Healthcare delivered via interprofessional healthcare teams (IHTs) has been found to improve patient satisfaction, enhance collaborative behaviors, reduce clinical error rates, and streamline management of care delivery.1 Unfortunately IHTs are facing a new reality—responding to mass casualty events. Be it school shootings, terrorist activities in city streets, or bombings, our IHTs must be ready to save lives in chaotic, high volume situations. How can we prepare our IHTs to meet these demands? To date, teams with the most relevant experience in dealing with these situations were military interprofessional healthcare teams (MIHTs). However, research into what makes MIHTs uniquely prepared to respond to such events is sparse.2 If civilian teams are to effectively offer care in similar situations, we should learn how MIHTs secure a 92% survival rate in wartime situations.3 To address this gap, we conducted a two phase, sequential mixed-methods study. Phase 1 was a qualitative study of purposefully sampled military healthcare professionals who had experience working with, in, or for a MIHT. This study asked: What characteristics are important for ensuring MIHT success in different care contexts, including mass casualty responses? Phase 2 was a quantitative study of approximately 20,000 military healthcare professionals who had experience working in MIHTs. This study used findings from Phase 1 to ask: Which specific MIHT characteristics were essential to successful patient care in different care contexts, including mass casualty responses?
Approach/Methods
In Phase 1, we used a Grounded Theory approach, conducting 30 interviews with multiple healthcare professionals (e.g., physician, nurse, medic) and with a variety of experiences in MIHTs. We conducted 3 cycles of 10 interviews, iteratively collecting and analyzing data, developing themes describing characteristics that enabled MIHT success. An interprofessional team, including a physician, a nurse, 5 PhD-trained researchers, and a research assistant conducted this research.
The characteristics identified in Phase 1 were used to develop a survey aimed at quantifying the relative importance of each MIHT success characteristic across care contexts, including mass casualty events. The survey comprised 57 items relating to MIHT success characteristics, 30 items from the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPs™) tool for validity purposes, and 13 demographic questions. TeamSTEPPS™, an evidence-based program, rests on four integrated core competencies that, together, “foster delivery of safe, quality care as a cohesive patient care team”: leadership, situation monitoring, communication, and mutual support which can be tailored to suit diverse contexts. 4,5, 6,7,8 The survey was disseminated to all care providers working in 8 military care facilities.
Results/Outcomes
In Phase 1, we identified 14 characteristics that enable MIHT success. These are: (1) adaptability, (2) confidence in competent team members, (3) esprit de corps, (4) ethical bearing, (5) followership, (6) leadership, (7) freedom to work at the maximum of your skill set, (8) mission focus, (9) military healthcare requires a broader skill set, (10) military policies and considerations, (11) resilience/perseverance, (12) the personal is professional, (13) negotiation across multiple hierarchies, and (14) situational awareness. We also identified 5 characteristics that overlap with civilian IHTs: (1) clinically competent, (2) communication skills, (3) interprofessional integration, (4) professionalism, (5) right/full team composition.
Initial analysis of Phase 2 data suggests that specific MIHT characteristics are essential for success in mass casualty responses. These include: adaptability, confidence in competent team members, freedom to work at the maximum of your skill set, resilience/perseverance, and situational awareness.
Discussion
Given the dramatic increase in domestic terrorism and mass shootings, MIHTs are uniquely positioned to offer insight to civilian IHTs. The lessons learned from MIHTs can help prepare healthcare providers to face the challenges unique to care in these contexts.
Significance
Findings from our research inform our understanding of the abilities and experiences that can save lives in mass casualty events—events that are occurring more frequently every year.
Disclaimer: the views expressed herein are those of the authors and do not necessarily reflect those of the Uniformed Services University of the Health Sciences, the United States Army, the United States Navy and the United States Department of Defense or other federal agencies.
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