Effective coordination in medical emergency teams: The moderating role of task type

Coordination in health care action teams is an important factor in clinical performance and patient safety. Implementing a high-fidelity in situ simulation study, we investigated the performance-relevant effects of task distribution, provide information without request (PIWR) and closed-loop communication (CLC) in 68 medical emergency teams (METs) composed of fully qualified clinicians. We differentiated between two task types: algorithm-driven and knowledge-driven tasks. We assigned two different emergency tasks to each task type. We proposed not only a direct relationship between the three coordination behaviours and clinical performance, but also a moderating role for the type of task. Only CLC was related to performance and also moderated by task type. There was no relationship between the coordination behaviours task distribution and PIWR and performance. We discuss the differential effects of the three coordination behaviours on performance and emphasize the importance of the task in team research. In particular, we highlight theoretical and practical implications.     

Interactions of team mental models and monitoring behaviors predict team performance in simulated anesthesia inductions

In the present study, we investigated how two team mental model properties (similarity vs. accuracy) and two forms of monitoring behavior (team vs. systems) interacted to predict team performance in anesthesia. In particular, we were interested in whether the relationship between monitoring behavior and team performance was moderated by team mental model properties. Thirty-one two-person teams consisting of anesthesia resident and anesthesia nurse were videotaped during a simulated anesthesia induction of general anesthesia. Team mental models were assessed with a newly developed measurement tool based on the concept-mapping technique. Monitoring behavior was coded by two organizational psychologists using a structured observation system. Team performance was rated by two expert anesthetists using a performance-checklist. Moderated multiple regression analysis revealed that team mental model similarity moderated the relationship between team monitoring and performance; a higher level of team monitoring in the absence of a similar team mental model had a negative effect on performance. Furthermore, team mental model similarity and accuracy interacted to predict team performance. Our findings provide new insights on factors influencing the relationship between team processes and team performance in health care. When investigating the effectiveness of a specific team coordination behavior, team cognition has to be taken into account. This represents a necessary and compelling extension of the popular process-outcome relationship on which previous teamwork research in health care has focused. Moreover, the current study adds further external validity to the concept of team mental models by highlighting its usefulness in health care.     

The Epidemiology of Homicide followed by Suicide: A Systematic and Quantitative Review

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide‐suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide‐suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide‐suicide and other homicide but there was modest but significant association between rates of suicide and homicide‐suicide. Homicide‐suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide‐suicide.     

Intersection crossing assist system: Transition from a road-side to an in-vehicle system

Due to high vehicle velocities rural intersections have a disproportionately high rate of fatalities. The current study examines the transition from an infrastructure-based rural intersection crossing assist system to one located inside a vehicle. Moreover, we investigate the efficacy of the in-vehicle system. Three different designs of the assist system were examined regarding their impact on driving performance and applicability to varying age groups and visibility conditions. These designs differed in terms of their complexity based on the amount of information that drivers received about the intersection traffic. Seventy-two older and younger participants divided into the three design groups crossed a busy rural intersection in a simulated environment. Drivers completed four blocks of trials in which the presence of the assist system and visibility conditions (limited, clear) were counterbalanced. When presented with the assist system drivers were less likely to accept a smaller gap, especially under low-visibility conditions. The design of the assist system that resulted in the best overall intersection crossing performance was also the most informative about the traffic. Older drivers exhibited some benefits from the presence of the assist system, although not to the same extent as the younger drivers. The results suggest that some infrastructure-based assist or information display systems could successfully be transitioned to inside a vehicle.     

Deceptive-like behaviour in dogs (<Emphasis Type="Italic">Canis familiaris</Emphasis>)

Deception, the use of false signals to modify the behaviour of the receiver, occurs in low frequencies even in stable signalling systems. For example, it can be advantageous for subordinate individuals to deceive in competitive situations. We investigated in a three-way choice task whether dogs are able to mislead a human competitor, i.e. if they are capable of tactical deception. During training, dogs experienced the role of their owner, as always being cooperative, and two unfamiliar humans, one acting ‘cooperatively’ by giving food and the other being ‘competitive’ and keeping the food for themselves. During the test, the dog had the options to lead one of these partners to one of the three potential food locations: one contained a favoured food item, the other a non-preferred food item and the third remained empty. After having led one of the partners, the dog always had the possibility of leading its cooperative owner to one of the food locations. Therefore, a dog would have a direct benefit from misleading the competitive partner since it would then get another chance to receive the preferred food from the owner. On the first test day, the dogs led the cooperative partner to the preferred food box more often than expected by chance and more often than the competitive partner. On the second day, they even led the competitive partner less often to the preferred food than expected by chance and more often to the empty box than the cooperative partner. These results show that dogs distinguished between the cooperative and the competitive partner, and indicate the flexibility of dogs to adjust their behaviour and that they are able to use tactical deception.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.