This document presents a proposed training program to improve team leadership and functionality for healthcare teams operating under stress. It discusses how stress can degrade individual cognitive abilities and team communication/coordination. The training aims to teach strategies for managing stress to modulate its effects and improve adherence to clinical guidelines, teamwork, and self-reported stress measures. The approach involves developing the training through literature review, qualitative research, pilot testing and refinement, and evaluation initially in simulations and later clinically. Limitations include recruitment for research, expertise with stress biomarkers, and a strategy for long-term clinical impact assessment.

1. ALERT Presentation:
Team leadership under stress –
exploration of methods to improve
performance
Elizabeth Hunt, Mike Rosen

2. Background
• Healthcare teams frequently operate under high stress
conditions; the team leader’s ability to manage that
stress can impact team functioning.
• Effects of acute stress on performance
– Individual level effects: E.g., degrades cognitive capacities,
increases fixation errors
– Team level effects: E.g., reduces meaningful
communication and coordination, shift in focus from the
team task to individual tasks
• Knowledge Gaps
– What are the most effective strategies for managing stress and
improving resilient performance in time-critical healthcare
teams?
– What are the best methods for training these strategies?

3. PICO Question
• Population
– Teams of pediatric healthcare providers in simulated time-critical care emergencies
• Intervention
– A training program focused on improving leader and team functionality during
highly stressful situation, i.e. to modulate stress with the intent of improving team
functionality and adherence to guidelines
• Comparison
– Simulations where the healthcare teams have not had the stress modulation
intervention
• Outcome
– Adherence to clinical guidelines (ex. PCCM shock guidelines, PALS guidelines, ATLS
guidelines), Teamwork scores (tool to be used not yet decided), cortisol levels,
oxytocin levels, self-report workload and stress measures from team leader and
team members

4. Approach
• Systematic training development and
validation
1. Review the literature and existing training programs
2. Conduct qualitative field studies to elicit additional
training requirements
3. Develop, pilot test, and refine training program
4. Implement and evaluate training program in the
simulation center
5. Evaluate training program in clinical practice

5. 3 Limitations / Challenges
• Recruitment and scheduling of healthcare
providers to participate in focus groups
• Developing the necessary expertise to utilize
stress biomarkers effectively
• Developing a strategy for translational research,
i.e. a long term strategy to measure teamwork in
the clinical setting and whether the intervention
developed in this project has an impact on
performance and patient outcomes