Carnegie Mellon University

Emergency room

How Strong Transactive Memory in Trauma Units Benefits Patients

By Linda Argote, Thomas Lord Professor of Organizational Behavior and Theory; Director, Center of Organizational Learning, Innovation and Knowledge

A shared memory system improves outcomes for patients in trauma centers.

I’m working with coauthors Dr. Jeremy Kahn and Dr. Matthew Rosengart on a study of transactive memory in trauma resuscitation teams at University of Pittsburgh Medical Center. Jerry Guo of Aarhus University and KiWon Haan of CMU are also collaborating on the project. Transactive memory is a concept developed by psychologists to describe the sort of memory specialization that develops when people interact. For example, for married couples, it might be that one person remembers the birthdays for both sides of the family.

Measuring Transactive Memory in the Trauma Unit Environment

Over the years my colleagues and I have also studied transactive memory in business teams. In these organizations, we can measure transactive memory with surveys. But that’s not possible in the life-and-death environment of a trauma unit.

UPMC is a Level 1 trauma center, so it gets the most serious cases. It is also a teaching hospital. As the teams work together to stabilize patients, they are video recorded for later review and feedback.

Our project team watched the recordings to see how transactive memory played out. In lieu of a survey, we coded behavior that indicated a transactive memory.

For example, if the chief resident takes a team member off a task, while it is the right thing to do for patient care, it shows the team lacks good transactive memory because the task initially went to someone who didn’t have the expertise and skills to perform it successfully. The same is true on teams where a lot of explicit direction is required.

On the other hand, transactive memory is evident where team members specialize in different tasks, have the skills to perform them successfully, and rely on each other to accomplish their tasks.

Patients Treated By Teams With Well-Developed Transactive Memory Have Shorter Hospital Stays

When we tracked the progress of patients after they were stabilized and admitted, the preliminary results were exciting. Patients treated by teams with well-developed transactive memory have shorter stays in both the ICU and the hospital than patients treated by teams with less transactive memory.

Reducing a patient’s length of stay benefits both the patient and the hospital. The patient has a reduced chance of infection. And in an era of value-based health care, the hospital allocates its resources more effectively.

How to Build a Transactive Memory in the Trauma Team Context

Our next step is to determine how to build a transactive memory in the trauma team context. We know from other settings that keeping staff together facilitates a transactive memory. So staffing patterns that promote stability in team composition are worth exploring.

Another approach would be a training intervention. Team members would meet briefly at the start of the shift to go over their expertise and experience, reinforcing transactive memory before the first patient arrives.

Our goal is to provide a way for trauma teams to build stronger transactive memory systems and thereby ensure better patient care.