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Do No Harm: A Case Study of Interprofessional Healthcare Team Adaptation in Response to Adverse Events

机译：勿害：跨专业医疗团队适应不良事件的案例研究

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摘要

This qualitative, explanatory case study addressed one primary research question: How do interprofessional healthcare teams adapt in response to an adverse event? There were two subquestions: How does employing the components of change enable interprofessional healthcare teams to adapt? and How does employing the components of team enable interprofessional healthcare teams to adapt? Despite knowledge of the benefits of interprofessional teams, flawed teamwork is often to blame for adverse events (Manser, 2009). Unfortunately, most studies have not identified what aspects of teamwork need to be improved to prevent adverse events. In addition, Bowie, Skinner, and de Wet (2013) concluded from a study of healthcare root cause analysis (RCA) conducted after adverse events that only 82% of changes suggested by the RCA were implemented fully or partially. Literature that addresses how teams adapt after an adverse event is limited.;This study examined three interprofessional healthcare teams within a large academic medical center. Data gathered from document review, supervisor interviews, focus groups, and team member interviews were used to explain how teams adapted in response to an adverse event by examining factors related to change and teams. The contributions of factors of change and teams to team adaptation were also revealed.;The study offered the following broad conclusions. First, it is important to capture ongoing learnings from teams beyond the RCA. Second, the type and pace of change contribute to how ambiguity manifests. Third, a common mental model focused on the patient enables teams to make changes to reduce harm. Fourth, strong communication and leadership can help reduce ambiguity resulting from change. Fifth, team learning is robust when relationship conflict is minimal and psychological safety is strong. Lastly, team adaptation is composed of cognitive and behavioral adaptations, which are enabled by change and team factors, respectively. The study concludes with implications for theory and practice, as well as recommendations for further research.
机译：该定性，解释性案例研究解决了一个主要研究问题：专业间医疗团队如何适应不良事件？有两个子问题：采用变化的要素如何使跨专业的医疗团队适应？以及如何利用团队的组成部分使跨专业的医疗团队适应？尽管了解跨专业团队的好处，但不良事件常常归咎于团队合作有缺陷（Manser，2009年）。不幸的是，大多数研究还没有确定团队工作的哪些方面需要改进以防止不良事件。此外，Bowie，Skinner和de Wet（2013年）从对不良事件发生后进行的医疗根本原因分析（RCA）的研究中得出结论，只有82％的RCA建议的变更得到了完全或部分实施。有关不良事件发生后团队如何适应的文献有限。这项研究调查了大型学术医疗中心内的三个跨专业医疗团队。从文档审查，主管访谈，焦点小组访谈和团队成员访谈中收集的数据用于解释团队如何通过检查与变更和团队相关的因素来应对不良事件。还揭示了变化因素和团队对团队适应的贡献。该研究得出以下广泛结论。首先，重要的是要从RCA之外的团队中获取不断学习的经验。其次，变化的类型和速度会导致歧义的显现。第三，针对患者的共同心智模型使团队能够做出改变以减少伤害。第四，强有力的沟通和领导可以帮助减少因变化而产生的歧义。第五，当关系冲突最小且心理安全性较强时，团队学习会很稳健。最后，团队适应由认知和行为适应组成，分别由变化和团队因素促成。研究结束时对理论和实践都有启示，并提出了进一步研究的建议。

著录项

  • 作者

    Gronow, Thomas M.;

  • 作者单位

    The George Washington University.;

  • 授予单位 The George Washington University.;
  • 学科 Organizational behavior.;Health care management.;Social psychology.
  • 学位 Ed.D.
  • 年度 2018
  • 页码 201 p.
  • 总页数 201
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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