The impact of environment and occupation on the health and safety of active duty air force members

Erich, R., Eaton, M., Mayes, R., Pierce, L., Knight, A. P., Genovesi, P., Escobar, J., Mychalczuk, G., Selent, M. (2016). The impact of environment and occupation on the health and safety of active duty Air Force members: Database development and de-identification. Military Medicine, 181, 821-826.

Abstract. Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields.

Impact of preoperative briefings on operating room delays

Nundy, A., Mukherjee, A., Sexton, J. B., Pronovost, P. J., Knight, A. P., Rowen, L., Duncan, M., Syin, D., & Makary, M. (2008). Impact of preoperative briefings on operating room delays: A preliminary report. Archives of Surgery, 143, 1068-1072.

Conclusions. Preoperative briefings reduced unexpected delays in the OR by 31% and decreased the frequency of communication breakdowns that lead to delays. Preoperative briefings have the potential to increase OR efficiency and thereby improve quality of care and reduce cost.

Dynamic delegation

Klein, K. J., Ziegert, J. C., Knight, A. P., & Xiao, Y. (2006). Dynamic delegation: Shared, hierarchical, and deindivididualized leadership in extreme action teams. Administrative Science Quarterly, 51, 590-621.

Abstract. This paper examines the leadership of extreme action teams—teams whose highly skilled members cooperate to perform urgent, unpredictable, interdependent, and highly consequential tasks while simultaneously coping with frequent changes in team composition and training their teams’ novice members. Our qualitative investigation of the leadership of extreme action medical teams in an emergency trauma center revealed a hierarchical, deindividualized system of shared leadership. At the heart of this system is dynamic delegation: senior leaders’ rapid and repeated delegation of the active leader- ship role to and withdrawal of the active leadership role from more junior leaders of the team. Our findings suggest that dynamic delegation enhances extreme action teams’ ability to perform reliably while also building their novice team members’ skills. We highlight the contingencies that guide senior leaders’ delegation and withdrawal of the active leadership role, as well as the values and structures that motivate and enable the shared, ongoing practice of dynamic delegation. Further, we suggest that extreme action teams and other “improvisational” organizational units may achieve swift coordination and reliable performance by melding hierarchical and bureaucratic role-based structures with flexibility-enhancing processes. The insights emerging from our findings at once extend and challenge prior leadership theory and research, paving the way for further theory development and research on team leadership in dynamic settings.

Teamwork in the operating room

Sexton, J. B., Makary, M., Tersigni, A., Pryor, D., Hendrich, A., Thomas, E., Holzmueller, C., Knight, A. P., Wu, Y., & Pronovost, P. (2006). Teamwork in the operating room: Frontline perspectives among hospital and operating room personnel. Anesthesiology, 105, 877-884.

Background & ConclusionsThe Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007.However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.

Variation in caregiver perceptions of teamwork climate

Sexton, J. B., Holzmueller, C., Pronovost, P. J., Thomas, E., McFerran, S., Nunes, J., Thompson, D., Knight, A. P., Penning, D., & Fox, H. (2006). Variation in caregiver perceptions of teamwork climate in labor and delivery units. Journal of Perinatology, 26, 463-470.

Objectives & Conclusions. To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data. We demonstrate a psychometrically sound teamwork climate scale, correlate it to external teamwork-related items, and provide labor and delivery teamwork benchmarks. Further teamwork climate research should explore the links to clinical and operational outcomes.