failures in
comparison to those teams where
the majority of members were
unfamiliar with the operating
surgeon.
FINAL EXAM
Identify the good and bad aspects of
teamwork and communication in the
following videos...
Video 1
Video 2
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Acknowledgements
Videos courtesy of Bill Taggart, Michael
Leonard, Eric Thomas and Kaiser
Permanente and the Surgical Safety
Institute.
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