Tara Cohen
@cshs.org
Research Scientist/ Assistant Professor, Department of Surgery
Cedars-Sinai Medical Center
EDUCATION
PhD - Human Factors - Embry-Riddle Aeronautical University
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Ken Catchpole, Tara Cohen, Myrtede Alfred, Sam Lawton, Falisha Kanji, Daniel Shouhed, Lynne Nemeth, and Jennifer Anger
SAGE Publications
Objective Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. Background New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. Results Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. Conclusion There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care. Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
Tara N. Cohen, Falisha F. Kanji, Jennifer Zamudio, Daniel Shouhed, Bruce L. Gewertz, and Harry C. Sax
Wiley
AbstractBackgroundDespite substantial efforts to reduce operating room (OR) turnover time (TOT), delays remain a frustration to physicians, staff, and hospital leadership. These efforts have employed many systems and human factor‐based approaches with variable results. A deeper dive into methodologies and their applicability could lead to successful and sustained change. The aim of this study was to conduct a systematic review to evaluate relevant research focused on improving OR TOT and clearly defining measures of successful intervention.Material and MethodsA systematic review of OR TOT interventions implemented between 1980 through October 2022 was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Research databases included: 1) PubMed; 2) Web of Science; and 3) OVID Medline.ResultsA total of 38 articles were appropriate for analysis. Most employed a pre/post intervention approach (29, 76.3%), the remaining utilized a control/intervention approach. Nine intervention methods were identified: the majority included a process redesign bundle (24, 63%), followed by overlapping induction, dedicated unit/team/space feedback, financial incentives, team training, education, practice guidelines, and redefinition of roles/responsibilities. Studies were further categorized into one of two groups: (1) those that utilized predetermined interventions based on anecdotal experience or prior literature (18, 47.4%) and (2) those that conducted a prospective analysis on baseline data to inform intervention development (20, 52.6%).DiscussionThere are significant variability in the methodologies utilized to improve OR TOT; however, the most effective solutions involved process redesign bundles developed from a prospective investigation of the clinical work‐system.
Tara N. Cohen, Carl T. Berdahl, Bernice L. Coleman, Edward G. Seferian, Andrew J. Henreid, Donna W. Leang, and Teryl K. Nuckols
Ovid Technologies (Wolters Kluwer Health)
Background: Incident reports submitted during times of organizational stress may reveal unique insights. Purpose: To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge. Methods: We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare. Results: Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19. Conclusions: Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.
Cecilia B. Leggett, Tara Cohen, Erica Sauro, and Melissa S. Wong
Elsevier BV
Carl T. Berdahl, Andrew J. Henreid, Tara N. Cohen, Bernice L. Coleman, Edward G. Seferian, Donna Leang, Sungjin Kim, Marcio A. Diniz, Matthew Grissinger, Karen Kaiser,et al.
Elsevier BV
Jennifer Zamudio, Jeffrey Woodward, Falisha F. Kanji, Jennifer T. Anger, Ken Catchpole, and Tara N. Cohen
Elsevier BV
Tara N. Cohen, Falisha F. Kanji, Andrew S. Wang, Edward G. Seferian, Harry C. Sax, and Bruce L. Gewertz
Elsevier BV
Jennifer Zamudio, Falisha F. Kanji, Connor Lusk, Daniel Shouhed, Barry R. Sanchez, Ken Catchpole, Jennifer T. Anger, and Tara N. Cohen
Springer Science and Business Media LLC
Alexandra Dubinskaya, John R Heard, Eunice Choi, Tara Cohen, Jennifer Anger, Karyn Eilber, and Victoria Scott
Oxford University Press (OUP)
Abstract Introduction Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. Objectives The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. Methods We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. Results Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. Conclusion Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.
Shawn M. Doherty, Andrew C. Griggs, Elizabeth H. Lazzara, Joseph R. Keebler, Bruce L. Gewertz, and Tara N. Cohen
SAGE Publications
Background Teams are essential to a wide array of applications and organizations often utilize varying interventions to improve the effectiveness of their teams. Due to their collaborative and modifiable characteristics, escape rooms are being increasingly utilized as an avenue to both deliver team interventions and to function as testbeds in research. Escape rooms are complex, interdependent activities which warrant careful planning to be effectively implemented. Despite the growing literature base concerning escape rooms, there is still limited practical guidance to inform the development of an escape room. Aim The purpose of this article is to provide seven considerations that are relevant to the development, implementation, and effectiveness of an escape room. Specifically, guidance is provided in determining the objectives, identifying a theme, assigning the roles, establishing participant interdependence, selecting a venue, designing the puzzles, and creating the assessments. Conclusion The considerations provided in this article can advance the science underlying the use of escape rooms and preclude difficulties associated with their use.
Brittney L. Chau, Jonnby S. LaGuardia, Sungjin Kim, Samuel C. Zhang, Eric Pletcher, Nina N. Sanford, Ann C. Raldow, Lisa Singer, Jun Gong, Sukhmani K. Padda,et al.
American Medical Association (AMA)
ImportanceTumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited.ObjectiveTo investigate what physician-related and tumor board–related factors are associated with higher tumor board burden among oncology physicians.Design, Setting, and ParticipantsTumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers.Main Outcomes and MeasuresTumor board burden was measured on a 4-point scale (1, not at all burdensome; 2, slightly burdensome; 3, moderately burdensome; and 4, very burdensome). Univariable and multivariable probabilistic index (PI) models were performed.ResultsSurveys were completed by 111 physicians (median age, 42 years [IQR, 36-50 years]; 58 women [52.3%]; 60 non-Hispanic White [54.1%]). On multivariable analysis, factors associated with higher probability of tumor board burden included radiology or pathology specialty (PI, 0.68; 95% CI, 0.54-0.79; P = .02), attending 3 or more hours per week of tumor boards (PI, 0.68; 95% CI, 0.58-0.76; P < .001), and having 2 or more children (PI, 0.65; 95% CI, 0.52-0.77; P = .03). Early or late tumor boards (before 8 am or at 5 pm or after) were considered very burdensome by 33 respondents (29.7%). Parents frequently reported a negative burden on childcare (43 of 77 [55.8%]) and family dynamics (49 of 77 [63.6%]). On multivariable analysis, a higher level of burden from early or late tumor boards was independently associated with identifying as a woman (PI, 0.69; 95% CI, 0.57-0.78; P = .003) and having children (PI, 0.75; 95% CI, 0.62-0.84; P < .001). Independent assessment of 358 tumor boards from 22 institutions revealed the most common start time was before 8 am (88 [24.6%]).Conclusions and RelevanceThis survey study of tumor board burden suggests that identifying as a woman or parent was independently associated with a higher level of burden from early or late tumor boards. The burden of early or late tumor boards on childcare and family dynamics was commonly reported by parents. Having 2 or more children, attending 3 or more hours per week of tumor boards, and radiology or pathology specialty were associated with a significantly higher tumor board burden overall. Future strategies should aim to decrease the disparate burden on parents and women.
Andrew C. Griggs, Elizabeth H. Lazzara, Shawn M. Doherty, Joseph R. Keebler, Bruce L. Gewertz, and Tara N. Cohen
SAGE Publications
Background Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team-based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data.
Tara N. Cohen, Jennifer T. Anger, Falisha F. Kanji, Jennifer Zamudio, Elise DeForest, Connor Lusk, Ray Avenido, Christine Yoshizawa, Stephanie Bartkowicz, Lynne S. Nemeth,et al.
Ovid Technologies (Wolters Kluwer Health)
Introduction There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as “serious games” may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the “RAS Olympics,” a game-based educational competition to improve skills needed to successfully perform RAS. Methods This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the “RAS Olympics” to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs. Results Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment. Conclusions The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.
Myrtede Alfred, John Del Gaizo, Falisha Kanji, Samuel Lawton, Ashley Caron, Lynne S Nemeth, A V Alekseyenko, Daniel Shouhed, Stephen Savage, Jennifer T Anger,et al.
BMJ
Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct observation research in healthcare. Although prior literature has offered key considerations for observational research in healthcare, operationalising these recommendations may pose a challenge and unless guidance is also provided on observer training. In this article, we offer guidelines for training non-clinical observers to conduct direct observations including conducting a training needs analysis, incorporating practice observations and evaluating observers and inter-rater reliability. The operationalisation of these guidelines is described in the context of a 5-year multisite observational study investigating technology integration in the operating room. We also discuss novel tools developed during the course our project to support data collection and examine inter-rater reliability among observers in direct observation studies.
Ken Catchpole, Connor Lusk, Matthias Weigl, Jennifer Anger, and Tara Cohen
Springer Science and Business Media LLC
This letter to the editor provides a response to “Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery.” The authors provide much needed clarification on misconceptions of flow disruption studies. The evolving methodology is not aimed at creating a “non-stop” flow, or optimizing efficiency, but understanding the clinical process from a systems perspective.
Tara N. Cohen, Jennifer T. Anger, Kevin Shamash, Kenneth R. Catchpole, Raymund Avenido, Eric J. Ley, Bruce L. Gewertz, and Daniel Shouhed
Springer Science and Business Media LLC
Challenges associated with turnover time are magnified in robotic surgery. The introduction of advanced technology increases the complexity of an already intricate perioperative environment. We applied a human factors approach to develop systematic, data-driven interventions to reduce robotic surgery turnover time. Researchers observed 40 robotic surgery turnovers at a tertiary hospital [20 pre-intervention (Jan 2018 to Apr 2018), 20 post-intervention (Jan 2019 to Jun 2019)]. Components of turnover time, including cleaning, instrument and room set-up, robot preparation, flow disruptions, and major delays, were documented and analyzed. Surveys and focus groups were used to investigate staff perceptions of robotic surgery turnover time. A multidisciplinary team of human factors experts and physicians developed targeted interventions. Pre- and post-intervention turnovers were compared. Median turnover time was 67 min (mean: 72, SD: 24) and 22 major delays were noted (1.1/case). The largest contributors were instrument setup (25.5 min) and cleaning (25 min). Interventions included an electronic dashboard for turnover time reporting, clear designation of roles and simultaneous completion of tasks, process standardization of operating room cleaning, and data transparency through monthly reporting. Post-intervention turnovers were significantly shorter (U = 57.5, p = .000) and ten major delays were noted. Human factors analysis generated interventions to improve turnover time. Significant improvements were seen post-intervention with a reduction in turnover time by a 26 min and decrease in major delays by over 50%. Future opportunities to intervene and further improve turnover time include targeting pre- and post-operative care phases.
Tara N. Cohen, Falisha F. Kanji, Colby Souders, Alexandra Dubinskaya, Karyn S. Eilber, Harry Sax, and Jennifer T. Anger
Elsevier BV
STUDY OBJECTIVE
To apply a structured human factors analysis to understand conditions contributing to vaginal retained foreign objects (RFO).
DESIGN
All potential vagina RFO events from January 1, 2000, to May 21, 2019, were analyzed by trained human factors researchers. Each narrative was reviewed to identify contributing factors, classified using the Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare).
SETTING
An 890-bed, academic medical center in Southern California.
PATIENTS
Patients who underwent a vaginal procedure in which a vaginal RFO-related event occurred were included in this study. However, no patient information was included, only the relevant details from their procedures.
INTERVENTIONS
No interventions were developed or implemented.
MEASUREMENTS AND MAIN RESULTS
Over the 19-year period, 45 events were reported. The most common items were vaginal packing and vaginal sponges (53.33%). Less frequently retained items involved broken instruments (20.20%). The majority of cases were laparoscopic hysterectomies or vaginal deliveries. Based on HFACS, 75 contributing factors were identified, consisting primarily of preconditions for unsafe acts (communication challenges, coordination breakdowns and issues with the design of tools/technology) and unsafe acts (errors).
CONCLUSION
While rare, vaginal RFOs do occur. The top two contributing factors were skill-based errors and communication breakdowns. Both types of errors can be addressed and improved with human factors interventions, including simulation, teamwork training, and streamlining workflow to reduce the opportunity for errors.
Douglas A. Wiegmann, Laura J. Wood, Tara N. Cohen, and Scott A. Shappell
Ovid Technologies (Wolters Kluwer Health)
ABSTRACT
This article reviews several key aspects of the Theory of Active and Latent Failures, typically referred to as the Swiss cheese model of human error and accident causation. Although the Swiss cheese model has become well known in most safety circles, there are several aspects of its underlying theory that are often misunderstood. Some authors have dismissed the Swiss cheese model as an oversimplification of how accidents occur, whereas others have attempted to modify the model to make it better equipped to deal with the complexity of human error in health care. This narrative review aims to provide readers with a better understanding and greater appreciation of the Theory of Active and Latent Failures upon which the Swiss cheese model is based. The goal is to help patient safety professionals fully leverage the model and its associated tools when performing a root cause analysis as well as other patient safety activities.
Tara N. Cohen, Douglas A. Wiegmann, Falisha F. Kanji, Myrtede Alfred, Jennifer T. Anger, and Ken R. Catchpole
Elsevier BV
This systematic review provides information on the methodologies, measurements and classification systems used in observational studies of flow disruptions in clinical environments. The PRISMA methodology was applied and authors searched two databases (PubMed and Web of Science) for studies meeting the following inclusion criteria: (a) were conducted in a healthcare setting, (b) explored systems-factors leading to deviations in care processes, (c) were prospective and observational, (d) classified observations, and (e) were original research studies published in peer-reviewed journals. Thirty studies were analyzed and a variety of methods were identified for observer training, data collection and observation classification. Although primarily applied in surgery, comparable research has been successfully conducted in other venues such as trauma care, and delivery rooms. The findings of this review were synthesized into a framework of considerations for conducting rigorous methodological studies aimed at understanding clinical systems.
Lucy Cofran, Tara Cohen, Myrtede Alfred, Falisha Kanji, Eunice Choi, Stephen Savage, Jennifer Anger, and Ken Catchpole
Springer Science and Business Media LLC
The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)—small deviations from the optimal course of care—can be used to understand how systems problems manifest. Prior studies showed that the docking process in robotic assisted surgery (RAS), which requires careful management of process, people, technology and working environment, might be a particularly challenging part of the operation. We sought to explore variation across multiple clinical sites and procedures; and to examine the sources of those disruptions. Trained observers recorded FDs during 45 procedures across multiple specialties at three different hospitals. The rate of FDs was compared across surgical phases, sites, and types of procedure. A work-system flow of the RAS docking procedure was used to determine which steps were most disrupted. The docking process was significantly more disrupted than other procedural phases, with no effect of hospital site, and a potential interaction with procedure type. Particular challenges were encountered in room organization, retrieval of supplies, positioning the patient, and maneuvering the robot. Direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and configuration of the OR environment, with the eventual goal of improving safety, efficiency and teamwork in high technology surgery.
Tara N. Cohen, Falisha F. Kanji, Claire S. Burton, Deven C. Patel, A. Lenore Ackerman, Karyn S. Eilber, and Jennifer T. Anger
Elsevier BV
OBJECTIVES
To apply a human factors approach, the study of interactions between humans and complex systems, to investigate patient preparedness, satisfaction, and perceived usability with sacral neuromodulation (SNM) and develop interventions aimed at improving patient experience.
MATERIALS AND METHODS
Ten patients with overactive bladder undergoing staged SNM were observed, and data including pre-operative preparedness, satisfaction, perceived usability and barriers impacting patient experience were collected. Interventions were developed and an additional ten patients were observed. All patients were English-speaking and at least 18 years of age.
RESULTS
Pre-intervention patients had difficulty understanding the risks of the procedure, did not know what to expect post-operatively and were unsatisfied with pre-operative materials. Interventions included: a pre-procedure educational video and informational sheet, detailed discharge instructions; and a nursing inservice. Pre-operative preparedness (Stage I: U = 100, z = 3.785, p = .000; Stage II: U = 80, z = 2.864, p = .003), post-operative satisfaction (Stage I: U = 100, z = 3.788, p = .000; Stage II: U = 77.5, z = 2.665, p = .006.) and perceptions of usability (Stage I: U = 77.00, z = 2.056, p = .043.; Stage II: U = 80.50, z = 2.308, p = .019) increased significantly after the intervention.
CONCLUSIONS
Our observations highlight the value of implementing a human factors approach to identify and mitigate barriers impacting patient experiences with SNM. Through the implementation of systems-level interventions (i.e., interventions that impact the non-clinical aspects of surgery such as patient/staff education), significant improvements can be made.
Albert Boquet, Tara Cohen, Fawaaz Diljohn, Jennifer Cabrera, Scott Reeves, and Scott Shappell
Ovid Technologies (Wolters Kluwer Health)
OBJECTIVES
This investigation explores flow disruptions observed during cardiothoracic surgery and how they serve to disconnect anesthesia providers from their primary task. We can improve our understanding of this disengagement by exploring what we call the error space or the accumulated time required to resolve disruptions.
METHODS
Trained human factors students observed 10 cardiac procedures for disruptions impacting the anesthesia team and recorded the time required to resolve these events. Observations were classified using a human factors taxonomy.
RESULTS
Of 301 disruptions observed, interruptions (e.g., those events related to alerts, distractions, searching activity, spilling/dropping, teaching moment, and task deviations) accounted for the greatest frequency of events (39.20%). The average amount of time needed for each disruption to be resolved was 48 seconds. Across 49.87 hours of observation, more than 4 hours were spent resolving disruptions to the anesthesia team's work flow.
CONCLUSIONS
By defining a calculable error space associated with these disruptions, this research provides a conceptual metric that can serve in the identification and design of targeted interventions. This method serves as a proactive approach for recognizing systemic threats, affording healthcare workers the opportunity to mitigate the development and incidence of preventable errors precedently.
Falisha Kanji, Tara Cohen, Myrtede Alfred, Ashley Caron, Samuel Lawton, Stephen Savage, Daniel Shouhed, Jennifer T. Anger, and Ken Catchpole
MDPI AG
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = −2.488, df = 54, β = −0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.
Tara N. Cohen, Andrew S. Wang, Edward G. Seferian, Harry C. Sax, and Bruce L. Gewertz
American Medical Association (AMA)
Tara N Cohen, Andrew C Griggs, Falisha F Kanji, Kate A Cohen, Elizabeth H Lazzara, Joseph R Keebler, and Bruce L Gewertz
SAGE Publications
Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p < .001; Wilks’ Λ = .725; partial η2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.