Reflection in the heat of the moment: The role of in‐action team reflexivity in health care emergency teams

• Date: 01 July 2018
• Published date: 01 July 2018
• DOI: http://doi.org/10.1002/job.2299

SPECIAL ISSUE ARTICLE

Reflection in the heat of the moment: The role of in‐action

team reflexivity in health care emergency teams

Jan B. Schmutz

1

|Zhike Lei

2

|Walter J. Eppich

3

|Tanja Manser

4

1

Department of Management, Technology,

and Economics, ETH Zürich, Zürich,

Switzerland

2

The Graziadio Business School, Pepperdine

University, Malibu, California, U.S.A.

3

Northwestern University Feinberg School of

Medicine, Chicago, Illinois, U.S.A.

4

FHNW School of Applied Psychology,

University of Applied Sciences and Arts

Northwestern Switzerland, Olten, Switzerland

Correspondence

Jan B. Schmutz, Department of Management,

Technology, and Economics, ETH Zurich,

Weinbergstr. 56/58, 8092, Zürich,

Switzerland.

Email: jschmutz@ethz.ch

Funding information

Swiss National Science Foundation, Grant/

Award Number: PP00P1_128616

Summary

Team reflexivity (TR)–defined as a team's conscious reflection on their objectives, strate-

gies, and processes—is an important team process that fosters adaptation and information

processing. However, traditional conceptualizations frame TR as a process that occurs in

periods of downtime to reflect on past, terminated performance, largely ignoring reflective

team processes occurring during intense performance events of action teams. To address

this gap, we conceptualize TR as a team process that occurs not only during periods of

downtime after the action but also during performance events as brief TR moments. We

elaborate on the concept of in‐action TR and explore it by delineating its relationship to

task type and timing during a performance event. Further, we test a team level contin-

gency model of in‐actionTR, namely, team size and performance. Using behavior observa-

tion, we test our hypothesis with 70 medical teams responding to simulated in‐hospital

emergencies. Task type is related to in‐actionTR and reflection tends to increase as action

progresses. Further, in‐actionTR is related to team performance and is especially impor-

tant for larger teams. Our study is the first to investigate in‐action TR and provides theo-

retical and practical implications on how in‐actionTR operates in extreme action teams.

KEYWORDS

extreme environments, performance, reflection, reflexivity, teamwork, team size

1|INTRODUCTION

Fighting the World Trade Center inferno, rescuing the 33 Chilean

miners trapped underground for more than 2 months, or resuscitating

a trauma patient after a multicar collision present examples of unusual

team endeavors under extreme and dynamic conditions. These extreme

environments, characterized by tremendously high levels of velocity,

complexity, ambiguity, and consequences, all possess extraordinary

physical, psychological, and interpersonal demands and challenges

(Klein, Ziegert, Knight, & Xiao, 2006; Manzey & Lorenz, 1998). Due to

the dynamic nature of these extreme environments, teams must adapt

to changing circumstances and process emerging information in the

midst of active task performance to perform effectively.

Research suggests that team reflexivity (TR)—defined as a team's

consciousreflection on their objectives,strategies, and processes(West,

2000)—is an importantteam process fostering adaptation and informa-

tion processing(Konradt, Otte, Schippers,& Steenfatt, 2015; Schippers,

Edmondson,& West, 2014). Although considerable theory and research

linksTR to adaptive team performance (Konradt et al.,2015; Konradt &

Eckardt, 2016;Vashdi, Bamberger, & Erez,2013), this work suffers from

three major limitations especiallyrelated to action teams.

First, existing team research has conceptualized TR as a transition

process (e.g., Schippers, Den Hartog, Koopman, & van Knippenberg,

2008; Schippers, West, & Dawson, 2015), which refers to “periods

of downtime where team members can reflect upon past events and

prospect future events”(DeChurch & Haas, 2008, p. 544) taking place

after completion of taskwork and during episodes of low activity in the

team (Fernandez, Kozlowski, Shapiro, & Salas, 2008). These periods of

downtime represent debriefings or after‐action reviews (Tannenbaum

& Cerasoli, 2013). Due to this focus on TR as an elaborate and time‐

The authors thank Ellen Heimberg and Florian Hoffman and the PAEDSIM net-

work (www.paedsim.org) for their collaboration. Also, we thank Laurenz L.

Meier for its support with the statistical analysis.

Received: 15 February 2017 Revised: 4 April 2018 Accepted: 30 April 2018

DOI: 10.1002/job.2299

J Organ Behav. 2018;39:749–765. Copyright © 2018 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/job 749

consuming process, the team literature has largely ignored how teams

reflect on what they are doing while they are doing it. Especially in

complex and dynamically evolving work settings, teams must also

reflect during an ongoing performance event (e.g., during military field

missions or complex surgeries) in order to adapt and complete their

task. As a result, extant TR research contributes little to a nuanced

understanding of how reflection emerges during performance events

and unfolds in extreme environments.

Second, it remains unclear how reflection that takes place in the

“heat of the moment”influences the performance of action teams

and under what conditions. Although these brief episodes of reflection

have been briefly discussed in the general team literature (Marks,

Mathieu, & Zaccaro, 2001), the specific role of reflection during ongo-

ing performance events in extreme environments has thus far received

little research attention. To advance theory, research, and practice on

team functioning, we must better understand how and under what

conditions TR during performance events—in‐action TR

1

—has perfor-

mance implications for action teams.

Third, prior research on the role of TR in team performance relies

heavily on self‐report questionnaires for data collection (e.g., Konradt

& Eckardt, 2016; Schippers et al., 2015; Shin, 2014), which represents

a methodological limitation especially for assessing TR during stressful

performance events. Beyond common downsides of questionnaires

(e.g., response bias, diverging understanding of items), items assessing

TR (e.g., “We reflect on the way of communication”; Schippers, Den

Hartog, & Koopman, 2007) often fail to capture specific behaviors

teams engage in while reflecting. As a result, this research cannot

define specific behaviors that have implications for team training

design. Further, self‐report questionnaires are not suited to assess

TR occurring during stressful performance events. Due to high task

demands, team members may likely report inaccurately the amount

or types of TR behavior they engaged in retrospectively. Behavioral

observation as an alternative approach provides promising insights

to support managers in better assessing and training TR.

Our research strives to explore the characteristics of in‐actionTR,

to investigate its relationship with team performance, and to identify

the boundary conditions of its effects on team performance. In partic-

ular, we aim to build on and extend prior research in three ways. First,

we advance the current understanding of TR by elaborating on the

notion of in‐action TR as a process that emerges during performance

events, a previously unexplored aspect. Second, we explore the con-

cept empirically from various angles and delineate its relationship to

task type and the timing of in‐action TR. Ultimately, we investigate if

the widely demonstrated positive effect of TR on performance (e.g.,

Schippers et al., 2014; Vashdi et al., 2013) also holds true for in‐action

TR. Moreover, we assert that team size constitutes an important

boundary condition affecting the extent to which in‐action TR posi-

tively impacts team performance in extreme environments. This mod-

erating role of team size aligns with the literature on team

effectiveness that acknowledges team composition, such as team size,

as an essential contextual property enhancing or constraining team

performance (LePine, Piccolo, Jackson, Mathieu, & Saul, 2008; Stew-

art, 2006). Third, we use behavioral observation to focus on behaviors

that constitute in‐action TR in medical emergency teams in an

immersive simulation setting. Thereby we demonstrate how the

behavioral features of in‐action TR emerge and unfold and offer a

more nuanced understanding of processes that comprise in‐action

TR that is especially needed for effective team trainings.

As teams are increasingly faced with extreme environments that

are more dynamic, complex, fast‐paced, the field needs a refined

understanding of in‐actionTR in these settings. Such teams often deal

with sudden nonroutine situations (e.g., emergencies) with little or no

preparation time, making information processing behavior—like TR—

even more important during task execution. Furthermore, tasks in

extreme environments often feature high levels of uncertainty, with

information often only emerging during the course of action requiring

teams to reflect on critical new information concurrent with active

task performance. These concurrent activities make in‐actionTR indis-

pensable as an information processing mechanism that supports adap-

tive team performance.

2|THEORETICAL BACKGROUND AND

HYPOTHESIS DEVELOPMENT

2.1 |Action teams and TR

Action teamsrepresent groups of experts whoconduct interlinked tasks

during complex, time‐limited performance events involving audiences,

adversaries,or challenging environments(Sundstrom, McIntyre, Halfhill,

& Richards, 2000) associated with substantial physical, psychological,

and interpersonal challenges(Ishak & Ballard, 2011). These performance

events(e.g., a match for a sportsteam) are discrete and boundedin space

and time (Morgeson, Mitchell, & Liu, 2015), which makes them clearly

distinguishable from other phaseswith less activity (i.e., planning,reflec-

tion). During performance events, action teams face finality of action

often associated with highly significant events (e.g., harm or death of

patient or teammember; Ishak & Ballard,2011; Sundstrom et al., 2000).

Action teams in military, aviation, and medicine apply TR success-

fully in the form of after‐action reviews or debriefings (Dalenberg,

Vogelaar, & Beersma, 2009; Vashdi et al., 2013; Vashdi, Bamberger,

Erez, & Weiss‐Meilik, 2007; Yule et al., 2008). In fact, the origins

of TR during debriefings became deeply embedded in military culture

during WWII, when personnel began conducting “interviews after

combat”to gather intelligence and to inform future strategies

(Gardner, 2013). Today, team debriefings comprise a substantial com-

ponent of training programs in medicine and aviation (Cheng et al.,

2014; Tannenbaum & Cerasoli, 2013).

In line with these practices, the literature conceptualizes TR as an

elaborate process after performance events that allows for all team

members to overtly reflect on objectives, strategies, processes, and

outcomes in order to evaluate their performance. Examples include

formal interventions that prompt teams to reflect collectively (e.g.,

Gabelica, Van den Bossche, De Maeyer, Segers, & Gijselaers, 2014;

Gurtner, Tschan, Semmer, & Nägele, 2007; Okhuysen & Eisenhardt,

2002), team meetings, retreats (Schippers et al., 2015; Schippers,

1

In‐action TR refers to TR “in”or “during”the action and must not be confused

with inaction. The term originates from a recent framework (Schmutz & Eppich,

2017) that defines three phases during which teams can reflect: pre‐action, in‐

action, and post‐action phase.

750 SCHMUTZ ET AL.