ful approach for developing these skills. Ideally, the training should address the three cognitive processes that govern how well people respond during a crisis: (1) overall knowledge of background information and related conditions; (2) attention dynamics, or the control and management of mental workload, maintenance of situation awareness, and avoidance of fixations; and (3) strategy development, which includes considering trade-offs between conflicting goals, dealing with uncertainty and ambiguity, setting effective priorities, and making good decisions (Bea, 1998).

A third team- and safety-related theory focuses on team effectiveness, including the ability to avoid or minimize the potential for error. In this model, team effectiveness is measured by the team’s ability to solicit and value differences in team members’ assumptions and world views (Korsgaard et al., 1995). Even in the best of circumstances, however, team members may become disengaged from the team if they believe the action taken by the team differs from their personal view. For this reason, reviews of effective team decision making should consider both the quality of the decision and the impact of the decision-making process on team members’ commitment to the decision, their continued attachment to the team, and their trust in the team leader. These latter three dimensions serve as antecedents to cooperation among team members, which is essential to the ultimate support for and action on a decision made.

One approach to determining the potential level of team member support for a team decision is consideration of a team member’s perceived level of procedural justice during the decision-making process. The tenets of procedural justice suggest that fair treatment is central to all humans and is a major determinant of their reaction to how decisions are made and executed (Korsgaard et al., 1995). The concept is focused in particular on the meaning of involvement in the decision-making process and less so on the individual’s ultimate control over the decision outcome. Perceptions of fairness are influenced by the extent to which team members show consideration for the input of other team members and the extent to which individual members’ input affects or is reflected in the final decision. In the case of health care teams designed according to hierarchical reporting determiners, procedural justice is influenced considerably by the senior members of the team. If the senior members routinely seek and incorporate junior members’ opinions in decision making, junior members are more likely to perceive the team process as just and supportable. If, on the other hand, junior team members perceive the process as unjust, they are much less likely to cooperate with or support any decisions made. They also are far more likely to disengage from the group and to minimize the potential benefit of the group process for patient safety decisions.

This theory of team effectiveness and the impact of team leader consideration and responsiveness was tested in a study of intact teams of middle-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement