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The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Academics from diverse disciplines are recognizing not only the procedural ethical issues involved in research, but also the complexity of everyday "micro" ethical issues that arise. While ethical guidelines are being developed for research in aboriginal populations and low-and-middle-income countries, multi-partnered research initiatives examining arts-based interventions to promote social change pose a unique set of ethical dilemmas not yet fully explored. Our research team, comprising health, education, and social scientists, critical theorists, artists and community-activists launched a five-year research partnership on arts-for-social change. Funded by the Social Science and Humanities Research Council in Canada and based in six universities, including over 40 community-based collaborators, and informed by five main field projects (circus with street youth, theatre by people with disabilities, dance for people with Parkinson's disease, participatory theatre with refugees and artsinfused dialogue), we set out to synthesize existing knowledge and lessons we learned. We summarized these learnings into 12 key points for reflection, grouped into three categories: community-university partnership concerns ( n  = 3), dilemmas related to the arts ( n  = 5), and team issues ( n  = 4). In addition to addressing previous concerns outlined in the literature (e.g., related to consent, anonymity, dangerous emotional terrain, etc.), we identified power dynamics (visible and hidden) hindering meaningful participation of community partners and university-based teams that need to be addressed within a reflective critical framework of ethical practice. We present how our team has been addressing these issues, as examples of how such concerns could be approached in community-university partnerships in arts for social change.

Objective: To develop and validate a survey instrument designed to measure team dynamics in primary care., Data Sources/study Setting: We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care., Study Design: We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling., Data Collection: We administered the survey between September 2012 and March 2013., Principal Findings: Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49)., Conclusions: It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes)., (© Health Research and Educational Trust.)

Objective: The aim of this study was to review literature relevant to cohesion measurement, explore developing measurement approaches, and provide theoretical and practical recommendations for optimizing cohesion measurement., Background: Cohesion is essential for team effectiveness and performance, leading researchers to focus attention on understanding how to enhance it. However, cohesion is inconsistently defined and measured, making it difficult to compare findings across studies and limiting the ability to advance science and practice., Method: We reviewed empirical research through which we uncovered specific information about cohesion's conceptualization, measurement, and relationships with performance, culminating in a set of current trends from which we provide suggestions and possible solutions to guide future efforts and help the field converge toward greater consistency., Results: Cohesion demonstrates more significant relationships with performance when conceptualized using social and task (but not other) dimensions and when analyses are performed at the team level. Cohesion is inherently temporal, yet researchers rarely measure cohesion at multiple points during the life of a team. Finally, cohesion matters in large, dynamic collectives, complicating measurement. However, innovative and unobtrusive methodologies are being used, which we highlight., Conclusion: Practitioners and researchers are encouraged to define cohesion with task and social subdimensions and to measure with behavioral and attitudinal operationalizations. Individual and team-oriented items are recommended, though team-level analyses are most effective. Innovative/unobtrusive methods should be further researched to enable cohesion measurement longitudinally and in large, dynamic collectives., Application: By applying our findings and conclusions, researchers and practitioners will be more likely to find consistent, reliable, and significant cohesion-to-performance relationships., (This work is not subject to U.S. copyright restrictions.)

The present manuscript extends previous research on the reciprocal relation between team confidence and perceived team performance in two ways. First, we distinguished between two types of team confidence; process-oriented collective efficacy and outcome-oriented team outcome confidence. Second, we assessed both types not only before and after the game, but for the first time also during half-time, thereby providing deeper insight into their dynamic relation with perceived team performance. Two field studies were conducted, each with 10 male soccer teams (N = 134 in Study 1; N = 125 in Study 2). Our findings provide partial support for the reciprocal relation between players' team confidence (both collective efficacy and team outcome confidence) and players' perceptions of the team's performance. Although both types of players' team confidence before the game were not significantly related to perceived team performance in the first half, players' team confidence during half-time was positively related to perceived team performance in the second half. Additionally, our findings consistently demonstrated a relation between perceived team performance and players' subsequent team confidence. Considering that team confidence is a dynamical process, which can be affected by coaches and players, our findings open new avenues to optimise team performance.

A nomological network on team dynamics in sports consisting of a multiframework perspective is introduced and tested. The aim was to explore the interrelationship among cohesion, team mental models (TMMs), collective efficacy (CE) and perceived performance potential (PPP). Three hundred and forty college-aged soccer players representing 17 different teams (8 female and 9 male) participated in the study. They responded to surveys on team cohesion, TMMs, CE and PPP. Results are congruent with the theoretical conceptualisation of a parsimonious view of team dynamics in sports. Specifically, cohesion was found to be an exogenous variable predicting both TMMs and CE beliefs. TMMs and CE were correlated and predicted PPP, which in turn accounted for 59% of the variance of objective performance scores as measured by teams' season record. From a theoretical standpoint, findings resulted in a parsimonious view of team dynamics, which may represent an initial step towards clarifying the epistemological roots and nomological network of various team-level properties. From an applied standpoint, results suggest that team expertise starts with the establishment of team cohesion. Following the establishment of cohesiveness, teammates are able to advance team-related schemas and a collective sense of confidence. Limitations and key directions for future research are outlined.

Purpose: The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students., Methods: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team's clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.)., Results: The teamwork scores on case 2 (22.67 ± 6.58) were higher than for case 1 in the HS (20.47 ± 7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS., Conclusion: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.

Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.