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is working with medical teams associated with JUMP Simulation to research teamwork in healthcare settings. The goal is to expand upon established team neurodynamic research of physiologic neurodynamic markers of teamwork to new and expert surgical teams going through simulation.
Written by Ann Willemsen-Dunlap
You've seen it before. Your favorite basketball team seems to be on its way to winning the game. Its members are working together flawlessly until all of sudden, a teammate literally and figuratively drops the ball. The team falls apart, it takes them a while to recover, and before you know it–the team loses the game. What if you could predict when a team is about to fall off the edge and help them recover faster? That's the idea behind ongoing research taking place at Jump. Jump is working with Dr. Ron Stevens and Trysha Galloway of The Learning Chameleon to collect brainwave data in hopes of predicting when teams lose their organization, and to minimize the time it takes them to regroup following disturbances in their normal rhythms. One aspect of the study is looking at how a team's ability to reorganize changes with expertise. The project is called Team NeuroDynamics.
Dr. Stevens and Galloway were recently at Jump for the second round of collecting data. Back in February, wireless EEG headsets were secured to groups of experienced operating room teams. There were two sessions with the experienced teams, each consisting of four individuals from the OSF Saint Francis Medical Center operating rooms. One simulation began in the virtual Operating Room with the anesthesia personnel sedating the patient – one of our high-fidelity manikins – for a standard surgery. After the patient was sedated, the circulating nurse prepped the site of the incision. While this was going on, the scrub tech and surgeon gowned and gloved. After the prep, the patient was draped, and the surgeon began making an incision on a simulated skin plate using an electrocautery unit. Pop! The room was suddenly drenched in darkness as smoke and a flame shot up from the equipment. As the backup lights kicked on, the surgical team quickly evacuated the patient from the OR. The simulation was over. The EEG headsets collected brainwave data the entire time as the physicians and nurses went about the simulation. Now that the Learning Chameleon and Jump have data showing the neurodynamics of experienced health care teams, we've moved on to novice learners. Brainwave data was collected this month from medical students entering their fourth year of study. They were also in a simulated environment, but the scenarios were more in line with their medical education to date. "What we're working on is the ability to study trainees in medical school, from practicing to expert," said Dr. Stevens. "We want to understand how neurodynamic expertise develops, and how these different groups handle these perturbations when they arise. That's really good for theory building."
By Lt. Will Spears
The demands of operating submarines have long exceeded the capability of any one human being. It's not the skillful action of any single brilliant tactician that achieves the submarine's mission, but the coordinated effort of a well-honed team of operators. In the post-hoc analysis of serious mishaps like collisions and groundings, it is never the individual mistake of any one critical sailor that leads to a mishap, but a collective failure of the organization. Achievements are team achievements, and failures are team failures. We've known this for a long time. Why, then, do we continue to rely on a training program that focuses on the technical skills of the individual? That's something the Submarine Force has begun to ask itself in earnest. The short answer is that individual skills are relatively easy to observe and measure. Team skills, on the other hand, are enormously complicated and difficult to quantify and require very specific circumstances to observe. The quality of teamwork depends not just on the skills of individual team members, but their personalities, as well as their efficiency and comfort in working together. That's a tough thing to measure directly, so we've historically inferred it through the results of team efforts.
The problem with results-based inference is that it does nothing to prevent catastrophes. After two avoidable collisions in 2012, the Submarine Force underwent a rigorous self-assessment effort, identifying force-wide deficiencies in the interactions of tactical watch teams. The lack of a consistent, formally endorsed model for team interaction was cited as a significant contributing factor. Despite the numerous models of teamwork and volumes of supporting literature in the business and academic worlds, the Submarine Force had no way to get everyone on the same page as to what great teamwork looks like or how to get there. It had become apparent that, however difficult it may be to measure, we can't afford to continue inferring the presence of good teamwork—we must come to understand it and observe it directly.
Enter the STBT, or Submarine Team Behaviors Tool. It is derived from a behavioral model developed by a multi-disciplinary team of consultants led by the Naval Submarine Medical Research Laboratory (NSMRL), including neuroscientists, behavioral experts, and "Greybeards," the retired submarine COs trained to systematically evaluate and provide feedback to tactical watch teams. The STBT is essentially a grading rubric that fits on the front and back sides of a single sheet of paper, with supporting literature. It is the product of deep analysis of submarine mishaps, the scientific study of Submariner team behavior, and the collective wisdom of tactical subject matter experts. The underlying model represents significant progress in the formal understanding of teamwork in submarines.
Levels of Resilience
The STBT classifies watch teams based on their resilience—their ability to absorb shocks and continue performing at a high level. A team’s level of resilience essentially determines how much stress or complexity it can manage before it “fractures” and stops functioning. Approaching fracture, the team will become confused, informal, emotional, sluggish, myopic, or otherwise will cease to communicate as a cohesive unit. Somewhat ironically, the situations most likely to cause team fracture also happen to be the worst conceivable times for it to occur.
The STBT divides watch teams into four levels of resilience: Unstressed Battle Rhythm, Leader-Dependent Battle Rhythm, Team-Based Resilience, and Advanced Team Resilience.
Unstressed Battle Rhythm. A team at this level can perform basic functions and will adhere to standard checklists and procedures for simple problems. As long as nothing goes wrong, they will appear to be formal and proficient. Tested with an unanticipated event, though, elevated stress will cause them to struggle with basic functions and communications. Confronted with complex problems or casualties, they will quickly become overwhelmed. This is a brittle team.
Leader-Dependent Battle Rhythm. Sometimes a weak team can remain convincingly functional under the guidance of a strong coordinating presence, such as an experienced Contact Manager, Sonar Supervisor, Assistant Navigator, or Officer of the Deck (OOD). The team is able to maintain structure under stress so long as a leader acts quickly to prioritize objectives and refocus the operators when necessary. The operators will rely on the leader’s direction not just for decision-making, but basic problem-solving as well. A team in this state is also brittle, as they will fracture if the leader becomes confused or distracted in a complex problem.
Team-Based Resilience. True resilience emerges when individual operators begin to naturally think beyond the context of their individual watch stations. Operators at this level process the information as well as the data and provide meaningful backup to tactical decision makers. Routine functions and formal reports are automatic, so they don’t consume important mental resources and they continue to occur under elevated levels of stress and complexity. Importantly, a team operating at this level is aware of its own limitations and will take action to bring additional resources (such as extra watchstanders) to bear when appropriate.
Advanced Team Resilience. An exceptionally proficient team may reach this level with sufficient effort and experience. Operators at the advanced level will have the flexibility and processing power to manage a variety of dynamic problems and unexpected events simultaneously. They will anticipate one another’s needs for information and actively challenge their own and others’ assumptions. Tactical decisions will emerge from deep within the team as sound recommendations, and senior leaders will become comfortably detached from the detailed problem-solving, instead providing big-picture oversight and mission focus.
Fig (1): STBT
Building Blocks of Resilience
To properly assess a team’s level of resilience, evaluators must know what indicators to look for. The STBT’s developers identified dozens of behaviors that a watch team may exhibit as it manages a challenging tactical situation. These behaviors each fall under one of five critical “practices” that are fundamental to the team’s performance: dialogue, decision making, critical thinking, bench strength, and problem-solving capacity. Where any of these practices are deficient, overall team resilience suffers markedly.
Dialogue considers the overall communicativeness of the team and is the most revealing single indicator of the team’s resilience. A team with good dialogue skills can quickly shift between formally structured reports and conversational exchanges as appropriate to the situation.
Decision making relates to the team’s distribution of authority. Leaders of resilient teams push authority downward such that subordinate leaders or operators make critical decisions appropriate to their responsibilities and skills.
Critical thinking concerns the team’s culture of questioning assumptions. An appropriately critical team will instinctively attack one another’s theories and will be sensitive to the influence of cognitive biases in their analyses. Team members give voice to their intuitions so that the other operators can consider their perspective and incorporate it if appropriate.
Bench strength considers not just the skills of individual team members, but the team’s approach to improving their skills. A team with good bench strength is deliberately inclusive of its least-developed members and will relentlessly work with them and push them to improve. The cultivation of specialized “A-teams” for high-risk evolutions is considered a dangerous practice since it can leave the other watch teams unprepared for unanticipated complexity.
Problem solving capacity describes the team’s ability to handle a variety of problems without losing the big picture. Contributing to this practice is the team’s propensity to develop efficient workflows and novel techniques or solutions, thereby freeing up resources for more pressing tactical concerns.
The resilience-building practices do not emerge all at once as a team develops. For example, dialogue is the most fundamental of team practices, and it has little room for improvement once Team-Based Resilience is achieved. Decision-making is the major determinant that brings a team beyond the Leader-Dependent Battle Rhythm level, and true critical thinking doesn’t fully materialize until the team has achieved Advanced Team Resilience.
Not “Another Checklist?”
For the junior officers recoiling in horror at the prospect of managing yet another checklist, you can relax. In its current state, the STBT is promoted as a tool for those at the CO level or higher, not as a new set of grading criteria but as a means to standardize feedback from evaluators to commanding officers. The standards are not new; the best crews have operated at high levels of resilience since the dawn of the modern submarine. Crew evaluators have scrutinized team behavior for just as long, with a generally agreed-upon understanding of what good teamwork looks like. The STBT does not contradict that understanding, but formally codifies it, establishing a common vernacular for team behaviors and degrees of resilience.
Nobody wants to see a junior officer on the conn, laminated STBT in hand, training their team to recite certain “trigger phrases” calculated to elicit a desired “resilience grade.” That kind of misdirected effort would do more harm than good. Instead, OODs should continue training to high standards and allow their teams to naturally develop resilience as a function of proficiency. Where the STBT may be useful to junior leaders is in self-assessment; specifically, it might help to identify hidden weaknesses. Whether or not the STBT eventually evolves into a training tool, the research that went into it provides several interesting points for consideration by OODs.
It’s easy to think you’re good and be wrong. Unfortunately, many of the indicators for discerning team resilience do not emerge without stress and chaos. In low-stress scenarios, a brittle team does not look especially different from a resilient one—they make formal reports, they give decisive orders, and they adhere to checklists and procedures. In other words, they make the routine look routine and are susceptible to the illusion that this basic functionality indicates proficiency.
An important concept in the model underlying the STBT is that of “reserve capacity,” defined as the cognitive resources available for processing information and making decisions, beyond what the team has already committed to routine operations. In a low-stress situation, a marginally proficient team can appear decisive and professional, but they will have to think hard to do it. Operators may privately struggle to recall routine procedures or pause before giving orders or reports to ruminate on the proper phraseology. Such a team will have few mental resources available to accommodate the unexpected, such as a sudden contact maneuver or an equipment casualty. Events like this can cause brittle teams to freeze up or engage in dangerous tunnel-vision.
While some reserve capacity can be conserved through prudent team management, the only way to develop additional capacity is through deliberate practice. As the routines become automatic, more cognitive resources become available for the unexpected. Team leaders should strive to make every watch or training scenario “count” to the maximum degree possible, strictly adhering to operational discipline so that formal reports and procedures become effortless. Given the high OPTEMPOs and constrained training resources faced by today’s submarine crews, operational watch teams cannot afford to waste any training opportunities.
Fig (2): Team performance vs. neuro-dynamic entropy
A weak team led by a rock star is still a weak team. Commanding officers are naturally inclined to pair up their weakest operators with their most capable OODs. Analysis of collisions and groundings that have occurred under the leadership of strong OODs suggests that this intuitive practice can be dangerous if not carefully managed. The danger is that the commanding presence of a strong watch officer can lead even the most capable operators to feel comfortable “dropping the pack,” so to speak, so that they become less aggressive in challenging assumptions or offering alternative courses of action. This effect is more pronounced with inexperienced operators, either due to their own lack of confidence or the watch officer’s lack of receptiveness to their input. Most teams will transition through this phase naturally, but an overly commanding OOD can actually inhibit the progression of the team to a more resilient state.
The strong leader then becomes the single point of failure in a situation that requires the capabilities of an engaged, cohesive team. This can be especially dangerous when the CO takes direct control of the ship, such as emergencies or battle stations. However frequently the CO has reassured the crew that he expects forceful backup, fleet experience has repeatedly demonstrated that tactical watch teams are reluctant to interrupt or contradict their commanding officer.
There is such a thing as “too formal.” Some of the more interesting research that has contributed to the STBT is an ongoing DARPA-funded study of submarine teams under stress. Contributing to the emerging science of Team Neurodynamics, a group of UCLA scientists studied the behavior of Submariners at various levels of proficiency in the Submarine Piloting and Navigation (SPAN) trainer. The subjects were outfitted with wireless electroencephalograph (EEG) monitors, enabling the scientists to record the neurological activity of the team throughout the scenario.
The scientists were specifically concerned with something called “NS Entropy,” which basically signifies the flexibility and randomness in a subject’s neurological state—the speed at which thought patterns change. Low entropy suggests a narrow focus, rigidly adhering to a specific set of thought patterns or routines. High entropy suggests a lack of focus and rapidly changing mental states. This is all very fascinating, but what does it have to do with operating a submarine? The findings might surprise you.
The worst-performing teams, those with essentially zero training, were those with the highest entropy levels, suggesting a general lack of structure to the team’s thoughts and behaviors. Only slightly better, though, were teams with rudimentary training, who exhibited the lowest levels of entropy. These teams used formal language and adhered to their procedures, but they were so narrowly focused and rigid that they easily lost focus on the big picture. When something went wrong, the individual team members would all become fixated on the same problem, and it could take 10 minutes or more for the team to reorganize into a functional battle rhythm.
The best-performing teams, composed of experienced submarine piloting parties, exhibited moderate levels of neurological entropy. The scientists called this region of performance the “sweet spot,” which they believe represents a transition point from an optimal state of mental flexibility into randomness. While the inexperienced teams were either too rigid or too random, the experts were fluid, and could quickly communicate concerns and priorities to one another with appropriately varying degrees of formality. When they encountered unexpected problems, the expert teams could quickly deal with them and recover without losing sight of the big picture.
The takeaway from this isn’t that formality is bad for us in high doses, just that it alone will not get us home. The expert teams presumably had to transition through a state of mental and procedural rigidity to achieve a state of fluid proficiency. Part of what made them able to quickly transition between formal reports and procedures to efficient discussions and flexible action is that the formality was well-rehearsed and took very little mental effort to execute.
Reception The COMSUBLANT Director for Training announced the STBT’s initial rollout in December of 2013. Feedback from the fleet has been mostly positive, with a few voices of caution. Prone to charts and tables of unquantifiable concepts, behavioral models tend to get a skeptical eye from technically minded people, and organizations do not get any more technically minded than the Submarine Force. Critics may charge that the STBT attempts to metricize something that is better judged holistically through the lens of experience rather than a grading rubric. Introducing another evaluative tool necessarily draws from bandwidth that is already crowded with evaluative tools.
Proponents of the STBT would argue that it was never meant to metricize teamwork or make it a graded event and that using the STBT in such a fashion would be a fundamental misuse of the tool. It is designed for use by subject matter experts in shaping their feedback to COs, and a junior officer attempting to evaluate a watch team with it would probably come to a different conclusion than a Greybeard. Using the STBT is optional, so it only requires time and energy from those who deem it worthwhile.
The most salient criticism of the STBT is that it is really nothing new; that the best crews have demonstrated advanced team resilience for decades, and their evaluators have had no problem identifying excellent teamwork. That may be true, but sometimes the defining point of an idea’s progress is that somebody took the trouble to write it down. If it is true that the best teams have always used the resilience-building practices identified in the STBT, then we must ask ourselves why it is only the best teams that do these things. Why not the average teams? Historically, where the Submarine Force arrives at an agreed-upon definition of what excellent performance looks like, we have a tendency to make it the standard.
The Submarine Team Behaviors Tool and supporting literature is available for download at the COMSUBLANT SIPRnet site.
This original article may be found at: http://www.public.navy.mil/subfor/underseawarfaremagazine/Issues/Archives/issue_55/STBT.html
Lt. Will Spears is an active-duty Submariner, a 2008 graduate of the United States Naval Academy, and a 2014 graduate of the Naval Postgraduate School. He will return to sea duty with SOAC Class 14060 in March of 2015.
C.L. Lamb, J.C. Lamb, R. Steed, R.H. Stevens, “A Robust and Realistic Model of Submarine Tactical Team Performance,” Submarine Technology Symposium Proceedings, Session 1, 2014.
C.L. Lamb, R. Steed, T. Smallidge, “Submarine Tactical Team Performance,” United States Naval Institute Proceedings, 79-81, June, 2013.
R.H. Stevens, J.C. Gorman, P.G. Amazeen, A. Likens, and T.L. Galloway, “The Organizational Neurodynamics of Teams,” Nonlinear Dynamics, Psychology, and Life Sciences, 17, 67-86, 2013.