Is Team Training Effective at Healthcare Sites?

In the June 2016 issue of the Journal of Applied Psychology the authors Eduardo Salas, Lauren Benishek, Megan Gregory and Ashley Hughes in an article titled “Saving Lives: A Meta-Analysis of Team Training in Healthcare” set out to answer the question as to whether team training is effective in healthcare, whether it leads to reduced mortality and improved health outcomes.

Their research stated that a preventable medical error occurs in one in every three hospital admissions and results in 98,000 deaths per year, a figure corroborated in To Err is Human. Teamwork errors through failure in communications accounts for 68.3% of these errors. Thus, effective team training is necessary to reduce errors in hospitals and ambulatory sites.

The authors used a meta-analysis research method to determine whether there are effective training methods in the healthcare setting that can have a significant impact on medical errors, which would in turn improve outcomes and reduce costs by eliminating the costs associated with the errors. A meta-analysis is a broad research of existing literature to answer the research questions posed by the research team or authors.

The research team posed three questions to answer:

1. Is team training in healthcare effective?

2. Under what conditions is healthcare team training effective?

3. How does healthcare team training influence bottom-line organizational outcomes and patient outcomes?

The team limited its meta-analysis to healthcare teams even though there is a great deal of research available about the effectiveness of team training in other industries and service organizations. The team believes that healthcare teams differ significantly from teams in other areas in as much that there can be much greater team fluidity in healthcare. That is, team membership is not always static, especially at sites such as hospitals and outpatient surgical centers. There are more handoffs at these sites.

Although there is greater fluidity in team membership at healthcare sites, roles are well defined. For instance, a medical assistant’s role at a primary care site is well defined even though different MA’s may be working with one physician. These roles are further defined and limited by state licensure. As the research team stated in their article, “these features make healthcare team training a unique form of training that is likely to be developed and implemented differently than training in more traditional teams… ”

The team assessed their research of articles using Kirkpatrick’s model of training effectiveness, a widely used framework to evaluate team training. It consists of four areas of evaluation:

1. Trainee reactions

2. Learning

3. Transfer

4. Results

Reaction is the extent to which the trainee finds the instruction useful or the extent to which he enjoys it. Learning is defined as a relatively permanent change in knowledge, skills and abilities. The authors note that team training is not a hard skill, as learning to draw blood. Rather, it is a soft knowledge skill. Some researchers question whether it is possible to measure the acquisition of these soft team skills effectively. The team of authors effectively argue that it can.

Transfer is the use of trained knowledge, skills and abilities at the work site. That is, can team training be effectively applied in the work setting? Results are the impacts of the training on patient health, the reduction of medical errors, the improved satisfaction of patients and a lowering of costs in providing care.

In order to assure that the changes in these four areas were ‘real’ the team only used literature that had both pre-assessments and post-assessments to see if there were statistically significant changes in the four areas.

Using this assessment rubric the team was able to answer the three questions that it posited. First, team training in healthcare is effective. Healthcare team training closely matches training in other industries and service organizations.

Secondly, training is effective, surprisingly, regardless of training design and implementation, trainee characteristics and characteristics of the work environment. The use of multiple learning strategies versus a single training strategy does not matter. Simulations of a work environment are not necessary. Training can occur in a standard classroom.

Training is effective for all staff members regardless of certification. Training of all clinical personnel as well as administrative staff is effective. Team training also is effective across all care settings.

Lastly, the team’s meta-analysis shows that within the Kirkpatrick rubric team training is effective in producing the organizational goals of better care at lower costs with higher patient satisfaction. In the rubric trainee reactions are not nearly as important as learning and transfer in producing results. It is important that trainers use both pre-training assessments and post-training assessments to measure whether there learning of skills, knowledge and abilities were learned and whether these were transferred to the work site. Effectiveness of training should always be assessed in order that training programs can be consistently improved.

In my September 2017 newsletter “Team Meetings” I described the elements of good team training as well as provided a link to the American Medical Associations team training module as part of Stepsforward series of learning modules. You can find this newsletter online here. With these training instructions as a beginning healthcare providers can learn to work more effectively as teams and thus produce better care at a lower cost with higher satisfaction of both patients and providers.

Setting The Record Straight on Meat Health

Red meat is often wrongly portrayed as being unhealthy. Even chicken has been getting attacked by some in the media as being unhealthy or not environmentally friendly. Vegan, fish and other non-meat diets have been proposed as healthier alternatives. The result of this onslaught of negative meat messages has influenced many persons including moms and dads to drastically cut back on their meat and poultry purchases. Perceptions may be seen as reality, yet truth trumps non truths. Parents and other consumers want what is best for their health and that of their families. They are also aware that a lot of false information is out there and as such are open to scientific facts that can correct their misconceptions. Below are the facts:

A) LETS IRON OUT THE TRUTH ON MEAT!
1) “You would need to eat a massive amount of spinach to equal (the iron content) in a steak,” says Christopher Golden, an ecologist and epidemiologist at Harvard University in Cambridge, Massachusetts. (As quoted by nature.com in the article ‘Brain food- clever eating’.)
2) Let’s get precise. For a woman to receive her recommended daily intake of 18 mg of iron would need just 300 grams of cooked bovine liver, 625 grams of cooked beef or an astounding 2.4 kg of spinach!
3) In addition, the Iron found in vegetables is harder to absorb than the iron found in meat as it is attached to fibre which inhibits its absorption.

B) MEAT FOR A HEALTHIER BRAIN!
1) Being deficient in the micronutrients found in meat have been linked with low IQ, autism, depression and dementia says Dr. Charlotte Neumann, a pediatrician at the University of California, as quoted in the above article.
2) Zinc found in meat is crucial for learning and memory.
3) Vitamin B12 found in meat preserves the sheaths that protect nerves.

C) MEAT- BOOST YOUR IMMUNITY!
Due to its antioxidant powers, zinc is involved in creating antibodies to fight free radicals that increase our risk for chronic diseases.

D) MEAT- POWER YOUR MUSCLE GROWTH!
1) The protein in meat helps build and repair body tissues.
2) Muscles are made of protein. That is why athletes who are building muscle strength increase their meat protein consumption.
3) The protein and zinc found in meat are important for muscle growth and repair.

E) MEAT- THE COMPLETE PROTEIN!
Meat contains all of the nine essential amino acids that your body cannot make by itself. Say ‘hello’ to histidine, leucine, isoleucine, lycine, methionine, phenylalanine, tryptophan, threonine, and valine. Meat supplies all nine. That is why it is called a complete protein.

F) MEAT- FOR A HEALTHY HEART!
1) Meat contains lots of the B vitamins needed for the production of hormones, red blood cells and for the proper functioning of your nervous system.
2) Say ‘hello’ to niacin, folic acid, thiamine, biotin, panthothenic acid, vitamin B12 and vitamin B6. They are all found in meat.

So let’s counter those negative meat health myths, by setting the record straight.

The Present and Future of Radiotherapy

The radiotherapy market is growing due to several factors, such as an increase in the number of new cancer cases and technological advancement in the hardware and software used in radiotherapy. The current international markets are underequipped to address new cases of cancer. In low- and middle-income countries, only 10% of the population has access to radiotherapy. Therefore, there exists a wide gap between the demand and the installed base of equipment, which offers a huge opportunity for the companies to grow in the radiotherapy market. Expansion of the radiotherapy market can be both lifesaving and profitable.

Effective planning for the treatment

It is necessary, and continuous technological developments are taking place to minimize the exposure to radiation of healthy tissue, in order to avoid any side effect. This goal is a driving force of R&D for radiotherapy. Software plays an increasingly significant role in cancer care. Population growth and increased life expectancy are adding to the incidences of cancer. The software & services segment includes software, which is used for treatment planning, analysis, and services, which are needed for the maintenance and efficient use of radiotherapy devices. The software & services segment of the companies are expected to grow, as software products help improve physician engagement and clinical knowledge-sharing, patient care management, and the management of cancer clinics, radiotherapy centers, and oncology practices for better performance. Companies like Varian are continuously increasing their software portfolio. Software plays an increasingly significant role in cancer care. At the same time, healthcare systems are subject to harsh budgetary constraints in nearly every country. As a result, healthcare providers face the challenge of achieving more while using fewer resources. To achieve this goal, hospitals have a strong need for software platforms that make radiotherapy treatment cost-effective. The development of effective software will improve the delivery of advanced radiotherapy in the future.

Introduction of new technology
Technology is another salient feature. Radiation therapy remains a significant modality for cancer treatment, which is the primary driving factor for the designing of new techniques to improve the survival rate of cancer patients. New technologies, like proton beam therapy, are available in developed countries like the United States, Germany, and United Kingdom, due to well-established reimbursement policies. Proton therapy can be used on tissues that are highly sensitive, like brain, spine, and eye tumors. It is more accurate, as compared to other X-ray radiation therapies.

Advancement in the technology is also helping to execute the planning of the radiation therapy.

Technological advancement in existing technologies, such as CT imaging, is making imaging more accurate and consistent. This can give a better representation of a tumor and help in better planning. Already-existing technology, such as IMRT, SBRT, IGRT, conformal 3D, VMAT, and others that are used for radiation therapy treatment is undergoing various advancements. For example, Varian is developing a software, which can be used to develop better planning tools, in which statistical models can be used to calculate the quality of an IMRT treatment for a patient. This is expected to increase the usage of IMRT for treating cancer. IGRT is the type of radiotherapy. Research is more focused on IGRT, in order to prove its fewer side-effects. IGRT may include electronic portal imaging, fluoroscopy, ultrasound, CT scan reconstruction, and respiratory gating technology. SBRT is also growing as an option for treating cancer. SBRT is used to escalate the dose to the targeted tumor, which can increase local control while limiting the dose to nearby critical structures and normal tissues. This will cause minimum damage to the surrounding tissues and hence, will experience strong growth in the forecast period.

Internal radiation therapy holds a low share in the radiotherapy market. Containing Yttrium 90, a radioactive substance, this is also an emerging technology. There are only two manufacturers that provide commercialized forms of SIRT, as of April 2015. SIRT is becoming more of a mainstream treatment; other manufacturers are actively looking toward its marketing, resulting in the growth of the internal radiation therapy segment. However, SIRT is not yet widely available in the United Kingdom.

Internal radiation therapy is more precise in targeting cancerous cells because it is placed near a tumor, which reduces the risk of damaging healthy tissues and organs, thereby contributing to the growth of the internal radiation therapy market segment.

To increase the market share, companies are constantly investing in R&D. The positive results of this extensive R&D and strategic partnerships can help the companies gain a significant boost in the emerging field of radiotherapy.