Flash teams in the ED resus room

By Andy Buck on September 4, 2013 in Uncategorized

I’ve written previously of my skepticism for the word “team” in relation to the groups of strangers who congregate in ED resus rooms. Since then I’ve been trawling through the literature to find the best available evidence on how to teach human factors and non-technical skills, in particular team leading and teamwork skills to people in this setting. This post is the first in a series of articles looking at this concept in detail.

A huge downfall of most of the literature on training healthcare “teams” is that they focus on stable teams. Groups of people who often know each other, or who have worked together previously. Another big problem is the lack of a clear definition of the word “team” for researchers in this area.

A recent article by West and Lyubovnikova [1] tackles the terminology of teams and teamwork. Whilst it is a review article, they describe “pseudo-teams”, (or groups who do not have “real team” characteristics), as those teams which have little requirement to interact or communicate, whose objectives are not shared, and who rarely meet to reflect on performance. This description partly covers ED resuscitation teams. What is accurate and applicable to the aforementioned teams I work with, is that “pseudo-teams” report higher rates of errors, incidents and near-misses, they experience more harassment, bullying and abuse from other staff and patients, an report higher levels of stress and lower levels of well-being. Clearly the pseudo-team characteristics should be avoided in teamwork training.

In a separate article [2], they describe further the characteristics of “real teams”, “pseudo teams”, and they also quote the phrase “flash teams”, which I believe more accurately describes the groups that congregate in ED resuscitation settings. Flash teams are teams in which membership turns over quickly, with “peripheral” individuals (for example the ICU, Anaesthetic and Surgical team members) coming and going, whilst “core” team members (for example the Emergency department medical and nursing staff) are more likely to remain constant. They also go on in this article to describe how widespread, poorly defined use of the term “team” and “teamwork” in the literature by researchers who have adopted a more managerial definition of teams (ie any group of people that interact or work together, no matter how loosely), has made researching teams with a clear and precise approach, especially dynamic teams, very difficult.

Tannenbaum et al [3] coined the phrase “flash teams”. They highlight that in many industries including healthcare, dynamic composition, membership fluidity, reconfiguring temporary teams and belonging to multiple teams all have pros and cons for the function of the team, yet there is very little research to date into these dynamic teams. Their comprehensive review covers in detail many of the characteristics, problems and benefits of dynamic teams. Based on their analysis, they suggest the following recommendations for team-based practice with dynamic teams:

The need to provide those who choose and allocate team members with criteria to optimise team formation by ensuring members are qualified to participate, and can work well together.
Creation of role clarity, and guidance for team leaders to how to create a sense of team identity.
Transportable teamwork competencies: ie skills that can be used in any of an individuals team assignments – however these may need to be organisation (eg hospital) specific.
“Quick-start” protocols and “join-in-progress” protocols that allow teams to form quickly, and to ensure new members that join an already functioning team are brought up to speed quickly and seamlessly.
Explicit identification of the obligations of people with specific, high-value skills so as to avoid overloading them.
Defined team member number and skill mix for handover and transition periods, as well as a defined handover processes.
Evaluation and review of the process.

So here we have the building blocks for an educational program to teach teamwork with dynamic or “flash” healthcare teams, and these may help with setting learning objectives for anyone who is trying to do teamwork training in this area. These concepts will be applied to our scenario teaching and simulation sessions on the upcoming Emergency Trauma Management Course, so if you’re interested in seeing these concepts applied to trauma resuscitations, click here for more details and to register for a course!

For anyone interested in reading more on this topic, Scott Tannenbaum and Eduardo Salas are luminaries in the field of simulation and teamwork training, and I recommend their extensive catalogue of papers, in particular those by Salas as a starting point.

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