'You can't have an ego in this game': A simulation primed qualitative inquiry of team reflection in paediatrics

Acute care paediatric teams face ambiguous, dynamic patient care situations that demand adaptability to avoid patient harm. Team huddles and adaptation processes have shown promise in mitigating risk and reducing harm. One team process that may occur in huddles is team reflection (TR), defined as a team's capacity to consciously reflect on the group objectives or strategies to adapt to dynamic circumstances. Prior research on in-action TR during patient care episodes demonstrated improved team performance and learning. This study explored how interprofessional teams experience pre-action TR through a simulated huddle before patient arrival. A better understanding of pre-action TR behaviours may reveal an underutilized strategy for improving team function and patient outcomes.

The authors used simulation-primed qualitative inquiry to examine pre-action TR. Eleven multidisciplinary, interprofessional paediatric critical care teams (four to six members) participated in a simulation in which they were handed off a critically ill patient with imminent arrival time and instructed to plan care, immediately followed by focus groups to explore their experience of pre-action TR. A deductive then inductive approach to thematic analysis was applied using the TuRBO framework: (a) seeking information, (b) evaluating information, and (c) planning.

Teams reported that pre-action TR behaviours fostered psychological safety, reduced barriers for sharing input, supported inclusive leadership, and enhanced shared mental model generation. These behaviours also enabled more effective and efficient planning. Importantly, participants described how pre-action TR behaviours both relied on and reinforced team dynamics such as team familiarity, trust, and psychological safety-highlighting their self-amplifying nature.

Pre-action TR behaviours promote team engagement and coordination, serving as a powerful tool in both training and practice. Integrating TR behaviours into huddles is a feasible strategy to strengthen team training, team dynamics and readiness. Future research should quantify its impact on team performance and patient outcomes.