Team and Leadership Performance: An Exploratory Mixed-Methods Analysis Using Interprofessional In Situ Simulation
Abstract
Learning Objective: To assess leader and team performance during interprofessional in situ simulation and identify characteristics of effective teams.
Background: Patient care in the emergency department (ED) is dependent on highly effective interprofessional teams.
Objectives: To assess leader and team performance during interprofessional in situ simulation and identify characteristics of effective teams.
Methods: This mixed-methods study employed case study methodology. Eligible nurses, technicians, pharmacists, and PGY 2-4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated team performance using the Team Performance Observation Tool (TPOT) 2.0. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following the simulations we conducted semi-structured interviews. Transcripts were coded by two coders and underwent thematic analysis.
Results: 23 simulations took place between January-April 2021. Two raters’ scores were on the high end of the scales for the TPOT 2.0 (R1 4.90,SD=0.17;R2 4.53,SD=0.27), TEAM (R1 3.89,SD=0.19;R2 3.58,SD=0.39), and Ottawa GRS (R1 6.6,SD=.56;R2 6.2,SD=.54). Team leader attributes including year in residency, age, and gender did not correlate with performance scores. We identified 6 themes: leadership tone, interdependent energy, strategic staffing, optimal communication, simulation empowering team performance, and team entrustment. Participants acknowledged the effectiveness of in situ simulation in promoting entrustment in the clinical setting.
Conclusions: The TPOT and TEAM were not discriminatory for high-performing ED teams. Our qualitative analysis revealed features such as entrustability, energy, and team size are important for effective team dynamics but are not completely captured on current tools. ED-specific assessments of interprofessional entrustment may be useful in optimizing readiness for the clinical setting.