260 BAKER ETAL.

undermine patients' and health professionals' con- training. Finally, we offer a set of conclusions fidence in the health care system itself. recommendations for future research.

Key to this chapter's orientation toward team- work-related research, the IOM noted that the majority of mehcal errors result from health care system failures, rather than from individual providers' substandard performance. Thus, in con- i junction with its drive to implement organizational

crisis was to commission a review of the existing

of a team, we reviewed several often-cited d tions (Dyer, 1984; Guzzo & Shea, 1992; M

STRUCTURE OF THIS CHAPTER Cohen, & Mohrman, 1995; Salas, Di

dence concerning the extent to which training med- includes the following four characteristic ical personnel as teams is likely to improve patient teams consist of a minimum of two or

industries and presents a compelling argument for often work under conditions of high workload, teamwork's relation to patient safety. In the next (d) teams embody the coordmation that re section, we define the key characteristics of a team from task interdependency, which distingul and discuss the principles that underlie successful teams from small groups.

17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY a 261

:;ej ;&$ ' Teammate Characteristics Familiarity Knowing the Task-related competencies, preferences, C

c.9; >.&.,

f k\ @!$. ( EF;-

?.:%.. 6 I

1 Mutual Performance Monitoring Tracking fellow team members' performance to ensure 1 that the work is running as expected and that proper r procedures are followed

Team Leadership 1 Ability to direct / coordinate team members, assess team performance, allocate tasks, motivate subordinates.

>*: ?>:? vcv:> '3:.

.,?.

-: I Closed-Loop Commun~cat~on/ ) The ln~t~atlon of a message by the sender, the recelpt 13 ,

Information Exchange and acknowledgement of the message by the receiver, and ' *

.2 the ver~flcatlon of the message by the inlt~al sender

I , . c ATTITUDE COMPETENCIES

-4-

*. . 4 I Team Cohesion I g2.r I :Y ..I. .'1

' ' t t

ii$ . . L1*

I '':a , 1

aura, mood, climate of the team's ~nternal env~ronment ,

Collect~ve Orlentation The bellef that a team approach 1s better than an ~ndlvrdual one

I Importance of Teamwork

L

Exhlblt 17-1 Essential Team Knowledge, Skiil, and Attltude (KSA) Cornpetenaer-adapted horn (Salar '4 et al., 2001a)

Salas, & Baker, 1996), cross-training (Volpe, presented in Exhibit 17-1 provide an exce Cannon-Bowers, Salas, & Spector, 1996), stress resource for designing team trai management training (Driskell & Johnston, 1998), Cannon-Bowers and colleagues con and team self-correction (Smith-Jentsch, Zeisig, I(SA competencies should serve as the hcton, & McPherson, 1998). for conducting training needs analyses.

In ad&tion to the avadable team training research lishing a team's specific competency requrenl and practical guidance, the team competencies trainers must specitj appropriate training strate

17. RELATION BETWE

To meet this requirement, Cannon-Bowers and offered detailed information on the

nature Of training required for developing particular

ream and the strategies that are likely

to be (Cannon-Bowers et al., 1995). ~ i ~ d ~ a successful team training program con-

Sdtute~ more than developing team members' AS. For example, because organizational factors outside the training program itself affect the pro- gram's success, conducting a needs analysis before designing a training intervention is essential to

, determining the best delivery method or instruc- donal strategy. In addition, training developers should take advantage of the increased practice opportunities provided by certain training tools, such as advance organizers (e.g., outlines, diagrams, graphic organizers), preparatory information, prepractice briefs, attentional advice, goal orienta- don, and meta-cognitive strategies (Cannon- Bowers & Salas, 1998).

lvate subord~nates SUMMARY

jer, the receipt f i e preceding section discussed the elements that by the receiver, and . typify effective teamwork and effective team train- nitial sender ing. High-performing teams exhibit a sense of col-

lective efficacs are dependent on each other, and

qembers to remaln a means of task

ernal env~ronment

r t h a n a n

ed from [Salas 2

.owde an excellent; trainil :onten as the ialyses

'8 ~dec sta ;. A

believe that they can solve complex problems. Moreover, effective teams are dynamic: they opti- mize their resources, engage in self-correction, compensate for each other by providing back-up behaviors, and adapt as necessary. Because they can often coordinate without communicating overtly, effective teams can respond efficiently in high- stress, time-restricted environments.

Designing training that will improve teamwork skills on the job is a challenge. In virtually any field, team training requires a comprehensive, sustained strategy that targets many aspects of teamwork. Teams operate in complex environments. Yet team training is charged with improving trainee I<SAs and fachtating desirable performance outcomes (e.g., safety, timely and accurate responding, patient welfare) under these conditions. Therefore, effec- tive uaining programs must (a) systematically rep- resent sound theory and a thorough needs analysis; (p) provide trainees with information, demonstra- hens, guided practice and timely diagnostic feed- back and (c) reflect organizational cultures that encourage the transfer of the trained competencies 'O the task environment.

E N TEAMWORK A N D PATIENT SAFETY 263

TEAMWORK IN HIGH-RISK CONTEXTS

Commercial Aviation

Because aviation constitutes a Field in whch mis- takes can cause an unacce~table loss of life and property, the flight industry has been on the fore- front of developing teamwork training to reduce risk. Among the team training that have evolved w i h n aviation, the best known is crew resource management (CRM) training.

Recent research suggests that cRM training results in heightened safety-related attitudes; improved communication, coordination, and decision-making behaviors; and enhanced error- management skills (Helmreich & Merritt, 1998; Wiener et al., 1993). CRM training also has demon- strated consistentlv positive results across a wide

L

range of team structures, including pilot crews, maintenance crews, dispatch crews, and air traffic control teams (Helmreich & Foushee, 1993; Oser, Salas, Merket, & Bowers, 2001; Smith-Jentsch, Baker, Salas, & Cannon-Bowers, 2001).

CRM has grown from focusing solely on aware- ness and attitude change, to incorporating behav- ioral skills training, to integrating training in teamwork with training in technical flying skills, as is the case with the U.S. Federal Aviation Administration's new Advanced Qualification Program (AQP). Recent reviews suggest that CRM training results in positive reactions to teamwork concepts, increased knowledge of teamwork prin- ciples, and improved teamwork performance in the simulator (Salas, Burke, Bowers, & Wilson, 2001b).

CRMS effect on the ultimate criterion-a reduc- tion in the number of accidents-has yet to be empirically established (Salas et al., 2001b). However, accidents represent a poor criterion methodologically, because they exhibit an extremely low base rate (Helmreich & Foushee, 1993). Thus, researchers have relied on surrogate measures- like improvements in teamwork-related knowledge and skills, behavioral demonstrations of CRM skills on simulated fights, instructor evaluations of trained versus untrained crews, and changes in an organization's safety culture-to demonstrate the effectiveness of CRM training.

Viewed in isolation, each piece of evidence con- cerning the effectiveness of CRM training can be dsputed; nevertheless, the pattern of results sug- gests that CRM training does improve the margin of aviation safety. In short, the reasonable inference is

264 BAKER E T A L .

(Smith-Jentsch et al., 1998).

The other high-risk industry in which team training summary has grown to prominence is the military. The water- shed for this reseatch was USS Vincennes' acciden- This secdon bneny the empmcal

crew CRM (Spiker, Silverman, Tourville, & Nullmeyer, 1998). Current military aviation team

17. RELATION BETWEEN TEAMWORK AND PATJENT SAFETY 265

to discussing, learning about, and preventing them. professionals (Gaba, 1998; Gaba, Howard, Fish, CRM training-which falls under the domain of Smith, & Sowb, 2001a; Howard et al., 1992). To <'team training"-is one means for helping to bring facilitate this goal, ACRM training provides trainees

. &out this cultural shft. with critical incident case studies to review (Davies, Moreover, AHRQ is not alone in recognizing the 2001). In addition, ACRM provides training in

importance of teamwork for improving the perfor- technical skill and in team KSAs. Training in the mance of medical professionals. In concert with selected teamwork skills is intended to enable AHRQ's goals, the Accreditation Council for trainees to learn from adverse c h c a l occurrences Graduate hfedical Education (ACGLME) recently and to work more effectively with different leader- identified several teamwork-related competencies ship, followership, and communication styles that residents must master. These competencies (Gaba, Howard, Fish, Smith, & Sowb, 2001b). include communication with patients and significant ACRM training takes place in a simulated operat- others, patient counseling and education, working ing room (OR), after completing the reading assign- with othcr health care professionals, and facilitating ments that precede each module. The simulated OR

, medcal school and residency. The results ulate a patient's breathing, pulses, heart and lung revealed the importance of a number of teamwork- sounds, exhaled CO,, thumb twitches, and other

model, citing it as hlgh in impact but low in evi- module consists of a similar smucture: preassigned dence supporting its effecuveness (Pizzi et al., readings, course introduction and review of materials,

266 BAKER ETAL.

debriefing and a postcourse data collection. Each ACRM training on actual performance ou scripted training scenario is approximately 45 min With respect to individd (i.e., technical) long; each debriefing session lasts approximately mance, this lack of outcome-related 40 rnin (Gaba et al., 2001a).

training, is currently used at several major teaching constructive focus for future research. F institutions in the United States and around the more, given the current state of simulation,

practitioners as well as for trainees. Moreover, teamwork skills might be worthwhile. some malpractice insurers (i.e., Harvard Risk Management Foundation) have lowered their rate structure for hCRhf-trained anesthesiologists Med~eams' Purpose and Strategy

manEe on each dmension (Gaba et al.,-1998). ED team as a group of 3-10 (average = 6) Measures of interrater agreement exhibited rq personnel who work interdependently d values flames, Demaree, & Wolf, 1984) ranging shift and who have been trained to use

I

I

17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY 267

and refined during three 5-day expert CONCLUSIONS AND RECOMMENDATIONS

Lacks a Theoretical Model of Team Performance.

TO date, research has not developed a comprehen-

this gap in knowledge, the fust research effort we advocate is to develop a theoretical medical team performance model that hypothesizes (a) the rela- tions among predictors of performance and (b) the

mance model that focuses on medical teams per se, previous research has provided considerable relevant knowledge; the availability of this knowledge under- lies several of the remaining conclusions.

m assertive ro

curriculum was

. .

analysis of these data indicated a positive effect of training on orrtcome nitetia (e.g., medical errors, patient satisfaction; Morey et al., 2002). I-lowever, t h~s study suffered two significant limtations; participating hospitals self-selected into either the experimental or control groups, and observers were not blind to the experimental conditions. To address this limitation, a subsequent evaluation of MedTeams in labor and delivery units is in progress, using a randomized clin- ical trial design (Goldman, Shapiro, Mann, Risser, & Greenberg, 2002).

Summary

This chapter has summarized the general state of medical team training. We concentrated our discus- sion on ,%CR\I and MedTeams, because these are the most thoroughly documented medical team training programs. These programs have made progress in improving patient safety; nevertheless, despite the encouraging nature of the extant data, the degree to whch medical, CIirvI-inspired train- ing LVIII enhance patient safety remains in question. n u s , to provide a strategy for further investiga- Qon, the final section of t h s chapter integrates our fhdngs into conclusions and recommendations telexrant to medical team training.

Performance and Training can Help the Medical Community Improve Patient Safety.

As discussed in this chapter, a more general science of team performance and training has evolved and matured over the last 20 years. This science has produced a number of principles, lessons learned, tools, and guidelines that will serve the patient safety movement. Our recommendations are as fol- lows: (a) that the medical community continue to inform itself of the progress of this science through a variety of venues (e.g., specialized work- shops, books) and (b) that the medical community enlist the help of team training experts to apply to patient safety the principles, guidelines, and learn- ing afforded by previous research.

Conclusion 3: Research Has Already Identified Many of the Competencies Necessary for Effective Teamwork in Medical Environments.

Previous investigations have identified the compe- tencies required for effective team functioning in a number of complex settings. Many of these

268 BAKER ETAL

competencies apply to the medical community. However, as Cannon-Bowers and colleagues (1995) noted, the team skills literature is confusing, contra- dctory, and plagued with inconsistent labels and def- initions. For example, across studies, different labels are used to refer to the same teamwork skills, and the same labels are used to refer to different skills. Thus, we recommend using a two-step process to develop a taxonomy with standard nomenclature; thts taxon- omy would name and define teamwork-related KSAs that constitute the core cotnpetencies related to successful teamwork in the medical domain.

The first step in developing such a taxonomy is to determine an appropriate level of explanation; the constructs included in the taxonomy must be con- ceptudzed broadly enough to span the medical field yet be specific enough to facilitate valid measure- ment. Further, although this list of core competen- cies should reflect all relevant aspects of team performance, it must be concise enough to generate teamwork and team training research and to facilitate team training needs analyses in organizations.

The second step, determining relevant core com- petencies, encompasses two activities. One task is to establish whtch of the many competencies mani-

I fested in previous research are relevant to virtually all medical teams; another task is to identify core med-

4 ical team competencies that have not emerged from team research in other domains. We believe that

Q using task analpc techniques (e.g., survey question-

3 naires, structured interviews, and unobtrusive obser-

3 vations) will yield the most valid information. We

3 also emphasize the importance of large-scale, strati-

-@ fied data collections, because the goal is to identify ,F .

14ji generic competency requirements with which the medical community at-large concurs.

Conclusion 4: A Number of Proven lnstructional Strategies are Available for Promoting Effective Teamwork.

The science of team performance and training has developed and validated numerous training strategies that can provide requisite competencies to teams who perform in complex environments. Through a variety of formats and objectives, these strategies extend beyond CRM training. We recom- mend (a) that the medical community use these strategies wherever possible, given that some are relatively easy to design and deliver and @) that the community explore strategies other than CRM to

Conclusion 5: Team-Training Strategies Must Be Further Adapted to Medical Needs.

We are convinced that no single model of team tr ing can be applied across all medical practi contexts. For the purposes of this discuss define a "practice" as a medical specialty or cialty, such as emergency medicine, general or medicine, intensive care, surgical medicine, or obs rics. Medical practices differ dramatically acres variety of criteria: size, purpose, duration, red dancy of expertise, decision time, and conseque of error, to name but a few

Moreover, a particular practice may opera number of diverse contexts. As an example, gency medicine providers function in hospital in emergency-response mobile units, and on ba fields. Similarly, to mention several obvious dis tions, urban and rural general providers operate independent or multipractitioner offices, as well in community walk-in clinics. Neither the comp tencies that impel successful teamwork nor an o mal team-training strategy can be expected generalize across all these contexts. And, of cour not all members within the same team will ne sarily need the same IGAs.

Therefore, in addition to the core-compete taxonomy, we also recommend develop I

practice-specific taxonomies. These putative onomies would not be redundant with the genen - core-competency taxonomy. Rather, a practi specific taxonomy would denote the specific K requirements that are central to teamwork a given practice. The medical content and p dures that define this practice would drive identification of relevant team competencies.

Virtually no previous research has addres manner in which differences within and b medical practices should be reflected in prac specific taxonomies. Yet we find this issue su Gently compelling to warrant further investiga Because these taxonomies are derived from medical characteristics of specific practices contexts within them), subject-matter experts represent each practice might be invaluable in i tifying practice-specific team competencies th not redundant with the generic core-compe taxonomy. Nevertheless, we also suggest researchers avail themselves of survey ques naires, structured interviews, and unobtru observations.

17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY . 269

analysis to investigate the behaviors that result in successful and unsuccessful performance during medical school and residency. Although not origi- siderable Progress in Designing nally targeted toward team performance, the results

Team Training revealed the importance of a number of teamwork- ,,,,, a i umber of Sett ings. related competencies. Simply stated, for medical team training to deliver

ourreview of team training programs clearly shows the impact that it can potentially exert on patient

that he community is striving to implement safety, it must be instantiated at every stage of a mf tf&ing across a number of medical domains. provider's working life. For example, certain medical we recommend that this trend be continued. school assignments might require students to pre- However, the extent to whch these programs are pare team projects. Interns and residents might

being implemented with the help of what we know observe, participate in, and evaluate practicing teams the science of learfig, of team performance, in hospitals. The larger challenge, however, occurs

uld of training is less dear. Thus, we recommend after pro~lders have completed their formal training. ening the link between scientific knowledge We believe that the structure of health care, as

al team training. Furthermore, as noted currently conceptualized, does offer appropriate the medical community should explore junctures where teamwork skills could be evaluated.

that medical team training be developed to it might ultimately be usefui to develop a board certi- nflect the established instructional principles that fication test for teamwork. Such an exam might com-

team-training research. Second, we recom- bine a written test of knowledge and situational .earnwork nor an 0 mend that the quhty of these programs be evaluated judgment with performance in a simulated scenario.

on the basis of confirmed scientific criteria (e.g., Because the board examinations are practice specific, assessing the degree to whch training transfers to theit teamwork component could assess practice- he actual work environment). specific teamwork competencies. In addition, the

Joint Commission on Accrehtation of Healthcare Organizations currently evaluates hospitals on criteria Conclusion 7: The

Institutionalization of Medical- that range from medical practices to manageria' sys- tems to facilities maintenance. At some point in the

Team Training Across Different future, folding generic competency criteria into .the Medical Sett ings H a s Not Been Joint Commission evaluation might focus providers'

attention on the importance of teamwork in medical settings, as well as ylelding valuable research data.

Our h a 1 conclusion focuses on what we consider ice would drive the imperative need to embed medical team training

in professional development. By "embedding" we ACKNOWLEDGMENTS mean implementing and regulating medical team training throughout a health care provider's career. As This research was supported by a grant from the noted earlier, the ACGMF. identified several team- AHRQ and the DOD, TriCare Management

find h s issue su work-related competencies that residents must Activity. The views expressed herein are those of master. Sldarly, AAMC funded a "critical incident" the authors.

re derived from

t-matter experts w be invaluable in ide

K. h., Goodwn, G. F., Scarcy, C. A,, Norris, D. G., & Agency €01 Health Care Research and Quality (AHRQ ). C ) ~ ~ l e r , S. H. (2001). Deueioprnent o f a PerfomanceModel of the (2000). Doing What Countsfor Patient Sujeg: FederalActions to l"fcdicfll Ed~ication Process. Te~bniral &port Comm,isioned 5 the Reduce Medictrl Errors and Their Impnd. Rockvie, MD: A850[7fltio~ o f American Medical Colleges. Washington, DC: Author. American lnsurutes €or Kesearch. Boyatzis, R. E. (1982). The Competent Mannger. New York: Wiley.

270 BAKER ETAL.

Brannick, M. T., Salas, E., & Prince, C. (1997). Team Performance Assessment andilleasurement. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Campion, hf. A,, Medsker, G. J., & Higgs, A. C. (1993). Relations between work group characteristics and effectiveness: Gully, S. M., Incalcaterra, K. A., Joshi, A,, & Beaubi Implications for designing effective work groups. Personnel (2002). A meta-analysis of team efficacy, potency, P~chology, 46, 823-850. formance: Interdependence and l e ~ e l of analysis a

Cannon-Bowers, J. A,, & Salas, E. (1998). Making Decisions under ators of observed relationships. ]ournu1 of Applied P S&ess: Implications for Indi~ndualand Team Training. Washington, DC: American Psychological Association.

Cannon-Bowers, J. A., Tannenbaum, S. I., Salas, E., & Volpc, C. E. (1995). Defmng competencies and establishing team training requirements. In R. A. Guzzo, E. Salas, & Associates (Eds.), Team Efectiveness and Decirion-Making in Organarahans @p. 333-380). San Francisco: Jossey-Bass.

Cohen, S. G., & Bailey, D. E. (1997). What makes teams work: Group effecaveness research from the shop floor to the executive suite. ]ournu1 of Management, 23,239-290.

Dalies, J. M. (2001). hiedical applications of crew resource man- @p. 315-342). Englewood Cliffs, NJ: Prentice Hall. agement. In E. Salas, C. A. Bowers, & E. Edens (Eds.), Iqroving Teamwork in Organixations: Apphcations o f Resource of top management team heterogeneity on firms' co ~bfanagement Training @p. 265-281). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Driskell, J. E., &Johnston, J. H. (1998). Stress exposure training. (1995). Behavioral Markers in Acrident~ and Incidents. InJ . A. Cannon-Bowers & E. Salas Fds.), Making Deririons Commissioned By the F A A (NASA/UT/FAA Tec Under Strerclmplications for Indim'dual and Team Training @p. 191-21 7). Washington, DC: American Psychological Association.

Dnskell, J. E., & Salas, E. (1992). CoUective behavior and team performance. Human Factors, 34, 277-288.

Dunnington, ti . L., & Williams, R. G. (2003). Addressing the new competencies for residents' surgical training. Academic Helmeich, R. L., & Merritt, A. C. (1998). Culture at Wo Medi~ne, 78, 14-21. Aviation and Medicine: National, O~ani~ational, and ProjEr

Dyer, J. L. (1984). Team research and ttaining: A state of the Inf/wences. Brookfield, VT: Ashgate. art review. In F. A. Muckler (Ed.), Human Factors Review @p. 285-323). Santa Monica, CA: Human Factors and Ergonomics Society

Fleishman, E. A,, & Zaccaro, S. J. (1992). Toward a taxonomy of team performance functions. In R. W Swezey, & E. Salas (Eds.), Teams: Their Training and l'e$omance @p. 31-56). Nomood, NJ: Ablex. James, L. R., Demaree, R. G., & Wolf, G. (1984). Estima

Foushee, H. C. (1984). Dyads and triads at 35,000 feet: Factors affecting group processes and aircrew performance. bias. ]ournal of Applied Pyhology, 69, 85-98. A~nericnn Pgchologirt, 39, 885293.

Gaba, D. hI. (1998). Research techniques in human performance using realistic sirnulacion. In L. C. Henson & A. H. Lee (Eds.), Simulators in Anesthesiology Education @p. 95101). New York: Plenum.

Gaba, D. M., Howard, S. K., Fish, K. J., Smith, B. E., & Sowb, Y A. (2001a). Simulation-based training in anesthesia crisis Behavioral & Social Sciences. resource management (ACRhQ: A decade of experience. Simulahon & Gaming, 32, 175-1 93.

Gaba, D. M., Howard, S. K., Fish, K. J., Smith, B. E., & Sowb, Y. A. (2001b). Simulation-based training in anesthesia crisis resource management (ACRM): A decade of experience. 16173 Simulation d- Gaming, 32, 175-193. McGrath, J. E. (1984). Growps: Interaction and Pe$ornlcl'lr

Gaba, D. M., Howard, S. K., Fianagan, B., Smith, B. E., Fish, K. Englewood Cliffs, NJ: Prentice Hall. J., & Botney, R. (1998). Assessment of clinical performance Mohrman, S. A,, Cohen, S. G., & Mohrman, A. hi. (199 during simulared crises using both technical and behavioral Designing Team-Bused Organixations: New Forms for Knoiljle ratings. Anesthesiolo~, 89, 8-1 8. Work San Francisco: Jossey-Bass.

Goldman, M. B., Shaplro, D. E., Mann, S., Risser, D. T., & Morey, J. C., Simon, R., Jay, G. D., &Rice, M. M. (2003). A t~ tireenberg, P. (2002). S t u 4 design considerations for the sition from aviation crew resource management to hasp Melireams Evaltiation (unpubhshed technical reportj. emergency departments: The MedTeams story. In R. Andover, MA Dynamics Research Corporation. Jensen (Ed.), Proceedings of the 12th International J~JII,POS~/I~'/

17. RELATION BETWEEN TEAMWORK AND PATIENT SAFETY 271

h,orcf, j. c., Slmon, R., Jay, G. D., Wears, R., Salisbury, M., Dukes, K. A , et al. (2002). Error reduction and performance improvement m the emergency de~arunent through formal

training: Evaluation results of the MedTeams prole,-t Health SerMces Rejearth, 37, 1553-1 581. Smith, P. C., & Kendall, L. M. (1963). Retranslation of expecta-

hfurns, \q B., & Schneider, A. J. L. (1 997). Using simulators for bons: An approach to the construction of unambiguous educlnon and t.rainmg m anesthesiology. Americnn Son'e~ of anchors for rating scales. Journal oj Applied Plychology, 47,

149-1 55.

requirements: The case of air traffic control teams. In E. Salas, C. A. Bowers, & E. Edens Fds.), Improving Teamwork in Organixahons: Apptications of Resource Management Training

ose& R. L., Salas, E., Merket, D. C., & Bowers, C. A. (2001). @p. 31-54>. Mahwah, NJ: Lawrence Erlbaum Associates, Applying resource management training in naval aviation: A Inc. ,,thodology and lessons learned. In E. Salas, C. A. Bowers, Smith-Jentsch, I<. A., Salas, E., & Baker, D. l? (1996). Training & E. Edens (Eds.), Iqrozing teamwork in organi~ations: team performance-related assertiveness. Personne/ P~~choiogy, Applications o f resource management !raining @p. 283-301). 49, 909-936. bfahwah, NJ: Lawrence Erlbaum Associates, Inc. Smith-Jentsch, K. A,, Zeisig, R L., Acton, B., & McPherson, J.

parry, S. B. (1998). Just what is a competency? (And why should A. (1998). Team dimensional training. In J. A. Cannon- we care?). Training, 35, 558-64. Bowers & E. Salas (Eds.), Making Deciions Under Stre,,:

pizz,, L., Goldfarb, Pu'. I., & Nash, D. B. (2001). Crew resource Inplicationsfor Indiniiual and Team Training Washington, DC: managemrnt and its applications in medicine. In K. G. American PsychoIogical Association. Shojana, B. W. Duncan, K. M. McDonald, & R. hl. Wachter Splker, V. A,, Silverman, D. R., Tourville, S. J., & Nullmeyer, R. (Eds.), Mabng Health Care Sajr: a Critica/Ana~sir gf l'atient T. (1 998). Tactical Team Resource Management Elfies on Combat &fig Prad'cer @p. 501-510). Rockville, MD: AHRQ. Mijsion Training Pe$omance (USAF AMRL Technical Report

Salas, E., Bowers, C. A,, & Cannon-Bowers, J. A. (1995). Military AL-HR-TR-1997-0137). Brooks Air Force Base, San team research: 10 years of progress. Militay Pychology, 7, Antonio, 'I% U.S. Air Force Systems/Matenel Command.

Stevens, M. J., & Campion, M. A. (1994). The knowledge, skill, and ability requirements for teamwork: Implications for human resource management. Journal gf Management, 20,

Team training in the skies: Does crew resource management Sajeely Through Human Factors Training (HCR Reference (CR\n uaining work? Human Factorr, 43, 641-674. Number: 00080). Eglin Air Force Base, FL: Military Health

edinir 63, 765770. System Health Care. 1 in organizanons: Some 4, 129-139. have we learned from the Harvard Medical Practice Study? If, G. (1984). Esdmatlng In M. M. Rosenthal & I(. M. Sutcliffe (Eds.), MedicaIErroc

What DO We Know? What Do We Do? @p. 5 3 3 ) . San

son. At . S. (Eds.). (1999). ea/tii System. WashLngto~h adable from Institute of :.iom.edu/report.asp?id',

171-190). Mahwah, XJ: Lawrence Erlbaum Associates, Inc. .rartjon and Peghmann. . R., Langford, 5!, Locke, A,, Morey, J. C., Risser, D., & An empirical investigation. Human Factors, 38, 87-100.

Salisbury, hi. (2000). A successful transfer of lessons learned West, M. A,, & Anderson, N. R. (1996). Innovation in top man- ohman, .%. hi. (1995). in aviation psychology and flight safety co health care: The agement teams. Jouma/o/ Applied P~tcbology, 881, 680-693. Sew Foms for Knowled~ SledTeams system. In Patient Sa jg ln iha t i~~ 2000-Jpotirghting Wiener, E. L., Icanki, B. G., & Helmreich, R. L. (1 993). Cockpit

Sfrflregies, Sharing Soir~hons @p. 45-49). Chicago: Xational Resource Management. San Diegu: Academic. :e, X1. 31. (2003). A mn- , Patient Safer)- Foundation. managemenr to hospid : ITearns sror!. In R.

Copyright 2007 by Lawrence Erlbaurn Associates All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without prior written permission of the publisher.

Lawrence Erlbaum Associates, Inc., Publishers

10 Industrial Avenue

Mahwah, NJ 07430

Library of Congress Cataloging-in-Publication Data

Handbook of human factors and ergonomics in health care and patient safery / edited by Pascale Carayon.

p. cm. Includes bibliographical references and index.

ISBN 0 - 8 0 5 8 4 8 8 5 - 1 (cloth : alk. paper)

1. Medical errors-Prevention-Handbooks, manuals, etc. 2 . Human engineering-Handbooks, man- uals, etc. 3. Patients-Safety measures-Handbooks, manuals, etc. 4. Health facilities-Design and construction-Handbooks, manuals, etc. I. Carayon, Pascale.

[DNLM: 1. Medical Errors-prevention & control. 2. Human Engineering. 3. Safety Management. WU 100 H2355 20071

Books published by Lawrence Erlbaum Associates are printed on acid-free paper, and their bindings are chosen for strength and durability.

Printed in the United States of America 1 0 9 8 7 6 5 4 3 2 1