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OBJECTIVE: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD: We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS: Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION: Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.

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OBJECTIVE: We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve a mobile phone-based augmented reality application that teaches users about the contents of a standardized pediatric code cart. BACKGROUND: Understanding interactions between performance obstacles and facilitators can provide guidance to (re)designing sociotechnical systems to improve system outcomes. Clinicians should know about contents and organization of code carts, and an augmented reality mobile application may improve that knowledge but changes the sociotechnical system in which they learn. Prior work identified barriers and facilitators impacting the use of this application-participants described dimensions together, indicating interactions that are explored in the current study. METHOD: We conducted four focus groups (number of clinicians = 18) and two interviews with clinicians who used the application. We performed a secondary analysis of focus group data exploring interactions between previously identified barriers and facilitators to application use. We used epistemic network analysis to visualize these interactions. RESULTS: Work system barriers interacted with barriers and facilitators interacted with facilitators to amplify cumulative negative or positive impact, respectively. Facilitators balanced barriers, mitigating negative impact. Facilitators also exacerbated barriers, worsening negative impact. CONCLUSION: Barriers and facilitators interact and can amplify, balance, and exacerbate each other-notably, positives are not always positive. To obtain desired outcomes, interactions must be further considered in sociotechnical system design, for example, the potential improvements to the application we identified.

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OBJECTIVE: The goal of this study was to determine if using a standing desk would affect the productivity of workers, based on the type of work they perform. BACKGROUND: Standing desks are a promising new health intervention in the workplace, but users and employers often require more specific recommendations related to productivity, such as the type of work that is more suited for the standing desk. METHOD: Thirty-seven young and healthy adults performed eight cognitive tasks in a 2 × 2 × 2 within-subject design of the following independent variables: posture (sitting/standing), task difficulty (easy/hard), and input device (computer mouse/tactile screen) in a counterbalanced order. RESULTS: Our results revealed that using a standing desk had no negative effect on performance or perception, but it did lead to increased brain activity in the alpha band for the parietal region (ß = 0.186, p = .001). CONCLUSION: We conclude that users of standing desks can freely stand for any level of task difficulty for work that involves working memory. However, more research is needed to generalize these results to other types of cognitive abilities and prolonged use of standing desks. APPLICATION: Our results simplify recommendations for workers as they do not need to worry about the type of work they are performing when using a standing desk.

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OBJECTIVE: The aim of this study was to review literature relevant to cohesion measurement, explore developing measurement approaches, and provide theoretical and practical recommendations for optimizing cohesion measurement. BACKGROUND: Cohesion is essential for team effectiveness and performance, leading researchers to focus attention on understanding how to enhance it. However, cohesion is inconsistently defined and measured, making it difficult to compare findings across studies and limiting the ability to advance science and practice. METHOD: We reviewed empirical research through which we uncovered specific information about cohesion's conceptualization, measurement, and relationships with performance, culminating in a set of current trends from which we provide suggestions and possible solutions to guide future efforts and help the field converge toward greater consistency. RESULTS: Cohesion demonstrates more significant relationships with performance when conceptualized using social and task (but not other) dimensions and when analyses are performed at the team level. Cohesion is inherently temporal, yet researchers rarely measure cohesion at multiple points during the life of a team. Finally, cohesion matters in large, dynamic collectives, complicating measurement. However, innovative and unobtrusive methodologies are being used, which we highlight. CONCLUSION: Practitioners and researchers are encouraged to define cohesion with task and social subdimensions and to measure with behavioral and attitudinal operationalizations. Individual and team-oriented items are recommended, though team-level analyses are most effective. Innovative/unobtrusive methods should be further researched to enable cohesion measurement longitudinally and in large, dynamic collectives. APPLICATION: By applying our findings and conclusions, researchers and practitioners will be more likely to find consistent, reliable, and significant cohesion-to-performance relationships.

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