Assessment of Clinical Performance During Simulated Crises Using Both Technical and Behavioral Ratings

Gaba, David M.; Howard, Steven K.; Gan, Brendan Flana; Smith, Brian E.; Fish, Kevin J.; Botney, Richard

doi:10.1097/00132586-199904000-00057

Cited by 62 publications

(86 citation statements)

References 0 publications

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“…This line of research began with the work of Gaba et al (2001) who developed Anesthesia Crisis Resource Management (ACRM). ACRM was designed to help anesthesiologists effectively manage crises by working in multidisciplinary teams that include physicians, nurses, technicians, and other medical professionals (Howard et al 1992;Gaba et al 1998Gaba et al , 2001. ACRM uses patient simulators to provide training in specific technical and generic teamwork skills.…”

Section: Critical Components Of Teamworkmentioning

confidence: 99%

Teamwork as an Essential Component of High‐Reliability Organizations

Baker

Day

Salas

2006

Health Services Research

686

487

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Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. Highreliability organizations (HROs) are those that exist in such hazardous environments where the consequences of errors are high, but the occurrence of error is extremely low. In this article, we argue that teamwork is an essential component of achieving high reliability particularly in health care organizations. We describe the fundamental characteristics of teams, review strategies in team training, demonstrate the criticality of teamwork in HROs and finally, identify specific challenges the health care community must address to improve teamwork and enhance reliability.Key Words. High-reliability organization, teams, teamwork, health care, patient safety, training A healthy 38-year-old woman was admitted to a major medical center to deliver her first child. Although she was a low-risk patient with only mildly elevated blood pressure, her admission ended tragically when she underwent an emergency cesarean after a failed forceps delivery. Once inside the abdominal cavity, the uterus was found to have ruptured, and the placenta was in the abdomen. She delivered a stillborn fetus. After an unsuccessful attempt to repair her uterus, she received a full hysterectomy, underwent blood transfusions, and endured endless complications resulting in a 3-week hospital stay, including 18 days in intensive care. What went wrong? According to root cause analyses, lack of teamwork played a significant role. Specifically, communication was poor; there was a lack of mutual performance cross-monitoring, inadequate conflict resolution, poor situational awareness, and work overload. A major response to the tragedy was the initiation of team training at the medical center (Sachs 2005).

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Section: Critical Components Of Teamworkmentioning

confidence: 99%

Teamwork as an Essential Component of High‐Reliability Organizations

Baker

Day

Salas

2006

Health Services Research

686

487

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“…The aim was to identify which command skills were considered to be essential for incident managers in the IMT. This type of skill set can be used to guide training, assessment and research, similar to those nontechnical skills systems used in aviation and medicine (Fletcher et al, 2003;Flin & Martin, 2001;Flin et al, 2003;Gaba et al, 1998). While recognising that members of the IMT work in a team environment, the focus for this case study was on the individual, as skill development begins at the individual level as opposed to the team or organisational level (Seamster & Kaempf, 2001).…”

Section: Methodsmentioning

confidence: 99%

Incident Command Skills in the Management of an Oil Industry Drilling Incident: a Case Study

Crichton

Lauche

Flin

2005

J Contingencies & Crisis Man

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The successful management of a complex, hazardous event in many domains demands a high level of incident command skills. In the oil and gas exploration and production industry, these skills were required by members of an Incident Management Team (IMT) established to respond the failure of a drilling riser in the Gulf of Mexico. When an incident occurs, members of an industrial IMT form an interdisciplinary, interdependent, but ad-hoc team. As actual experience of dealing with major incidents of this nature is relatively rare, IMT members have to rely on emergency exercises in training, along with existing domain-specific knowledge. Following a serious incident on an offshore drilling rig, semi-structured interviews with the on-shore strategic and tactical level IMT members (n 5 7) were conducted. These interviews have resulted in the identification and definition of incident command skills for members of an industrial IMT, namely decision making, situation awareness, communication, leadership, and teamwork, all of which can be affected by stress, as well as organisational factors that influenced the outcome of the incident. Limitations in current incident management training were identified, namely the need for specific incident command skills training. A framework is suggested around which specific incident command skills training can be structured. Key learnings from this case study are also presented which can provide guidance for the training and preparation of industrial incident management teams.

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“…In order for scrub practitioners to use the prototype taxonomy, a rating scale was required. Studies of behavioural rating systems with 5-point rating scales found that the point at the 'outstanding' end of the scale was rarely used and carried an additional cost to consensus agreement [33]. Pilot testing of the system for anaesthetists (i.e.…”

Section: Rating Scalementioning

confidence: 99%

“…The labels for the 4-point scale were 1 = poor, 2 = marginal, 3 = acceptable and 4 = good, since this avoided using terms such as 'substandard' or 'outstanding' as had been used in the Gaba et al [33] study. In addition to the 4-point scale, a rating option of 'not required' was included in the SPLINTS rating scale for occasions when a particular behaviour was not observed because it was not required by the scrub practitioner in that particular surgical case.…”

Section: Rating Scalementioning

confidence: 99%