Health Care Teams Under Pressure: The Impact of Complexity on Team Cognition and Team Performance
Year: 2026
Type: dissertation
Study design: Observational Study
Abstract: Healthcare teams play a central role in delivering care to patients and their families. Teamwork has been shown to be directly related to clinical performance and patient outcomes, making it essential that these teams receive appropriate training, feedback, and assessment. These teams work in complex, dynamic environments characterized by changing team membership, time pressures, and large amounts of information that may be ambiguous, missing, or unknown. These characteristics make it difficult to fully capture team-level performance. Despite the critical role of healthcare teams, most approaches to measuring team performance are static, capturing what teams do rather than how or why performance emerges. This study investigated the dynamics of team cognition in complex, dynamic environments. Using a concurrent mixed methods design with a qualitative strand nested within the quantitative strand, this observational study addressed three questions: 1) What patterns exist in team communication and coordination behaviours, and how do these vary with team experience and case complexity 2) How does the rate of team cognition mediate the relationship between case complexity and team performance, 3) What insights do teams’ reflections and reflexive practices provide into the cognitive processes that shape their performance. Data were collected from video recordings of flight paramedic teams performing simulated scenarios, demographic surveys, reflective interviews, and performance scores. Lag sequential analysis (LSA) was used to identify significant patterns of behaviour, and mediation analysis was used to determine whether the rate of team cognition mediated the relationship between case complexity and team performance. Thematic analysis of the post-simulation interviews provided additional insight into the cognitive processes underlying team performance. Findings showed that communication is central to developing shared understanding. Teams relied on adaptive coordination to respond to the changing environment. Empirical evidence shows that behavioural sequences were observable, forming a part of paramedic clinical practice, and varying by team experience. These findings provide a preliminary perspective on team cognition and team performance in dynamic environments.
Author: de Vries, Ingrid
Institution: Queen's University
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7214513145