Document Type


Publication Date



Research Objective: Research objectives are to: 1) assess effect of controller-led in situ simulation on emergency response capacity of state health department; 2) study effects of training on team function, dynamics, and communications among staff responsible for emergency operations at state health department; and 3) train public health teams for high reliability.

Data Sets and Sources: Thirty trials (one-hour functional exercises) conducted in the state department operations center over a 16-month period (May 2010 to September 2011). Data gathered using in situ simulation methodology (recording, live viewing, playback analysis). Behavioral markers data collected using event set observational tool (24 recordings analyzed); decision-making data collected using decision taxonomy tool (22 recordings analyzed).

Study Design: This quasi-experimental intervention with time-series analysis and comparison group determined effects of the intervention on participants. The study measured team performance in public health preparedness context; examined impact of intervention to achieve high reliability in emergency operations center; and looked at relationship among behavioral markers, decision-making, and team performance.

Analysis: Using a descriptive, longitudinal analysis, we examined the frequency and distribution of behavioral markers to identify and describe: distinct phases of team formation and reformation during incident response; patterns and distribution of team behaviors across phases; and relationship among behavioral markers (non-technical skills), leaders, and team effectiveness/performance.

Principal Findings: Data indicate that leader’s experience, training, expertise impacts team performance positively (in case of strong leader), as measured by trial scores. Converse is also true – poor leader, negative impact. We infer that team behavior dependent on/associated with leader behavior, and identifiable behaviors of leaders exist based on leadership skills.

Conclusion: Our research shows that public health emergency response team performance depends to a certain degree on who the leader is during the response/exercise. To effectively train and prepare response teams, it is essential to understand how non-technical skills, behavioral markers, and leadership interact and impact team performance and high reliability.

Implications for The Field of PHSSR: The intervention may be less important in improving response team performance than the leader and his training and experience. No study of leaders at the micro-system level exists with respect to behavioral markers necessary to achieve high reliability in crisis settings. Our data and findings provide insight into that process.


Reproduced with permission of the National Coordinating Center for PHSSR and the Robert Wood Johnson Foundation, Princeton, N.J.

For audio of the presentation, visit the Keeneland Conference site.


Oral presentation at the 2013 Keeneland Conference on Public Health Systems and Services Research