R-3 Repository :: Browsing by Author "Salas, Eduardo"

Browsing by Author "Salas, Eduardo"

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Adapting TeamSTEPPS for school mental health teams: a pilot study
(BioMed Central, 2019) Wolk, Courtney Benjamin; Stewart, Rebecca E.; Cronholm, Peter; Eiraldi, Ricardo; Salas, Eduardo; Mandell, David S.
Background: School mental health care often is provided by teams contracted from community mental health agencies. The team members that provide this care, however, do not typically receive training in how to work effectively in a team-based context. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) provides a promising, evidence-based strategy for improving communication and climate in school-based teams. Methods: In collaboration with stakeholders, we adapted and piloted TeamSTEPPS for use with school mental health teams. Teams in six schools were randomized to receive the adapted TeamSTEPPS approach or usual supports. The main outcomes of interest were feasibility and acceptability of the adapted TeamSTEPPS strategy. Results: Results indicated that team member burnout was significantly higher at follow-up than pretreatment for both control and intervention teams. TeamSTEPPS was feasible and acceptable to implement, and leadership emerged as an important facilitator. Barriers to implementation success included staff turnover, lack of resources, and challenges in the school mental health team relationship. Additional supports to implement TeamSTEPPS were suggested, including ongoing consultation and booster training to address high staff turnover. Conclusions: Results suggest that TeamSTEPPS is promising for school mental health teams but additional modifications are likely needed.
Associations between teamwork and implementation outcomes in multidisciplinary cross-sector teams implementing a mental health screening and referral protocol
(Springer Nature, 2023) McGuier, Elizabeth A.; Aarons, Gregory A.; Byrne, Kara A.; Campbell, Kristine A.; Keeshin, Brooks; Rothenberger, Scott D.; Weingart, Laurie R.; Salas, Eduardo; Kolko, David J.
Teams play a central role in the implementation of new practices in settings providing team-based care. However, the implementation science literature has paid little attention to potentially important team-level constructs. Aspects of teamwork, including team interdependence, team functioning, and team performance, may affect implementation processes and outcomes. This cross-sectional study tests associations between teamwork and implementation antecedents and outcomes in a statewide initiative to implement a standardized mental health screening/referral protocol in Child Advocacy Centers (CACs).
Beyond communication: an update on transforming healthcare teams
(Frontiers Media S.A., 2024) Fernández Castillo, Gabriela; Khalid, Maha; Salas, Eduardo
In 2018, Salas et al. (2018b) offered ten observations on the science of teams in healthcare. This perspective article offers a quick update, providing a new set of observations based on the latest findings. As a point-of-departure for these observations, we use one of medicine's most cited culprits of error: communication (see Table 1* for a complete list of articles discussing communication; see also Etherington et al., 2019;Street Jr. et al., 2020;Tiwary et al., 2019) -and our belief that while important, a sole focus on it fails to take a holistic approach.Upon surveying recent literature (i.e., 2018 -2023), we found that 89% of articles discuss communication in some way, and 28% mention communication as one of the leading causes of medical error (i.e., Chamberland et al., 2018;* Real et al., 2018;* Seidlein et al., 2022;* Wu et al., 2020). However, in the following piece, our stance is that despite communication having been repeatedly cited as "the" medical culprit, it may not be the source of all contention (Clapper & Ching, 2020). More recent findings identify other challenges, such as accountability (e.g., Randall Curtis et al., 2018), conflict management (e.g., Bajwa et al., 2020;* Keller et al., 2019*), decision-making (e.g., Papermaster & Champion, 2021*), reflecting on progress, and coaching as the primary challenges healthcare teams face (Zajac et al., 2021). Moreover, communication is a multi-faceted competency that also requires a holistic view.In our review...
Conditions Promoting Psychological Safety in Self-Managed Teams
(2018-04-17) Marlow, Shannon L; Salas, Eduardo
Although psychological safety has been identified as critical to team performance, and team composition represents an inherent influence on teamwork components, there is a dearth of research examining the relationship between team composition and psychological safety. The present effort addresses this gap in the literature by exploring the influence of team personality composition, using the five-factor model of personality, on the development of psychological safety in self-managed, autonomous teams. Psychological safety is measured at two time points, in the beginning of the team’s life cycle and several months after the teams have been working together on a highly interdependent task; this ensures the teams have sufficient time to interact and develop psychological safety. The results suggest that team composition does not have an effect on the development or maintenance of psychological safety, suggesting that other factors are more impactful in influencing levels of psychological safety across teams. This study also examines the influence of emergent leadership on the development of team psychological safety. Although there is evidence that leadership is related to psychological safety, the influence of leadership in the context of emergent leadership has yet to be examined. The present findings suggest that the emergence of a leader, and effective leadership, are critical for developing and maintaining psychological safety over time. Exploratory analyses further indicate that in accordance with previous evidence, more extraverted individuals are likely to emerge as leaders at the initial time point. Individuals with a learning orientation are also likely to emerge as leaders, however, these individuals also were found to have a negative influence on psychological safety. This result is contrary to theory. I suggest that the context, an unstructured task requiring a high degree of autonomy, may explain this discrepancy. A higher learning orientation is associated with an increased willingness to accept failure as necessary for learning. A leader exhibiting task failure may signify to the team that the team is a psychologically unsafe environment. Taken as a whole, this research provides insight into how psychological safety develops on self-managed teams.
Creating Space for Care: Enhancing Patient-Centered Performance Outcomes Through Organizational Change
(2020-07-24) Dinh, Julie Vy; Salas, Eduardo; King, Eden; Kimbro, Rachel T
Hospitals present serious challenges to the development of patient-provider relationships, particularly in the pediatric intensive care unit (PICU), where stakes, stress, and entropy are high. However, episodic change, particularly at the environmental and structural levels, can create space for more positive interpersonal dynamics. This series of studies triangulates mixed-methods data, collected in the field, to identify how one such intervention influenced patient-centered performance (PCP) outcomes, including patient trust and satisfaction. Overall, this research seeks to answer the question: how do the supportive design and departmentalization of hospital units impact PCP outcomes? Accordingly, this dissertation draws upon organizational change, supportive design, and classical organization theories, centering them around an intervention. A PICU (a) developed a new, larger, and improved physical space and (b) implemented departmentalization, geographically grouping patients and provider teams by subspecialty disease groups. Study 1 uses qualitative data to describe the psychologically supportive design aspects of the intervention. Study 2 quantitatively examines how this design-based intervention ultimately enhanced PCP outcomes, including patient trust and satisfaction. Study 3 uses numeric indices derived from archival data to investigate the effects of departmentalization on health care team volume and outcomes. This research also involves the validation of a parent satisfaction scale and the development of a novel, quantitative, group-level volume index. Theoretical contributions and practical implications are discussed.
Cross-cultural perspectives on collaboration: Differences between the Middle East and the United States
(Elsevier, 2021) Grossman, Rebecca; Campo, Maritza Salazar; Feitosa, Jennifer; Salas, Eduardo
Cross-cultural collaboration is critical for tackling many complex issues of the modern-day, yet can be challenging, particularly when it includes collaborators with a history of conflict, such as Middle Eastern countries and the United States. To explore how collaborators might have unique conceptualizations of collaboration that could ultimately contribute to this challenge, this research leverages comparative structural analysis of interview data from 113 participants across four nations in the Middle East and the United States. Several key differences in conceptualizations emerged. Middle Eastern samples emphasized (1) who is involved, including a spiritual element, (2) interpersonal aspects, (3) higher levels of motivation, and (4) equality of resources, more so than American participants. However, not all conceptualizations were different. These cultures all agreed collaboration is challenging and requires effort to be successful. Findings provide important insights for informing future research, as well as practical approaches to managing cultural differences in collaborative settings.
Cultural competency in healthcare providers: A qualitative investigation
(2018-04-16) Dinh, Julie V.; Salas, Eduardo
Cultural competency is the ability to establish effective interpersonal and working relationships with diverse individuals. In an increasingly diverse society, it is critical that healthcare providers be appropriately trained in issues of cultural awareness and sensitivity. This master’s thesis proposal is part of a larger research program, aiming to evaluate cultural competency in the field and develop an empirically-based training for healthcare professionals. Specifically, this proposal centers on a qualitative investigation targeting the identification of service gaps in the field. In collaboration with Texas Children’s Hospital, we interviewed 45 intensive care physicians, nurses, and patient families about cultural barriers in healthcare and systematically analyzed the resulting transcripts. Key themes included cultural barriers (particularly around end-of-life decision-making), cultural competencies (especially as they relate to team processes), and training interventions (including their evolution over the provider career span). Theoretical contributions, practical implications, and future directions are discussed.
Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills
(American Medical Association, 2024) Harari, Rayan Ebnali; Dias, Roger D.; Kennedy-Metz, Lauren R.; Varni, Giovanna; Gombolay, Matthew; Yule, Steven; Salas, Eduardo; Zenati, Marco A.
Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging.To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures.This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team’s nontechnical skills by 3 expert raters.NOTSS overall score, with motion features extracted from surgical videos as measures.A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = −0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, −12.64 [95% CI, −20.54 to −4.74]; P = .003) were associated with NOTSS scores.This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.
Designing Adaptive Instruction for Teams: a Meta-Analysis
(Springer, 2018) Sottilare, Robert A.; Burke, C. Shawn; Salas, Eduardo; Sinatra, Anne M.; Johnston, Joan H.; Gilbert, Stephen B.
The goal of this research was the development of a practical architecture for the computer-based tutoring of teams. This article examines the relationship of team behaviors as antecedents to successful team performance and learning during adaptive instruction guided by Intelligent Tutoring Systems (ITSs). Adaptive instruction is a training or educational experience tailored by artificially-intelligent, computer-based tutors with the goal of optimizing learner outcomes (e.g., knowledge and skill acquisition, performance, enhanced retention, accelerated learning, or transfer of skills from instructional environments to work environments). The core contribution of this research was the identification of behavioral markers associated with the antecedents of team performance and learning thus enabling the development and refinement of teamwork models in ITS architectures. Teamwork focuses on the coordination, cooperation, and communication among individuals to achieve a shared goal. For ITSs to optimally tailor team instruction, tutors must have key insights about both the team and the learners on that team. To aid the modeling of teams, we examined the literature to evaluate the relationship of teamwork behaviors (e.g., communication, cooperation, coordination, cognition, leadership/coaching, and conflict) with team outcomes (learning, performance, satisfaction, and viability) as part of a large-scale meta-analysis of the ITS, team training, and team performance literature. While ITSs have been used infrequently to instruct teams, the goal of this meta-analysis make team tutoring more ubiquitous by: identifying significant relationships between team behaviors and effective performance and learning outcomes; developing instructional guidelines for team tutoring based on these relationships; and applying these team tutoring guidelines to the Generalized Intelligent Framework for Tutoring (GIFT), an open source architecture for authoring, delivering, managing, and evaluating adaptive instructional tools and methods. In doing this, we have designed a domain-independent framework for the adaptive instruction of teams.
Does team orientation matter? A state-of-the-science review, meta-analysis, and multilevel framework
(Wiley, 2023) Kilcullen, Molly; Bisbey, Tiffany M.; Rosen, Michael; Salas, Eduardo
As teams are a foundational component of modern organizations, selection and training of employees to facilitate teamwork is of key importance. In this paper, we review and meta-analyze research on the construct of team orientation. We differentiate between organizational-, team-, and individual-level team orientation and discuss multilevel theory implications. A total of 39 articles comprising 210 effects were meta-analyzed. Results indicate that team orientation is important, particularly for effective teamwork and team-based outcomes. Specifically, at the overall level, we found significant and positive relationships with communication, coordination, cooperation, trust, shared mental models, backup behaviors, cohesion, innovation, satisfaction, leadership, and team performance. Team orientation was found to be negatively correlated with conflict. Interestingly, we found a negative relationship between team orientation and individual-level performance. We discuss the implications of these findings and make suggestions for future work to build upon these findings.
Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers
(Frontiers Media S.A., 2022) Mitchell, Andrew E.P.; Galli, Federica; Keyworth, Chris; Vegni, Elena; Salas, Eduardo
Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams
(Frontiers Media S.A., 2023) Bell, Elizabeth A.; Rufrano, Gabrielle A.; Traylor, Allison M.; Ohning, Bryan L.; Salas, Eduardo
Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science.
Functional framework for change leaders: results of a qualitative study
(BMJ, 2020) Woods, Amanda L.; Luciano, Margaret M.; Aloia, Thomas A.; Gottumukkala, Vijaya; Salas, Eduardo
Background: Healthcare organisations are increasingly placing the onus on care providers to lead change initiatives to improve patient care. This requires care providers to perform tasks in addition to their core job roles and often outside of their formal training. The existing literature provides few insights regarding the functions required of change leaders in healthcare organisations. Objective: To identify the core functions required of effective change leaders in healthcare organisations. Design: Qualitative interview study. Participants: Data were collected from semistructured interviews with 31 individuals employed by a large cancer centre in a variety of different positions (eg, surgeons, anaesthesiologists, nurse anaesthetists, nurses, project consultants and research coordinators) who had been involved in successful quality improvement initiatives. Results: Using inductive content analysis, we identified six core pillars of leading change, which are supported by a foundation of effective communication. Within these six pillars, there were 12 functions, including explain why, demonstrate value, create consensus, align efforts, generate enthusiasm, motivate commitment, institute structure, explain how, facilitate taskwork, promote accountability, enable adjustment and sustain effort. Our model offers unique insights on leading sustainable change in healthcare organisations. Conclusion: Using inductive content analysis of semistructured interviews, we have identified 12 important change leader functions and have organised them into a conceptual framework for leading change in healthcare. Individuals involved in leading change initiatives or developing training programmes to help others become effective change leaders can use this framework to ensure they are comprehensively addressing the necessary tasks for sustainable change.
Handoffs and the challenges to implementing teamwork training in the perioperative environment
(Frontiers Media S.A., 2023) Paquette, Shannon; Kilcullen, Molly; Hoffman, Olivia; Hernandez, Jessica; Mehta, Ankeeta; Salas, Eduardo; Greilich, Philip E.
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
Helping Healthcare Teams Save Lives During COVID-19: Insights and Countermeasures From Team Science
(American Psychological Association, 2021) Traylor, Allison M.; Tannenbaum, Scott I.; Thomas, Eric J.; Salas, Eduardo
As the COVID-19 pandemic has ravaged the United States, health care teams are on the frontlines of this global crisis, often navigating harrowing conditions at work, such as a lack of personal protective equipment and staffing shortages, and distractions at home, including worries about elderly relatives or making childcare arrangements. While the nature and severity of stressors impacting health care teams are in many ways unprecedented, decades of psychological research exploring teamwork in extreme contexts can provide insights to understand and improve outcomes for teams in a crisis. This review highlights the psychological principles that apply to teams in a crisis and illustrates how psychologists can use this knowledge to improve teamwork for medical teams in the midst of the COVID-19 pandemic., The review also provides a glimpse toward the future, noting both how psychologists can help health care teams recover and rebound, as well as how additional research can improve psychologists’ understanding of teamwork in times of crisis.
How to be an inclusive leader for gender-diverse teams
(Elsevier, 2022) Santos, Manuela; Luna, Miguel; Reyes, Denise L.; Traylor, Allison; Lacerenza, Christina N.; Salas, Eduardo
Gender inequity is globally present in the labor force and advocating for gender equality is not merely a fairness issue, but a benefit for organizations. In this paper, we identify common challenges for gender-diverse teams (i.e., turnover, discrimination, communication issues, conflict between team members, and low team cohesion). We also discuss the importance of inclusive leadership to overcome these challenges. Correspondingly, we provide practical actions for inclusive leaders to implement on their teams to address issues regarding diversity, and subsequently leverage its benefits.
How to Make an Internal Team Coach: An Integration of Research
(MDPI, 2024) Fernández Castillo, Gabriela; Linhardt, Rylee; Salas, Eduardo
Team coaching has been found to increase group effort, improve interpersonal processes, and increase team knowledge and learning. However, the team coaching literature is renowned for its inability to define team coaching itself—making it difficult to solidify its place in the world of team science. So far, there is no consensus on what specific training would serve internal leaders best, and how they would connect to the team coaching literature. We know leadership and team training are effective in improving organizational outcomes, but the gap in the literature lies in identifying what specific competencies internal team coaches need, and what training could fulfill these. In this piece, we seek to (1) identify what competencies internal team leaders need based on the outcomes we know team coaching yields, (2) identify specific behaviors that can fulfill these competencies, and (3) integrate the literature to form an evidence-based guide on what training to provide to internal team coaches. By doing so, we hope to provide a definitive understanding of what internal team coaches need to be successful.
Human Factors and Ergonomics in Healthcare: Industry Demands and a Path Forward
(Sage, 2022) Keebler, Joseph R.; Rosen, Michael A.; Sittig, Dean F.; Thomas, Eric; Salas, Eduardo
This article reviews three industry demands that will impact the future of Human Factors and Ergonomics in Healthcare settings. These demands include the growing population of older adults, the increasing use of telemedicine, and a focus on patient-centered care. Following, we discuss a path forward through improved medical teams, error management, and safety testing of medical devices and tools. Future challenges are discussed.
Improving Teamwork Competencies in Human-Machine Teams: Perspectives From Team Science
(Frontiers Media S.A., 2021) Stowers, Kimberly; Brady, Lisa L.; MacLellan, Christopher; Wohleber, Ryan; Salas, Eduardo
In response to calls for research to improve human-machine teaming, we present a “perspective” paper that explores techniques from computer science that can enhance machine agents for human-machine teams. As part of this paper, we (1) summarize the state of the science on critical team competencies identified for effective HMT, (2) discuss technological gaps preventing machines from fully realizing these competencies, and (3) identify ways that emerging AI capabilities may address these gaps and enhance performance in HMT. We extend beyond extant literature by incorporating recent technologies and techniques and describing their potential for contributing to the advancement of HMT.
Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams
(Elsevier, 2023) McGuier, Elizabeth A.; Feldman, Jamie; Bay, Mikele; Ascione, Sue; Tatum, Mary; Salas, Eduardo; Kolko, David J.
Background Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. Methods A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). Results The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. Conclusions TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.

Browsing by Author "Salas, Eduardo"

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