The culture of a trauma team in relation to human factors.
OBJECTIVE
The aim of this ethnographic study was to explore the culture of a trauma team in relation to human factors.


BACKGROUND
Traumatic injury is the leading cause of death in the first four decades of life in the western world. Evidence suggests that the initial assessment and resuscitation of trauma victims is most successfully carried out by an organized trauma team. Most trauma teams use Advanced Trauma Life Support principles which focus on rapid assessment and management of the patient's injuries. Similarly, most trauma education focuses on Advanced Trauma Life Support principles, concentrating firmly on the patient's physical status. Nevertheless, contemporary literature about emergency teams suggests that human factors, such as communication and interprofessional relationships, can affect the team's performance regardless of how clinically skilled the team members are.


METHODS
Focused ethnography was used to explore the culture of a trauma team in one teaching hospital. Six periods of observation were undertaken followed by 11 semi-structured interviews with purposively chosen key personnel. Data from transcripts of the observation field notes and interviews were analysed using open coding, followed by formation of categories resulting in the emergence of six central categories.


RESULTS
Findings suggest that leadership, role competence, conflict, communication, the environment and the status of the patient all influence the culture of the trauma team. Interpretation of these categories suggests that trauma team education should include human factor considerations such as leadership skills, team management, interprofessional teamwork, conflict resolution and communication strategies.


CONCLUSIONS
The findings suggest that support systems for role development of junior team leaders should be formalized. The proven airline industry techniques of Crew Resource Management, focusing on teamwork and effective communication, could be implemented into continuing professional development for trauma teams to engender collaboration and interprofessional practice.
Cole
Elaine
E
A&E/Trauma, City University School of Nursing/Barts and The London NHS Trust, London, UK. e.cole@city.ac.uk
Crichton
Nicola
N
D022561:Advanced Cardiac Life Support; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003220:Conflict, Psychological; D003253:Consultants / Q000523:psychology*; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006126:Group Processes; D006272:Health Facility Environment / Q000458:organization & administration; D006784:Hospitals, Teaching; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008131:London; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D017008:Negotiating / Q000523:psychology; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D010819:Physician's Role / Q000523:psychology; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014194:Traumatology / Q000193:education / Q000458:organization & administration*