Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams

Area of Science:

• Healthcare Team Dynamics
• Patient Safety
• Clinical Performance Improvement

Background:

• Acute care settings are complex and require adaptive teams.
• In-action team reflection (TR) is vital for processing information and adapting during patient care.
• A systematic method for observing and training in-action TR in healthcare is currently lacking.

Purpose of the Study:

• To develop and validate a framework for measuring in-action TR in acute care teams.
• To bridge the gap in systematic observation and training of in-action TR.
• To provide a tool for enhancing team processes in dynamic healthcare environments.

Main Methods:

• A theoretical framework was developed based on literature and theory.
• Exploratory reviews of training videos informed the adaptation of observation codes.
• The Team Reflection Behavioral Observation (TuRBO) framework was developed and validated using video recordings of acute care teams.

Main Results:

• The TuRBO framework comprises 3 dimensions and 7 subcodes for measuring in-action TR.
• Substantial interrater agreement (κ = 0.80) was achieved for the coding framework.
• In-action TR positively correlated with team performance, with physicians engaging more than nurses.

Conclusions:

• The TuRBO framework offers validity evidence for assessing in-action TR in acute care.
• TuRBO integrates team communication and calibration, providing behavioral markers for TR.
• This tool can enhance team training, fostering flexible, resilient, and safer patient care.