Knowing what’s going on : situation awareness and team performance in interprofessional teams

Abstract: Background Within critical care, it is necessary to have an awareness ofwhat is going on in order to be able to make the right decision at the right time.Situation awareness (SA) is a non-technical skill (NTS) that is important instressful, complex environments such as the intensive care unit (ICU).Deficiencies in NTS are well known to impact performance and thereby causeadverse events. More knowledge about how background factors are associatedto team performance and explore critical care team members experiencesteamwork are of importance to develop models for improving teamwork. Aneducational intervention aiming to improve SA during critical events might bevaluable to improve the performance of interprofessional teams. For this,instruments for assessment of SA and NTS are needed.Aim The aim of this thesis was to test different instruments for measuringSA, team performance and task performance for feasibility and reliability; to investigate the relationship between team background characteristics, teamperformance and task performance; to evaluate an educational programme inSA for intensive care teams; and to explore team members’ experience ofteamwork.Methods This thesis was based on data from 69 different video-recordedteam training sessions with a simulator as a patient (studies I–III) and ninefocus group interviews (Study IV). In Study I, the participants were 55 medicalstudents, and the sessions took place at a clinical training centre. Theparticipants in Study II (n=105) and III (n=75) were ICU staff members fromtwo different hospitals, and the sessions took place in situ at the respectiveICUs. In Study III, the participants were randomized into control orintervention group, where the intervention group received an educationalintervention comprising lectures and reflective discussions. The control grouponly performed team training without lectures and reflective discussions. Thetraining sessions were analysed with a focus on team and task performanceusing the TEAM instrument and the ABCDE checklist, respectively. Inaddition, a questionnaire (SAGAT) was used to assess individuals’ SA (StudyI and III). The data in Study I–III were quantitatively analysed. In Study IV,focus group interviews with staff members (n= 31) from the ICUs wereanalysed using qualitative content analysis.Results The findings in Study I showed that SAGAT was feasible to use andthat the inter-rater reliability for the ABCDE checklist and the TEAMinstrument indicated sufficient stability. In Study II, higher age wasassociated with several aspects of good team performance such as teamwork,task management, team overall and total team. Prior team training withoutvideo was associated with better task performance, while prior education incommunication was negatively associated with leadership. In Study III, theresults demonstrated that the educational intervention improved theperformance of the intervention group in the TEAM subscales of leadershipand task management, as well as in the total score. In Study IV, the mainfinding presented as a theme was balancing knowledge and behaviour inteamwork. The interviews revealed three categories of aspects that facilitatevor act as barriers to teamwork: (1) having potential for excellence while copingwith members who do not act as team players; (2) creating a safe atmospherewhile working in an unknown environment and struggling to maintain one’spositions; and (3) being in a workflow without becoming overwhelmed.Conclusions By implementing an educational programme focusing on SA,different parts of interprofessional team performance could be improved. Foroptimal interprofessional teamwork in the ICU, both knowledge andbehaviours were essential components. For the studies in this thesis, thedifferent instruments used were both feasible and reliable. High age wasrelated to good team and task performance, indicating that generic factors thatis associated with age might influence team and task performance.This thesis will probably contribute to a safer care of seriously ill patients at ICU.