Mythen und Fakten zur Teamarbeit, PD Dr. Michaela Kolbe

Von der Formel 1 und dem
Cockpit ins Spital oder auch
nicht:
Mythen und Fakten zur Teamarbeit
PD Dr. Michaela Kolbe
Universitätsspital Zürich / ETH Zürich Teamarbeit: Segen
Teamarbeit: Fluch
Zusammenhang zwischen “adverse events”
und schlechter Teamarbeit Bsp. Chirurgie: Schlechte Teamarbeit
zweithäufigste Fehlerursache; schlechte
Teamkommunikation sagt Operationsdauer
vorher
Risiken in der Teamarbeit
Viele herausfordernde Teamstrukturen (Adhoc Teams); wenig Training in Teamarbeit
Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: A study of human factors. Quality and Safety in Health Care. 2002;11:277-283.
Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133:614-621.
Gillespie BM, Chaboyer W, Fairwater N. Factors that influence the expected length of operation: results of a prospective study. BMJ Quality & Safety. 2011;21:3-12.
Greenberg C, Regenbogen S, Studdert D, et al. Patterns of Communication Breakdowns Resulting in Injury to Surgical Patients. J Am Coll Surg. 2007;204:533 - 540.
Pronovost P. Teamwork matters. In: Salas E, Tannenbaum SI, Cohen D, Latham G, eds. Developing and enhancing teamwork in organizations: Evidence-based best
practices and guidelines. San Francisco, CA: Jossey-Bass; 2013:11-12.
7 Mythen
Mythos 1
Mythos: Einigkeit und Harmonie im
Team sind das Allerwichtigste.
!
Realität: Beispiel 1: Entscheidung zur Invasion in die Schweinebucht (Kuba) von Kennedy
und seinen Beratern 1961
Starkes Gewicht auf Harmonie
und Abschottung nach Aussen
können zu “Gruppendenken”
und damit zu schlechten
Teamentscheidungen führen.
Beispiel 2: NASA’s
Entscheidung zum Start des
Spaceshuttles Challenger
(Sorge der Ingenieure z.T.
ignoriert) 1986
Janis IL. Groupthink: Psychological studies of policy decisions and fiascoes. Boston: Houghton-Mifflin; 1982.
Mythos 2
Mythos: Meinungs- und
Informationsvielfalt zahlen
sich automatisch aus.
!
Realität: Teams reden häufiger über
das, was alle schon wissen
(=geteilte Inf.), anstatt über
Dinge, die bisher nur wenige
wissen (=ungeteilte Inf.)
Larson, J. R. J., Christensen, C., Franz, T. M., & Abbott, A. S. (1998). Diagnosing groups: The pooling, management, and impact of shared and unshared case information
in team-based medical decision making. Journal of Personality and Social Psychology, 75, 93-108. doi: 10.1037/0022-3514.75.1.93
Mythos 3
Mythos: Teamarbeit ist immer besser als
Einzelarbeit.
!
Realität: Ob sich Teamarbeit lohnt, hängt von
der Zusammenarbeit im Team und von
der eigentlichen Aufgabe ab.
Zajonc RB. Social facilitation. Science. 1965;149:269-274.
Versuchsanordnung (aus: Aronson et al. 3004; S. 326):
Soziale Erleichterung & Soziale Hemmung
Zajonc RB. Social facilitation. Science. 1965;149:269-274.
Mythos 4
Mythos: In guten Teams gibt es keine
Konflikte, v.a. keine
persönlichen.
Realität: Gute Teams schaffen
“Psychologische Sicherheit”
und nutzen Konflikte, um
besser zu werden.
!
Catmull, E. (2008). How pixar fosters collective creativity. Harvard Business Review, September, 1-11. Edmondson, A. C., & McLain Smith, D. (2006). Too hot to handle? How to manage relationship conflict. California Management Review, 49(1), 6-31. Edmondson, A. C. (2012). Teaming: How organizations learn, innovate, and compete in the knowledge economy. San Francisco, CA: Jossey-Bass.
Mythos: Mythos 5
Einmal “aufgestellt”,
funktionieren gute Teams
mehr oder weniger
automatisch.
!
Realität: Gute Teams reflektieren über
und trainieren das
Zusammenarbeiten.
Edmondson AC. Teaming: How organizations learn, innovate, and compete in the knowledge economy. San Francisco, CA: Jossey-Bass; 2012.
Tucker AL, Edmondson AC. Why hospitals don't learn from failures: Organizational and psychological dynamics that inhibit system change. California Management
Review. 2003;45:55-72.
Mythos 6
Mythos: Haben die Teamkollegen ein
Anliegen, wenden sie sich
damit automatisch an die
Führungsperson.
!
Realität: “Habituiertes Schweigen”
Kish-Gephart JJ, Detert JR, Treviño LK, Edmondson AC. Silenced by fear: The nature, sources, and consequences of fear at work. Res Organ Behav. 2009;29:163-193.
Und nun?
6 Paradoxe Ratschläge
6 Paradoxe Ratschläge
1. Reden Sie nie über Ihre Zusammenarbeit im Team! (So etwas machen nur Psychologinnen.)
!
6 Paradoxe Ratschläge
Mathieu, J. E., & Rapp, T. L. (2009). Laying the foundation for successful team performance trajectories: The roles of
team charters and performance strategies. Journal of Applied Psychology, 94(1), 90-103. doi: 10.1037/a0013257
Tannenbaum, S. I., & Goldhaber-Fiebert, S. (2013). Medical team debriefs: Simple, powerful, underutilized. In E. Salas & K. Frush (Eds.), Improving patient safety
through teamwork and team training (pp. 249-256). New York: Oxford University Press.
West, M. A. (2004). Effective teamwork. Practical lessons from organizational research (2nd ed.). Oxford: BPS Blackwell.
6 Paradoxe Ratschläge
2. Lassen Sie Ihre Teammitglieder erraten, was Sie
wollen! (Klare Ansagen sind etwas für Anfänger.)
6 Paradoxe Ratschläge
2. b
Gleiches gilt für klare Rollen. (Wer’s nicht kapiert, dem ist
nicht zu helfen.)
Catchpole, K. R., de Leval, M. R., McEwan, A., Pigott, N., Elliot, M. J., McQuillan, A., MacDonald, C., & Goldman, A. J. (2007). Patient handover from surgery to intensive
care: Using Formula 1 pit-stop and aviation models improve safety and quality. Pediatric Anesthesia, 17, 470-478.
H A N D O V ER F R O M S U R G ER Y T O I N T EN S I V E C A R E
4 71
rds: communication; error; handover; quality; safety;
ork
P A T I E N T H A N D O V ER F R O M S U R G ER Y T O I N T EN S I V E C A R E
4 73
Table 2
Summary of the new handover protocol
Phase 0: prehandover
ex congenital
m, who have
the intensive
ortant period
e vulnerable
e technology
g lines, mulsferred twice,
ment, then to
min. At the
ained by the
re is handed
U). It is the
cess susceptatient is most
ity of care we
gh-reliability
Phase 1: equipment and
technology handover
The Patient Transfer Form is completed by the anesthetist and collected from theater at least
30 min before the patient is transferred to the ICU.
The receiving nurse ensures the bed space is set up according to the monitoring, ventilation and other
requirements specified on the Patient Transfer Form.
The receiving doctor ensures that all appropriate paperwork is ready.
On arrival the team transfers the patient ventilation, monitoring and support from portable
systems used during the transfer to the ICU systems.
Safety check: the anesthetist checks the equipment and that the patient is appropriately ventilated
and monitored and is stable. The receiving nurse and doctor are identified and confirm their readiness.
ing was seen
Phase 2: information
The anesthetist, then the surgeon, speak alone and uninterrupted, providing the relevant information
handover
about the case, using the Information Transfer Aid Memoir.
-professional
Safety check: the receiving nurse and doctor should use the Information Transfer Aid Memoir to check
o effectively
that all necessary information has been obtained, and ask appropriate questions.
Phase 3: discussion
The surgeon, anesthetist and receiving team discuss the case as a group. The receiving physician
tyres and fill
and plan
manages the discussions, identifies anticipated problems, and anticipated recovery is discussed.
The ICU team now has responsibility for patient care, and confirms the plans for the patient.
(approx 7 s)
s targeted as
Figure 1
A Formula 1 pit-stop.
handover of
open heart surgery to correct congenital heart
described in Table 1 and the new handover protocol
iprofessional
defects, and had been in the operating theater for
and process which emerged are summarized in
d ICU staff)
2–6 h. The RACHS-1 method (5) was utilized to class
Table 2.
patients into risk groups, with level 1 and 2 operme pressure,
ations
designated
as low risk,
and
levels 3 to
andintensive
4
Catchpole,
K. R., de Leval, M. R., McEwan, A., Pigott, N., Elliot, M. J., McQuillan,
A., population
MacDonald, C., & Goldman, A. J. (2007).
Patient
handover
from
surgery
Methods
rmation. The
Patient
designated as high risk. In the old handover group
y skills also
care: Using Formula 1 pit-stop and aviation models improve safety
and quality. Pediatric Anesthesia, 17, 470-478.
15 were in the low-risk surgery group, and eight
A total of 50 patient handovers were studied, with 23
Study design
https://vimeo.com/141795729
Valentine, M. A., & Edmondson, A. C. (2015). Team scaffolds: How mesolevel structures enable role-based coordination in temporary groups. Organization Science,
26, 405-422. doi: doi:10.1287/orsc.2014.0947
6 Paradoxe Ratschläge
6
N. Bienefeld & G. Grote: Silence in Aircrews
Table 3. Contingency table of reasons for crew members’ silence and chi-square tests
Frequencies (percentage) of reasons per occupational group
Reasons for silence
1. Status differences
2. Fear of damaging relationships
3. Feelings of futility
4. Lack of experience in current job
position or on aircraft type
5. Negative impact on others
6. Poor relationship with supervisor
Original Article
7. Fear of punishment
8. Fear of negative label
9. Perceived conflict efficiency versus safety
10. Perceived time pressure
Captain
n = 261
First officer
n = 334
Purser
n = 307
Flight attendant
n = 849
0
(0%)
137
(53%)
0
(0%)
36
36
(11%)
143
(43%)
111
(33%)
44
63
(20%)
45
(15%)
72
(23%)
10
343
(40%)
357
(42%)
436
(51%)
0
(14%)
63
(24%)
0
(0%)
0
(0%)
8
(3%)
55
(21%)
53
(20%)
(13%)
80
(24%)
67
(20%)
76
(23%)
97
(29%)
46
(14%)
37
(11%)
(3%)
49
(16%)
79
(26%)
206
(67%)
65
(21%)
215
(70%)
126
(41%)
(0%)
307
(36%)
299
(35%)
690
(81%)
55
(6%)
249
(29%)
110
(13%)
v2 (df = 3)
232.15*
101.84*
257.53*
122.46*
53.96*
137.05*
715.62*
150.28*
270.93*
132.87*
Notes. Percentages of reasons given add up to more than 100%, as most participants indicated more than one reason for their silence.
Figures in bold represent the three most frequently chosen reasons per occupational group.
*p < .001.
First Officers’ Main Reasons for Silence
Discussion
Bienefeld-Seall N, Grote
G. Silence
that43%
mayofkill:
When
aircrew
members
don't speak up and why. Aviation Psychology and Applied Human Factors. 2012;2(1):1-10.
In cockpit
crews,
first
officers
feared
that speaking
In this study, we explored past speaking up behavior and the
6 Paradoxe Ratschläge
6 Paradoxe Ratschläge
4. Fragen Sie nie nach und
hören Sie nie zu! (Sie wissen es eh selbst am
besten.)
Wahrnehmungsfehler 1: Implizite Persönlichkeitstheorien
!
!
Vermutung, dass manche
Persönlichkeitseigenschaften
„einfach zusammen gehören“
Beispiele: Grosszügige Menschen sind auch
warmherzig
Lehrer/innen führen schlechte
Leistung der Schüler/innen auf
deren Faulheit zurück
Wahrnehmungsfehler 2: Falscher Konsensus Effekt
Tendenz, die eigene Sicht
als normal und häufig
vorkommend zu erachten Führt zur (falschen)
Annahme, dass Andere die
eigene Ansicht teilen
Ross, L., Green, D., & House, P. (1977). The 'false consensus effect': An egocentric bias in social perception and attribution processes. Journal of Experimental
Social Psychology, 13, 279-301. Wahrnehmungsfehler 3: Fundamentaler Attributionsfehler
Tendenz, den Einfluss dispositionaler Ursachen auf das
Verhalten von Anderen zu überschätzen
Gilbert, D. T., & Malone, P. S. (1995). The correspondence bias. Psychol Bull, 117(1), 21-38. 6 Paradoxe Ratschläge
5. Zeigen Sie in keinem Fall Wertschätzung und seien
Sie respektlos! (Nur Warmduscher brauchen Lob.)
6 Paradoxe Ratschläge
Porath, C. L., & Erez, A. (2009). Overlooked but not untouched: How rudeness reduces onlookers' performance on routine and creative tasks. Organizational
Behavior and Human Decision Processes, 109(1), 29-44. doi: 10.1016/j.obhdp.2009.01.003
6 Paradoxe Ratschläge
Porath, C. L., Gerbasi, A., & Schorch, S. L. (2015). The Effects of Civility on Advice, Leadership, and Performance. J Appl Psychol, No Pagination Specified. doi: 10.1037/
apl0000016
6 Paradoxe Ratschläge
6. Jammern Sie! Und zwar so richtig!
6 Paradoxe Ratschläge
6 Paradoxe Ratschläge
Zusatz-Ratschlag:
Rühren Sie den “Elefanten im
Raum” nicht an!
Vielen Dank.
[email protected] !
!
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www.simulationszentrum.usz.ch