Collaboration Exercises in Emergency Work : Outcomes in Terms of Learning and Usefulness (original) (raw)
Outcome of collaborative emergency exercises: Differences between full‐scale and tabletop exercises
Journal of Contingencies and Crisis Management, 2020
The degree to which exercises improve the collaboration among different organisations during an emergency is under debate. This study aims to contribute to the scarce research on this topic by giving insight into the perceived effects of exercises on collaboration, learning, usefulness, and interorganisational trust. In particular, this quantitative study looked into the differences between the effects of tabletop and full-scale exercises. A questionnaire assessing collaboration, learning, usefulness, and trust-the CLUT instrument-was developed. Data were collected from 173 fulltime emergency management personnel in Norway and Canada. Usefulness, learning, and collaboration outcomes were perceived to be high for both types of exercises, but full-scale exercises were perceived to have greater learning and usefulness outcomes than tabletop exercises. Stronger relationships were identified between the perceived effects on learning and usefulness, collaboration, and trust in tabletop compared to full-scale exercise, whereas the relationship between the perceived effects upon collaboration and trust was stronger in full-scale exercises. Multiple regression analysis showed that the variables used to measure exercise usefulness can better predict tabletop exercise outcomes.
Collaboration Exercises—The Lack of Collaborative Benefits
International Journal of Disaster Risk Science, 2014
The purpose of this article is to analyze what professional emergency personnel learn during collaboration exercises and the benefits of what they have learned. Observations (n = 19) and semistructured interviews (n = 32) were carried out in conjunction with major exercises held in Sweden (2007-2012). The results show that exercises tend to be based on their own logic, which differs from actual events. Exercise participants believe that they mainly learn single-track, parallel, and pathdependent behavior. The exercises do not facilitate the use of cross-boundary activities. This means that learning, as well as benefits from the exercises for actual events, is limited. The exercises would be more appropriate if those participating had the opportunity to identify weaknesses, try alternative ways, and engage in comprehensive organizational analyses at the conclusion of the exercises. Based on the results of the study, alternative models for collaboration exercises are suggested, with elements that would better develop collaboration and contribute to learning.
When it matters most: Collaboration between first responders in incidents and exercises
Journal of Contingencies and Crisis Management
Inter-organizational collaboration is increasingly a topic for studies into accidents and disasters as well as exercises. In this study, which is based on interviews with first responders, we compared perceived collaboration during an exercise with crisis work. The three organizations included in this study-fire department, police and ambulance services-perceived the investigated tunnel exercise completely different, ranging from harmonious interaction to power struggles between commanding officers, fragmented decision-making and ambiguity. When comparing the exercise with an incident, we found that collaboration was more evident during incidents than in exercises. However, collaboration exercises appear to improve inter-organizational collaboration by stimulating informal structures, practicing listening and delegating, getting to know one another and learning a common language.
Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context
International Journal of Disaster Risk Science
This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge...
New collaborations in daily emergency response
International Journal of Emergency Services, 2015
Purpose – The purpose of this paper is to analyse costs and benefits from new collaborations in daily emergency response and to demonstrate how cost-benefit analysis (CBA) can be used for evaluating effects from these kinds of collaborations. Design/methodology/approach – CBA is used to evaluate two collaborations. The cases are: security officers that respond to fire and rescue service (FRS) calls; and home care nurses that assist the FRSs when they respond to urgent medical calls. Interviews, public documents and incident reports have been used as sources of data. Findings – Most costs are relatively straightforward to estimate. More difficult to estimate are the turn-out costs, including the services that cannot be performed when the new actors take on new assignments. One important benefit from these kinds of collaborations is reduced response time. Other benefits include increased situational awareness and improved preventive work in Case 1, as well as improved working conditio...
Health Services Research, 2002
Objective. To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting. Nine teaching and community hospital EDs. Study Design. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course TM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p 5 .012). Subjective workload was not affected by the intervention (p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p 5 .047) and staff assessments of institutional support showed a significant increase (p 5 .040). Conclusion. Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
Assessment of interprofessional collaboration before and after a simulated disaster drill experience
Nurse Education Today, 2019
Introduction: With increasing acuity, patient care requires a collaborative approach by a team of providers. Recent literature indicates healthcare professionals lack the ability to work in collaboration with other healthcare professionals resulting from communication and collaborative practice gaps. Background/Literature: Disasters require a rich collaboration of teams in order to be effective. As a result, interprofessional collaboration is a foundational underpinning of disaster preparedness. The overall purpose of this study was to assess perceptions of interprofessional collaboration before and after participating in an interprofessional simulated disaster drill as part of a Community Health Nursing course. Methods: This pre-test, post-test descriptive research design assessed communication, collaboration, roles/responsibilities, patient focus, team functioning and conflict management of nursing students who participated in a simulated disaster drill. Data/Results: Participants were nursing majors and primarily Caucasian females (n = 50, 89% and n = 56, 97% respectively), representative of the school of nursing population at the University. Wilcoxon Signed-Ranks test indicated that scores for the total ICAR post-test were significantly lower than the Total ICAR pre-test (Z = −2.006, p = .045, r = −0.19). While each of the individual sections of the ICAR had a lower mean score on the ICAR post-test as compared to the pre-test, collaborative patient/client-family centered approach was statistically significant (p = 0,0.002). Discussion: Following the simulated disaster drill experience, nursing students identified gaps in communication, collaboration, roles and responsibilities, collaborative patient/client-family centered approach, team functioning, conflict management/resolution. Conclusions: The study assessed the perceptions of interprofessional collaboration among undergraduate nursing students before and after a simulated disaster drill. The assessment identified the need to integrate interprofessional competencies in disaster preparedness education.
Emergency Medicine Journal, 2007
To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12 month (2005-6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results: Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p(0.001) and teamwork (p(0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions: The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere.
Toward a Definition of Teamwork in Emergency Medicine
Academic Emergency Medicine, 2008
The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well‐defined, well‐researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on “The Science of Simulation in Healthcare,” a subset of the group expertise and group assessment breakout sections identified evidence‐based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well‐defined, well‐described taxonomy that will help guide design, implementation, and assessment of simulation‐based te...
International Journal of Disaster Risk Science, 2021
This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning. An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 healthcare managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises. The response rate was 100%, although not all questions were answered in some cases. The results show that most participants strongly agreed that the exercises focused on collaboration (r2 = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises an...
Emergency Medicine Journal, 2007
Objective: To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12-month (2005)(2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi-professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results: Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, ''restricted transport codes'' of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi-professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a ''crew room'' blue collar view of inter-professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere.
Training interaction in primary care emergency teams: the role of the patient
Objective: “The needs of the patient” inform interactions in medical settings. Information regarding the role of the patient is, however, absent from emergency medicine guidelines and team training manuals. We sought to identify how we could introduce a greater focus on the needs of the patient in order to increase the person-centeredness of clinical services. Method: During the course of one year (May 2010-11), we applied a framework of action research to an exploration of the simulated patient’s role and participation in the context of interaction training in primary care emergency teams in Alta, a rural municipality in the county of Finnmark, Norway. All of the 10 rounds of team trainings we employed included 2 simulated scenarios. Each was followed by a de-briefing designed to elicit the participants’ reflections upon the simulations and moderated as a focus group. Our study material included: field notes; the transcribed audio-recordings from 18 de-briefings and the transcript ...
Academic Primer Series: Five Key Papers about Team Collaboration Relevant to Emergency Medicine
The western journal of emergency medicine, 2017
Team collaboration is an essential for success both within academics and the clinical environment. Often, team collaboration is not explicitly taught during medical school or even residency, and must be learned during one's early career. In this article, we aim to summarize five key papers about team collaboration for early career clinician educators. We conducted a consensus-building process among the writing team to generate a list of key papers that describe the importance or significance of team collaboration, seeking input from social media sources. The authors then used a three-round voting methodology akin to a Delphi study to determine the most important papers from the initially generated list. The five most important papers on the topic of team collaboration, as determined by this mixed group of junior faculty members and faculty developers, are presented in this paper. For each included publication, a summary was provided along with its relevance to junior faculty mem...
BMC Health Services Research, 2021
Background The need for interprofessional collaboration has been emphasized by health organizations. This study was part of a mixed-methods evaluation of interprofessional teamwork modules implementation in an emergency department (ED), where a major intervention was didactic training of team roles and behaviours in combination with practice scenarios. The aim of the study was to evaluate the implementation of interprofessional teamwork modules from a staff perspective and focus on how implementation fidelity may be sustained. Methods In this mixed-methods case study we triangulated staff data from structured observations, semi-structured interviews, and a questionnaire repeated at intervals over 5 years. A protocol of key team behaviours was used for the observations conducted in June 2016 and June 2018, 1½ and 3½ years after the initial implementation. A purposeful sample of central informants, including nursing and medical professionals and section managers, was interviewed from ...
Quality and Safety in Health Care, 2004
Objective. To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Study Setting. Nine teaching and community hospital EDs. Study Design. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course TM (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Data Collection. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. Principal Findings. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p 5 .012). Subjective workload was not affected by the intervention (p 5 .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p 5 .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p 5 .047) and staff assessments of institutional support showed a significant increase (p 5 .040). Conclusion. Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
The Organizer Dilemma: Outcomes from a Collaboration Exercise
International Journal of Disaster Risk Science, 2019
In crisis management, cross-sector collaboration exercises are perceived as improving preparedness and develop team-integration efforts. However, studies show that exercises may tend to produce results with limited learning and usefulness. The purpose of this nonexperimental, survey-based study was to measure the difference in perceived exercise effect between participants belonging to the exercise planning organizations and participants belonging to other participating groups. Surveys were distributed and collected from participants in a 2017 chemical oil-spill exercise set off the southern coast of Norway. The target population was operational staff, excluding exercise management and directing staff. The sample population consisted of operatives associated with the exercise organizer organization and others belonging to external public and nongovernmental emergency organizations. The data collection instrument was the ''Collaboration, Learning, and Utility Scale'' (CLU-scale). Findings indicated that the levels of CLU were higher among external participants than among those individuals who belong to the exercise planning organizations. This study recommends the development and adoption of a national maritime collaboration exercise framework. A practical implication is a recommendation to evaluate exercises to secure the outcome regarding collaboration skill using the same instrument.