Methadonbehandlungen im Kanton Bern 1979-1989
1993, Tschan, Franziska, Baillod, Jürg, Tüller, Niklaus, Seiler, Anton
Temporal aspects of processes in ad-hoc groups: A conceptual scheme and some research examples
2008, Tschan, Franziska, McGrath, Joseph, Semmer, Norbert, Arametti, Maurizio, Bogenstätter, Yvonne, Marsch, Stephan, Roe, Robert, Waller, Mary, Clegg, Stewart
Temporal Matters in the Study of Work Groups in Organizations
2007, McGrath, Joseph, Tschan, Franziska
The Surgeon?s Perspective: Promoting and Discouraging Factors for Choosing a Career in Surgery as Perceived by Surgeons
2014, Seelandt, Julia C., Kaderli, Reto M., Tschan, Franziska, Businger, Adrian P.
Impact of team familiarity in the operating room on surgical complications
2014, Kurmann, A., Keller, S., Tschan, Franziska, Seelandt, J., Semmer, N. K., Candinas, D., Beldi, G.
Activities during interruptions in cardiopulmonary resuscitation: a simulator study
2011, Tschan, Franziska, Vetterli, Maria, Semmer, Norbert K., Hunziker, Sabina, Marsch, Stephan U
OBJECTIVE: Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with "secondary activities", i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support. DESIGN: Prospective observational study. SETTING: Twenty teams of general practitioners were videotaped during a simulated cardiac arrest. OUTCOME MEASURES: Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support. RESULTS: Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members. CONCLUSIONS: Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.
Teamwork and Leadership in Cardiopulmonary Resuscitation
2011-3-8, Hunziker, Sabina, Johansson, Anna C, Tschan, Franziska, Semmer, Norbert K., Rock, Laura, Howell, Michael D, Marsch, Stephan U
Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.
Gruppen als informationsverarbeitende und handelnde Systeme?Konsequenzen für Gruppentraining
2003, Tschan, Franziska, Von Cranach, Mario, Hamborg, Kai-Christoph, Holling, Heinz
Leadership in medical emergencies depends on gender and personality
2011, Streiff, Seraina, Tschan, Franziska, Hunziker, Sabina, Buehlmann, Cyrill, Semmer, Norbert K., Hunziker, Patrick, Marsch, Stephan U
NTRODUCTION: Leadership is an important predictor of team performance in medical emergencies. There are no data on why some healthcare workers take the lead in emergencies while others do not. Accordingly, the aim of the study was to determine predictors of leadership in a medical emergency. METHODS: Two hundred thirty-seven medical students in fourth year of medical school participated and filled in a questionnaire assessing knowledge, experience, and personality traits. Students were randomly assigned to 79 groups of three. Each group was confronted with a standardized scenario of a simulated witnessed cardiac arrest. The primary outcome was the predictors of the number of leadership statements during the first 3 minutes of the cardiac arrest. RESULTS: In the first 3 minutes of the cardiac arrest, the participants made a median of five leadership statements (range, 0-22; interquartile range, 2). Thirteen participants (5.5%) made no single leadership statement. Multivariate analysis revealed that male gender (unstandardized coefficient, 1.9; P = 0.01), extraversion (unstandardized coefficient, 0.9; P = 0.02), and agreeableness (unstandardized coefficient, -1.1; P = 0.023) predicted leadership statements. Context knowledge, context experience, and other personality traits had no significant effect on leadership. CONCLUSIONS: During the initial phase of a medical emergency, there is a substantial interindividual variation in the amount of leadership. Leadership behavior as assessed by the number of leadership statements is determined by gender and personality and not by knowledge or experience.
Perceived stress and performance during a simulated resuscitation: A pilot study
2011-9-1, Hunziker, Sabina, Laschinger, Laura, Portmann, S, Semmer, Norbert K., Tschan, Franziska, Marsch, Stephan U