Tschan, Franziska

2009, Bogenstätter, Yvonne, Tschan, Franziska, Semmer, Norbert, Spychiger, Martin, Breuer, Marc, Marsch, Stephan

Objective: This study used a high-fidelity simulation to examine factors influencing the accuracy of 201 pieces of information transmitted to nurses and physicians joining a medical emergency situation. Background: Inaccurate or incomplete information transmission has been identified as a major problem in medicine. However, only a few studies have assessed possible causes of transmission errors. Method: Each of 20 groups was composed of two or three nurses (first responders), one resident joining the group later, and one senior doctor joining last. Groups treated a patient suffering a cardiac arrest. Results: Multilevel binomial analyses showed that 18% of the information given to newcomers was inaccurate. Quantitative information requiring repeated updating was particularly error prone. Information generated earlier (i.e., older information) was more likely to be transmitted inaccurately. Explicitly encoding information to be transmitted after the physicians arrived at the scene enhanced accuracy, supporting transfer-appropriate processing theory. Conclusion: Information transmitted to nurses and physicians who join an ongoing emergency is only partly reliable. Therefore, medical professionals should not take accuracy for granted and should be aware of the nature of transmission errors. Application: Medical professionals should be trained in adequate encoding of information and in standardized communication procedures with regard to error-prone information. In addition, technical devices should be implemented that reduce reliance on memory regarding information with error-prone characteristics.

2006, Tschan, Franziska, Semmer, Norbert, Gautschi, Dieter, Hunziker, Patrick, Spychiger, Martin, Marsch, Stephan

The influence of human factors on team performance was investigated in "medical emergency driven groups" composed of medical professionals treating a sudden cardiac arrest in a high fidelity simulator setting. The group composition is unique, but realistic, in that it is not constant. Three phases are distinguished: In Phase 1, 3 nurses are present; in Phase 2, a resident joins; and in Phase 3 a senior doctor joins. It was hypothesized that directive leadership behavior would enhance group performance. This was supported with regard to the directive leadership behavior of the nurse first on bedside in Phase 1, and for directive leadership of the resident in Phase 2-but only with regard to behavior occurring in the first 30 see after entering the group, which reflects the need for quick action in this time-sensitive task. For Phase 3, we expected not only directive leadership but also indirect guidance by "structuring inquiry" of the senior doctor to enhance performance. This was confirmed for structuring inquiry. Results indicate that to enhance group performance training should go beyond "technical" training that concentrates on medical necessities. Rather, it should include aspects of group coordination, emphasizing that coordinating behavior should be adapted (a) to the situation and (b) to professional role requirements.

2009, Tschan, Franziska, Semmer, Norbert, Gurtner, Andrea, Bizarri, Lara, Spychiger, Martin, Breuer, Marc, Marsch, Stephan

Teamwork is important in medicine, and this includes team-based diagnoses. The influence of communication on diagnostic accuracy in an ambiguous situation was investigated in an emergency medical simulation. The situation was ambiguous in that some of the patient's symptoms suggested a wrong diagnosis. Of 20 groups of physicians, 6 diagnosed the patient, 8 diagnosed with help, and 6 missed the diagnosis. Based on models of decision making, we hypothesized that accurate diagnosis is more likely if groups (a) consider more information, (b) display more explicit reasoning, and (c) talk to the room. The latter two hypotheses were supported. Additional analyses revealed that physicians often failed to report pivotal information after reading in the patient chart. This behavior suggested to the group that the chart contained no critical information. Corresponding to a transactive memory process, this process results in what we call illusory transactive memory. The plausible but incorrect diagnosis implied that the two lungs should sound differently. Despite objectively identical sounds, some physicians did hear a difference, indicating confirmation bias. Training physicians in explicit reasoning could enhance diagnostic accuracy.

2008, Ballard, Dawna, Tschan, Franziska, Waller, Mary

The role of time in measuring group and team temporality constitutes more than a methodological issue-it is a theoretical question. That is, if group interaction is theorized as processual and processes occur through time, then research on team temporality, as well as a range of other issues, must grapple with the methodological implications of our theories. This article contributes to INGRoup's aim to advance theory and methods for understanding groups by exploring methodological approaches that allow us to capture a variety of team processes over time. Three case studies address the practical issues involved with employing various types of time-sensitive data collection, time-dependent coding, and time-based analysis, including their advantages and disadvantages. Together, the authors describe diverse field and analytical methods useful for interrogating theoretical assumptions about time in groups. Doing so expands the notion of group temporality to consider the role of both epochal and fungible times at multiple stages of group research.