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Voices for Safer Care Home Designing Safer Systems Seeking the Right Stuff for Teams: In the Hospital or Distant Space

Seeking the Right Stuff for Teams: In the Hospital or Distant Space

Interior of HERA

Wanted: Talented, highly driven individuals to take on multiyear work assignment with potential for benefiting humankind. Requires the highest levels of technical skill, teamwork and adaptability. Must be able to tolerate social isolation, mental and physical fatigue, demanding and uneven work schedules, days and nights away from home. Risk of depression and burnout. Must be in it for the long haul.

This fictional ad might describe the challenges of a resident physician, working intense, 80-hour workweeks for years.

So, too, might it describe a new job on the horizon: astronauts on long-duration space exploration missions. If you follow NASA's work, you know that it is preparing for journeys that last three years or longer and carry crews to Mars and other destinations well beyond Earth's orbit. In these missions, picking the right individuals and forming an effective team that can work and live together in a cramped space vessel are of paramount importance.

When all of your candidates are highly accomplished, talented individuals, how do we select people and teams who have "the right stuff" for these journeys? What competencies do we seek out, and how do we measure them? What combinations of individuals will form successful teams? When you're picking six people to spend years together hurtling through space, there is little room for guesswork, no opportunities for do-overs.

There aren't great methods for making such decisions. In Houston, NASA operates a simulated space environment, in which four trainees spend up to two months. Yet with these small numbers, it would take a long time to develop assessment tools based on statistically meaningful results.

This is where we can benefit from the common characteristics between top-flight residency programs and long-duration space exploration. Working under a grant that NASA announced in January, a team from the Johns Hopkins Armstrong Institute for Patient Safety and Quality and Rice University aims to use two residency programs as analog environments to help create a sophisticated new assessment system that NASA can use to make these critical selections. Like much space-related research, this work should benefit Earth-bound endeavors, including in health care.

Assessing Performance in Real Time

Judgment, motivation, teamwork, adaptability, self-care: These are the kinds of competencies we want our residents to embody. They are also among those that NASA is seeking for these long-duration trips.

In medicine and other fields, traditional methods of rating such competencies involve self-assessments, ratings by peers or supervisors, direct observations, and tests. These are worthwhile but not good enough for yearslong space missions. They are also a time-consuming burden on the people involved and, therefore, hard to sustain.

Through this project, we aim to create a more robust assessment system by incorporating an array of wearable, sensor-based devices and other unobtrusive methods of tracking behavior among residents in our Surgery and Anesthesiology and Critical Care Medicine departments. These sensors can monitor cardiac function and stress levels, how often people move around, who interacts with whom, how often they speak to others and the volume of exchanges, and other information. In addition, we can trace their activity, in their use of paging systems and phones, emails, the electronic medical record and other systems.

Analyzing these data streams, as well as data from traditional assessment methods from residents, we hope to better understand individual and team behaviors and provide people with information to develop professionally. Is someone effectively balancing his or her individual tasks and work as part of a team? Are his or her social interactions calm and structured, with ample give and take, or are they stressful and chaotic? Is someone passive, more focused on computer systems than on interacting with his or her colleagues?

Certainly, any competency measures designed in a residency program would need to be validated and meaningful in the space flight assessment, so we will carry out similar assessments at NASA's Human Exploration Research Analog, formerly known as the Deep Space Habitat (see image above).

How Health Care Can Benefit

This endeavor has the potential to be more than a small step for humankind's space exploration endeavors. It could also help us to improve how we assess abilities and teamwork in health care, as well as patient safety improvement.

Traditional assessment will always be needed, but unobtrusive technologies can help to deepen our understanding of individual and team performance.

Sensor-based measurement has already shown promise in health care. For example, in a study of 67 PACU nurses, sensors tracking physical activity, speech and face-to-face interaction predicted four major personality traits: extraversion, openness, agreeability and neuroticism.

In another study, proximity detection sensors helped identify patterns between different role types on a clinical unit and pinpoint specific interactions to target for preventing infections.

Yet another demonstrated that sensors embedded in supplies and devices could be used to track the performance of trauma teams during resuscitation efforts.

Certainly, these approaches are early in development, and we have much to learn. Aside from ensuring that these assessment methods are scientifically sound, broader adoption would require that we address thorny privacy and security questions about measuring the behaviors of health care professionals. With exciting advances in sensors and other technology, we will need to balance any concerns against the opportunity to obtain more objective, thorough and sustainable assessments. Once these issues have been addressed, these tools can also provide better feedback to individuals, teams and larger organizational units. Measurement is critical for learning and improvement, and this work promises to help us generate insights and drive action.

Photo source: NASA


Mike Rosen

Mike Rosen, M.A., Ph.D., is a human factors psychologist leading research projects that focus on teamwork, simulation-based training, performance measurement and leadership in patient safety and quality improvement.

3 thoughts on “Seeking the Right Stuff for Teams: In the Hospital or Distant Space”

  1. When first reading the ad, I wanted it to be a real ad rather than fictional so I could apply. Doing meaningful work within a synergistic highly skilled team over years even decades is something I've experienced in shorter time frames -- a few days or a couple of months -- which I would classify as times of exhilaration and living on a higher plane than "normal" existence. While your study sounds very useful and needed as a step in learning how to measure the quantity of interactions and the reaction of individuals in teams, I'm sure you're wishing you could have a portable functional MRI on each subject that could take snapshots of what's lighting up in the brain throughout the study. But, maybe that's not all that far down the road. It seems your challenge is to measure the quality of interactions. To me one of the key components of synergistic teams is mutual respect. How does one measure that? Perhaps it is how often one person accepts another person’s decision or suggestion or the level of brainstorming back and forth. Another is whether the interactions are complete and meaning communications – what was said was heard and acknowledged – which is one of the biggest problems to solve in improving safety in health care. Big data analysis of the types (technical terms, acknowledgement words for example) and frequency of words spoken, repeated, and within proximity of each other may be ways to measure this. Can one resident get the essential information needed to treat a patient from another residents notes. Did the resident write the notes for the team? When thinking about the limitations of using resident programs, I don’t think of them as a good example of small, intact teams that could work together for decades. A resident works in multiple ephemeral teams with vastly different membership throughout the day to deal with different situations. Changing even one member of a team changes the entire dynamics of its performance. When I think of long-term, intact teams, the best example I could think of is the professional string quartet. They can dislike each other intensely, argue about every decision and yet produce some of the most beautiful music full of the nuances that can only be achieved by knowing each other so well and becoming one being when they perform. Listen to a string quartet who has been together for twenty years to hear the full depth of a composition and a precision of ensemble that is unparalleled. Thanks for letting me muse on your study and think back to those wonderful times of being a member of synergistic teams. Synergy is my favorite word! Enjoy!

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