short case study on teamwork

“Many team-building processes degenerate because team members are primarily focused on solving someone else’s problems. This process works because it encourages team members to focus primarily on solving their own problems!” ~ Marshall Goldsmith

Group discussions began with developing an understanding of how teams evolve and how a high performing team functions based on the available research. For example, we talked about Tuchman’s four-stage model of team development: forming, storming, norming and performing.  I also referenced Howard Guttman’s When Goliaths Clash: Managing Executive Conflict to Build a More Dynamic Organization ii .  My intent was to reduce the volume of self-depreciating thoughts among the group so that they were free to energize each other to make the necessary corrective changes by understanding that conflict is inevitable in any group of assertive bright people and that the trick is to learn how to navigate that conflict better.

Following the TBWTW model, I asked the group members to rate how well they were doing as a team on a scale of 1 – 10.   Again, there was much discussion on the subject and they asked to alter the question. They wanted to ask instead:  (1) On a 1 to 10 scale, how effective are we at achieving results? (2) On a 1 to 10 scale, how efficient are we at achieving our goals? (3) On a 1 to 10 scale how well do we need to be doing in terms of working together as a team?   For this group of engineers, talking about “results” and team “efficiency” resonated better and provided a clearer definition of team effectiveness.  Their request seemed reasonable to me especially since their answers to the questions would further reinforce the need for the process and create a stronger desire for positive outcomes.

For question 1, achieving our goals , they rated themselves at 6.9. For question 2, team efficiency they rated themselves 3.5.  Their response to question 3, how well do we need to be was 8.0.  As before, they didn’t want to just highlight how poorly they were doing, they wanted to give themselves credit for achieving results in spite of how poorly they functioned as a team.  The upshot was that they all concluded that they needed to change and were all on board to proceed with the rest of the TBWTW process.

I then asked the group what their team would look and act like if it were functioning at a higher level. Before moving on we recorded their response to use later in the day to develop a Code of Team Conduct.

As we moved through the next steps in the process the group members decided to focus on the following two team commitments:

• We will all exercise an ongoing process of prioritizing our goals and align our individual actions to them.
• We will spend time together as a team to discuss crucial issues and drive commitment to deliver on our priorities.

Step five of the TBWTW process took twice as long for this group than outlined in the Goldsmith and Morgan article for two primary reasons: Per group request we added an additional question: Describe two behaviors that you do that contributes to team effectiveness and efficiency, and the group asked clarifying questions.

I added two additional requirements to the step six of reviewing behavioral changes and choosing the two that seem most important by asking them to provide me with each of their full list of suggestions they would give to each other and the full list that they received.  I did this to accommodate a fair amount of expressed cynicism about George’s participation in the process.  Several team members told me during my private interviews that they doubted that he would pick the behaviors they thought he should work on. They felt that if he knew I was overseeing the tallying that he would be sure to focus on their concerns. Again, to help them feel that the process would net valid results, I accommodated their request.  To further support this, I suggested that each member pick the two suggested behavioral changes that received the most mention from their peers.

My ten-member team was scattered at multiple sites across the continent so it was necessary to alter the next step, step seven, to fit our situation. Instead of asking them to ask for brief five-minute monthly reports on their effectiveness, I asked them to ask four of their teammates to be their “change partners” and to conduct the brief (five-minute), monthly progress reports with them.

The remainder of the offsite time was devoted to developing a Code of Team Conduct which was the offshoot of step three mentioned earlier.  Their Code of Team Conduct follows:

• No triangulation – engage each other
• Actively support each other
• Do what you say you are going to do
• No hidden agendas – be up front
• Informal climate
• Proactive inclusiveness – keep track of each other – keep each other informed
• Tenet of respect
• Align and keep our priorities up to date
• Align individual actions to the group goals and objectives
• We spend time together as a team on crucial issues
• We seek commitment from the team before seeking business commitment
• We establish and follow meeting etiquette
• We take our goals seriously – professional pride.

When we concluded the offsite meeting time the real work began.  Of note, all of the executives informed their immediate subordinates of their personal behavioral change goals and asked for their support in achieving these goals.  Their heartfelt rationale for doing so was expressed quite well by one individual, “If our boss (the SVP) is willing to bare his soul to us and ask for our support in his growth, why shouldn’t we do the same.”

During the next four months, I worked with the SVP as his executive coach and met, when requested, with the other non-coached executives to provide support and coaching. I participated in weekly leadership meetings to observe how these individuals worked together, to support them in following through with their code of team conduct, and to provide real-time advice and guidance to improve how they conducted, and interacted during, meetings.

Four months later I initiated the “mini-survey” process suggested in steps eight and nine by preparing mini-surveys for each executive, I distributed them to their respective change partners, and tallied the results (see addendum – sample mini-survey).

We held a follow-up offsite meeting to work on steps ten and eleven and to review the results of this first survey. Individual dialogues helped each group member to refine and reinforce the team building process.  Everyone on the team made excellent progress toward achieving increased effectiveness in demonstrating the desired behaviors (average rating of  +2 or better on a -3 to +3 scale – please see the sample mini-survey addendum) except George; he showed no change.  Not too long after this meeting, based on a number of other factors including general performance related issues, the SVP decided to move George out of his role and placed him elsewhere in the company with the hope of his being more effective.

The remaining team members continued to work on their individual and team commitments and at the conclusion of four additional month’s time we initiated another mini-survey.  We held another offsite meeting to review the results, and refine and define next steps.  Everyone continued to make excellent progress. In addition to the formal ratings that showed continued progress we did a qualitative temperature check. I asked all of the participants how they felt they were doing as a team.  The executive who initially expressed the most doubt about the TBWTW process summed it up best when he said, “It’s a world of difference, the energy of our group is much higher, I feel that I’m supported by the group and I’m excited by our prospects.”

Roughly 12 months after we initiated the TBWTW process, we conducted another offset meeting, the last steps of Marshall and Morgan’s learning progression, and everyone concluded that they had made excellent progress and could concentrate on new successes.  The SVP surprised his team by telling them that corporate-wide they were now considered to be the poster children for how a functional team should work.

In conclusion, I did more than just follow Marshall’s and Morgan’s Team Building Without Time Wasting plan step by step, but their method was the primary overt vehicle used to work with this ten-member executive team. It made working with them easier because it was systematic in nature and appealed to their engineering mindset, as well as allowing time for me to work behind the scenes coaching the SVP and a couple of key stakeholders as well. I wanted the members of the team to both own their individual part in the dynamics of their group and to help them learn how to behave differently and more effectively. I was able to train them in real time to give constructive feedback to their team members.  In the adult learning model people learn best when they learn using real-time situations and get to practice the skills and this process is designed to encourage practice asking for feedback at regular intervals.

Since, I have successfully used the basic steps outlined in the TBWTW article, and included my modifications, with several different teams and have continued to see the same levels of success.

I’d like to reiterate Marshall and Morgan’s challenge to you as a team leader: “Try it! The “downside” is very low. The process takes little time and the first mini-survey will quickly show whether progress is being made. The “upside” can be very high. As effective teamwork becomes more and more important, the brief amount of time that you invest in this process may produce a great return for your team and an even greater return for you organization.”

Summary of changes to the TBWTW processes and some lessons learned:

• I included in Step Five some version of the following – Describe two behaviors that I do that contribute to team effectiveness.
• Allow extra time for participants to ask clarifying questions.
• When working with a large team, have the participants select a subset of “change partners” who will complete the mini-surveys for them. This will increase the likelihood that they will check in more frequently for feedback and much needed reinforcement.
• Consider requesting that the participants provide you with the list of suggested behavioral changes to ensure that they pick those of high value.
• Be flexible and allow the group to put their own stamp on the process.  You’ll get better buy-in.

Carl Robinson, Ph.D., Advanced Leadership Consulting, www.leadershipconsulting.com , [email protected] , t: 206.545.1990

Addendum: Mini – Survey Sample

College Educator Workshops & Conferences

Student Success, Retention & Engagement | On Course

Case Study: Team Work

Students in Mrs. Rickshaw’s Student Success class are required to do a half hour team presentation on a topic of their choice. Mrs. Rickshaw randomly assigns students to teams. Students have approximately four weeks to research and prepare, including two hours of class time. Marks are given based on an instructor evaluation of the presentation combined with a peer evaluation by their team members.

Jane, Robert, Danny, Sharon and Liz were assigned to Team 3. During their first team meeting they introduced themselves and began to decide on a topic.  After 45 minutes, they were still trying to settle on a topic. They finally settled on Money Management, however the instructor informed them that another team had already chosen that topic but Conflict Management was still available. During the last 15 minutes of class time, Robert tried to convince the group that they should present a role-play of conflict. Sharon wanted to do research and give a more detailed, informational presentation. Jane was excited by the role-play idea and suggested they make a video presentation of their own play-acting. Danny fell asleep some time before the topic was chosen and Liz sat quietly listening to the arguments of her teammates.  At the end of the class no work division had occurred but the team agreed to meet in a study area at 4:15 on the following Monday.

After waiting for Danny until 4:30, the team decided to start without him. Jane announced she had to leave in twenty minutes because she had to pick up her child at the day care by 5:00. Robert was ready to start script writing but Sharon wanted to discuss the content of their presentation and assign research – thinking they could write the script once they were knowledgeable. Liz just listened quietly.  An argument ensued, and Jane had to leave before a decision was reached. The next meeting was to be held during their class time the next week.

Before the next meeting, Robert convinced Jane that a role-play was the way to go, and together they put together a draft script, working hard to make the skit funny and entertaining. Robert confronted Danny and warned him to attend the class meeting or he wouldn’t get a part in the play.  In the meantime, Sharon picked up six books from the library and printed four articles from the Internet. She prepared an outline detailing various aspects of conflict management. Liz just worried about her role in the whole project.

At the class meeting, all team members were present. Robert informed the group that he and Jane had decided to do a skit, and they had a script all ready. Then he began to assign parts to his teammates. Sharon was incensed and insisted the script was short on content and demanded that they re-build the script around her outline. Robert said he wanted no part in a boring presentation.

Danny did not show up to the remaining team meetings. Liz agreed to do a small part in the play. Jane promised to gather props and costumes. Sharon stubbornly insisted on preparing an informational presentation. She would have liked to have this integrated into the role-play but Robert would not agree to change his script. They planned a practice of the role-play during their math class on the morning of October 16, the day of their presentation.

On the morning of October 16, Danny did not come to school and Liz forgot to bring the props. The practice ended up being more of an argument session. Danny showed up just before Student Success was to start and said “You mean it’s today?!” Liz was very nervous and felt very sick. She wasn’t sure she could do her part. The presentation began with Sharon reading her lengthy introduction and then the skit began. The skit was five minutes in length. The whole presentation left the other class members confused and it ran twelve minutes instead of the required thirty.

Questions for Discussion:

1. In your team, each member is to choose one of the characters in the case study. Complete the evaluation on the reverse of this sheet for your own character first and then for the other members of the team. This form will be given to you to evaluate your teammates when your own presentation is completed.

2. In your character groups, discuss the strengths and weaknesses displayed by your character. Make a list of at least three suggestions that could have improved that character’s input to the team project. Return to your home team and summarize the discussion for each character.

In your home team, discuss your own personal strengths and weaknesses as you perceive them regarding your contribution to the team project. As a team, write a list of guidelines for the team to follow.

 EVALUATION

Evaluate your character’s teamwork using the assessment below.  This is the same form you will use later to actually evaluate your team members for this class.

         Give a mark from 0 to 5 for each element on the checklist.

              Poor      Fair       Average     Good       Excellent

                  1         2                3             4                 5

          Give a mark of zero if the person did not participate.

                                     Jane       

• Communication
• Participation
• Give and Take
• Organization
• Preparation

Elements of Teamwork Checklist

COMMUNICATION

• Excellent:   Free, open expression of ideas and feelings at all appropriate times with no fear of embarrassment or reprisal.
• Poor:  Stifled, close to the vest, guarded.  Lets the other person start the communication.

PARTICIPATION

• Excellent:   Full contribution, reaches out to lend a hand, readily available.
• Poor:  Lack of initiative to help the other person? Not around when needed, begrudging contribution.

GIVE AND TAKE

• Excellent:   Open to compromise, flexible? Recognition that it is sometimes better to give in than be “Right.”
• Poor:  Stubbornly dug in on own viewpoint, uncompromising, always right, never wrong.
• Excellent:   Promotes team actions and decisions, recognizes he/she needs the team, and lets each member know where they stand. Team members support his/her suggestions.
• Poor:  No leadership initiated. Reacts rather than acts.  Poor or reluctant support of ideas.

ORGANIZATION

• Excellent:   Knows their responsibilities.  Provides structure to accomplish team goals.
• Poor:  Unclear of responsibilities or doesn’t care about responsibilities.

PREPARATION

• Excellent:   Did their homework.  Research was thorough, especially as it affects other team members.
• Poor:  Team progress was held up because of participant’s lack of preparation.  Consistently dropped the ball.
• Excellent:   Lives by the ground rules and procedures.  Functions smoothly, works with the team.
• Poor:  Absence of order, operates on their own rules, progresses from crisis to crisis.
• Excellent:   Members have confidence in participant and can rely on performance.
• Poor:  Mediocre “Class C” player not interested in becoming “Class A.”
• Excellent:   Participant rallies to the goals.  Goals clearly defined in his/her mind.
• Poor:  Lack of awareness of, or resistance to, team goals.
• Excellent:   An attitude of action and momentum, makes suggestions of steps forward.
• Poor:  Dead in the water ? “Everything is a drag” attitude.

–Joanne Fortuin, Northern Albert Institute of Technology, Alberta, Canada

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Case Study: When Two Leaders on the Senior Team Hate Each Other

• Boris Groysberg
• Katherine Connolly Baden

How should a CEO address friction between his CFO and the sales chief?

In this fictional case, the CEO of a sports apparel manufacturer is faced with an ongoing conflict between two of his top executives. Specifically, the head of sales and the CFO are at each other’s throats and the tension is having a ripple effect on their teams and the rest of the organization. The CEO, who tends to avoid conflict himself, is struggling with how to respond. His options include changing the company compensation scheme to encourage better collaboration, firing the two leaders, getting them each a coach, and doing more team building activities.

The feedback in the 360-degree reviews was supposed to be anonymous. But it was crystal clear who’d made the negative comments in the assessment of one executive.

• BG Boris Groysberg is a professor of business administration in the Organizational Behavior unit at Harvard Business School and a faculty affiliate at the school’s Race, Gender & Equity Initiative. He is the coauthor, with Colleen Ammerman, of Glass Half-Broken: Shattering the Barriers That Still Hold Women Back at Work (Harvard Business Review Press, 2021). bgroysberg
• KB Katherine Connolly Baden is a research associate at Harvard Business School.

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Outback Team Building & Training Blog

Tips, expert advice, exclusive interviews, and more on team building and employee engagement, 10 team building case studies & training case studies.

The key to a strong business is creating a close-knit team. Here's how 15 corporate teams did so using team building, training, and coaching solutions.

From corporate groups to remote employees and everything in between, the key to a strong business is creating a close-knit team. In this comprehensive case study, we look at how real-world organizations benefited from team building, training, and coaching programs tailored to their exact needs.  

We’re big believers in the benefits of   team building ,   training and development , and   coaching and consulting   programs. That’s why our passion for helping teams achieve their goals is at the core of everything we do. At Outback Team Building and Training,   our brand promis e   is   to be   recommended , flexible,   and   fast.   Because we understand that when it comes to building a stronger and more close-knit team, there’s no one-size-fits-all formula. Each of our customers have a unique set of challenges, goals, and definitions of success.   And they look to us to support them in three key ways:   making their lives easy by taking on the complexities of organizing a team building or training event; acting fast so that they can get their event planned and refocus on all the other tasks they have on their plates; and giving them the confidence that they’ll get an event their team will benefit from – and enjoy.   In this definitive case study, we’ll do a deep dive into:  

• 3  Unique Events Custom-Tailored for Customer Needs  
• 3 Momentum-Driving Events for Legacy Customers  
• 4 Successful Activities Executed on Extremely Tight Timelines

Unique Events Custom-Tailored for Customer Needs   We know that every team has different needs and goals which is why we   are adept at being flexible and   have mastered the craft of creating custom events for any specifications    

When the   Seattle, Washington -based head office of the Bill & Melinda Gates Foundation – a world-renowned philanthropic organization – approached us in search of a unique charity event, we knew we needed to deliver something epic. Understanding that their team   h ad effectively   done it all   when it comes to charity events, it was important for them to be able to get together as a team and give back   in new ways .  

Our team  decided the best way to do this was to   creat e   a brand-new event for the Bill & Melinda Gates Foundation   which had never been executed before.   We created an entirely new charitable event –   Bookworm Builders   – for them   and their team loved it! It allowed them to give back to their community, collaborate, get creative, and work together for a common goal. Bookworm Builders has since gone on to become a staple activity for tons of other Outback Team Building and Training customers!    

To learn more about how it all came together, read the case study:   A Custom Charity Event for the Bill & Melinda Gates Foundation .  

Who said hosting   an   impactful training program   means having your full team in the same place at the same time? Principia refused to let distance prevent them from having a great team, so they contacted us to help them find a solution. Their goals were to find better ways of working together and to create a closer-knit company culture among their 20 employees and contractors living in various parts of the country.   

We worked with Principia to host an   Emotional Intelligence   skill development training event   customized to work perfectly for their remote team. The result was a massive positive impact for the company. They found they experienced improved employee alignment with a focus on company culture, as well as more emotionally aware and positive day-to-day interactions. In fact, the team made a 100% unanimous decision to bring back Outback for additional training sessions.  

To learn more about this unique situation, read the full case study:   How Principia Built a Stronger Company Culture Even with its Remote Employees Working Hundreds of Miles Apart .  

W e know that employee training which is   tailored to   your organization can make the difference between an effective program and a waste of company time. That’s why our team jumped at the opportunity to facilitate a series of custom development sessions to help the Royal Canadian Mint discover the tools they needed to manage a large change within their organization.   

We hosted three custom sessions to help the organization recognize the changes that needed to be made, gain the necessary skills to effectively manage the change, and define a strategy to implement the change:   

• Session One:   The first session was held in November and focused on preparing over 65 employees for change within the company.  
• Session Two:   In December, the Mint’s leadership team participated in a program that provided the skills and mindset required to lead employees through change.  
• Session Three:   The final session in February provided another group of 65 employees with guidance on how to implement the change.  

To learn more, read the full case study:   Custom Change Management Program for the Royal Canadian Mint .  

3 Momentum-Driving Events for Legacy Customers We take pride in being recommended by   more than 14,000 corporate groups   because it means that we’ve earned their trust through delivering impactful results  

1. How a Satellite Employee “Garnered the Reputation” as Her Team’s Pro Event Planner  

We’ve been in this business for a long time, and we know that not everybody who’s planning a corporate event is a professional event planner. But no   matter   if   it’s their first time planning an event or their tenth, we   love   to help make our customers look good in front of their team. And when an employee at Satellite Healthcare was tasked with planning a team building event for 15 of her colleagues, she reached out to us – and we set out to do just that!  

Our customer needed a collaborative activity that would help a diverse group of participants get to know each other, take her little to no time to plan, and would resonate with the entire group.  

With that in mind, we helped her facilitate a   Military Support Mission . The event was a huge success and her colleagues loved it. In fact, she has now garnered the reputation as the team member who knows how to put together an awesome team building event.  

To learn more, read the case study here:   How a Satellite Employee “Garnered the Reputation” as Her Team’s Pro Event Planner .  

2. Why   PlentyOfFish   Continues to Choose ‘The Amazing Race’ for Their Company Retreat  

In 2013, international dating service POF (formerly known as   PlentyOfFish ) reached out to us in search of an exciting outdoor team building activity that they could easily put to work at their annual retreat in   Whistler, B.C . An innovative and creative company, they were in search of an activity that could help their 60 staff get to know each other better. They also wanted the event to be hosted so that they could sit back and enjoy the fun.  

The solution? We helped them host their first-ever   Amazing Race   team building event.  

Our event was so successful that POF has now hosted The Amazing Race at their annual retreat for   five consecutive years .  

To learn more, check out our full case study:   Why PlentyOfFish Continues to Choose ‘The Amazing Race’ for Their Company Retreat .  

3. How Team Building Helped Microsoft Employees Donate a Truckload of Food  

As one of our longest-standing and most frequent collaborators, we know that Microsoft is always in search of new and innovative ways to bring their teams closer together. With a well-known reputation for being avid advocates of corporate social responsibility, Microsoft challenged us with putting together a charitable team building activity that would help their team bond outside the office and would be equal parts fun, interactive, and philanthropic.   

We   analyzed which of   our six charitable team building activities   would be the best fit for their needs , and we landed on the perfect one :   End-Hunger Games . In this event, the Microsoft team broke out into small groups, tackled challenges like relay races and target practice, and earned points in the form of non-perishable food items. Then, they used their cans and boxes of food to try and build the most impressive structure possible in a final, collaborative contest. As a result, they were able to donate a truckload of goods to the local food bank.  

For more details, check out the comprehensive case study:   How Team Building Helped Microsoft Employees Donate a Truckload of Food .  

4 Successful Activities Executed on Extremely Tight Timelines Time isn’t always a luxury that’s available to our customers when it comes to plan ning   a great team activity which is why we make sure we   are fast, agile, and   can accommodate any timeline 

Nothing dampens your enjoyment of a holiday more than having to worry about work – even if it’s something fun like a team building event. But for one T-Mobile employee, this was shaping up to be the case. That’s because , on the day before the holiday weekend,   she found out that she needed to organize a last-minute activity for the day after July Fourth.    

So, she reached out to Outback Team Building and Training to see if there was anything we could do to   help   - in less than three business days . We were happy to be able to help offer her some peace of mind over her holiday weekend by recommending a quick and easy solution: a   Code Break   team building activity. It was ready to go in less than three days, the activity organized was stress-free during her Fourth of July weekend, and, most importantly, all employees had a great experience.   

For more details, check out the full story here:   Finding a Last-Minute Activity Over a Holiday .  

At Outback Team Building and Training, we know our customers don’t always have time on their side when it comes to planning and executing an event. Sometimes, they need answers right away so they can get to work on creating an unforgettable experience for their colleagues.  

This was exactly the case when Black & McDonald approached us about a learning and development session that would meet the needs of their unique group, and not take too much time to plan. At 10:20 a.m., the organization reached out with an online inquiry. By 10:50 a.m., they had   been connected with   one of our training facilitators for a more in-depth conversation regarding their objectives.  

Three weeks later, a group of 14   Toronto, Ontario -based Black & McDonald employees took part in a half-day tailor-made training program that was built around the objectives of the group, including topics such as emotional intelligence and influence, communication styles, and the value of vulnerability in a leader.  

To learn more about how this event was able to come together so quickly, check out the full story:   From Inquiry to Custom Call in Under 30 Minutes .  

When Conexus Credit Union contacted us on a Friday afternoon asking if we could facilitate a team building event for six employees the following Monday morning, we said, “Absolutely!”   

The team at Conexus Credit Union were looking for an activity that would get the group’s mind going and promote collaboration between colleagues. And we knew just what to recommend:   Code Break Express   – an activity filled with brainteasers, puzzles, and riddles designed to test the group’s mental strength.   

The Express version of Code Break was ideal for Conexus Credit Union’s shorter time frame because our Express activities have fewer challenges and can be completed in an hour or less. They’re   self-hosted,   so the company’s group organizer was able to easily and efficiently run the activity on their own.  

To learn more about how we were able to come together and make this awesome event happen,   take a look   at our case study:   A Perfect Group Activity Organized in One Business Day .  

We’ve been lucky enough to work with Accenture – a company which has appeared on FORTUNE’s list of “World’s Most Admired Companies” for 14 years in a row – on   a number of   team building activities in the past.   

T he organization approached us with a request to facilitate a philanthropic team building activity for 15 employees .   The hitch? They needed the event to be planned, organized, and executed within one week.   

Staying true to our brand promise of being fast to act on behalf of our customers, our team got to work   planning Accenture’s event . We immediately put to work the experience of our   Employee Engagement Consultants ,   the flexibility of our solutions, and the organization of our event coordinators.   And six days later, Accenture’s group was hard at work on a   Charity Bike Buildathon , building bikes for kids in need.  

To learn more about how we helped Accenture do some good in a short amount of time, read the full case study:   Delivering Team Building for Charity in Under One Week .  

Learn More About Team Building, Training and Development, and Coaching and Consulting Solutions 

For more information about how Outback Team Building and Training can help you host unforgettable team activities to meet your specific goals and needs on virtually any time frame and budget, just reach out to our Employee Engagement Consultants.   

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How to Calculate ROI of Remote vs. In-Person Work? (How to Video)

Let's Grow Leaders

AUGUST 23, 2021

2:55 A case study published by SHRM of an insurance company that allowed claims processors and claims examiners to work from home (before the pandemic.). 10:15 Karin: Have all of your studies shown that remote work results in higher ROI? Teamwork , collaboration, and engagement can go down. Review the case study .

5 Easy Steps to Make Your Next Leadership Training Day More Engaging and Effective

• Great Results Team Building

JUNE 3, 2024

This could involve simulations, case studies , or real-world scenarios. As a successful basketball coach, Sean gained valuable insights on turning talent into teamwork – and now he travels around the country to share those lessons. Incorporate opportunities for participants to practice their skills.

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First Look: Leadership Books for March 2023

MARCH 1, 2023

Most important, this book is not just another compilation of case studies . Culture Rules makes the case for why leaders should invest their time and energy on building culture and gives them three simple, actionable rules they must play by if they want to stay in the game and win! The result: mixed signals.

Remote Work Revolution: Mastering the Challenges and Opportunities in 2024

N2Growth Blog

FEBRUARY 29, 2024

These include maintaining productivity and efficiency, fostering teamwork , enabling a positive workplace culture, and establishing effective communication channels. However, harnessing the potential of a virtual workforce comes with unique challenges for business leaders.

Executive Search in the Legal Sector: Uncovering Excellence

DECEMBER 8, 2023

It is crucial to ask behavioral and situational questions that allow candidates to demonstrate their problem-solving abilities, adaptability, and teamwork skills. These assessments range from written exercises and case studies to mock client meetings or negotiation scenarios.

Transforming a Management System – A Case Study From the Madison Wisconsin Police Department

Curious Cat

MARCH 10, 2015

A Case Study Madison, Wisconsin (1981-1993). The chief continues to stress teamwork , Quality Leadership, and use of improvement methods in order to continue the process of transformation. This post in an excerpt from The Quality Leadership Workbook for Police by Chief David Couper and Captain Sabine Lobitz ( buy via Amazon ).

Is your Leadership Development Developing Leaders?

Great Leadership By Dan

OCTOBER 24, 2019

As I wrote Building Blocks — Case Studies of a Serial Entrepreneur , I realized that over the years, I toiled with many of my failures, but I never analyzed the variables of the successes. Shamis is CEO of Winding River Consulting and the author of Building Blocks— Case Studies of a Serial Entrepreneur.

ROI of Executive Coaching 500% Return

DECEMBER 16, 2023

Numerous studies and surveys have consistently demonstrated the significant impact executive coaching has on various business metrics. Anderson, Ph.D. of MetrixGlobal, LLC, highlights this impact. It was discovered that 77% of respondents experienced a significant impact on at least one of nine business measures due to executive coaching.

12 Books that Shaped My Leadership

Nathan Magnuson

MAY 16, 2016

If you’re looking for a case study on what great organizations (and great leaders) do that sets them apart from the rest, this is your book. In fact, it’s not just one case study , it’s two or three dozen between feature and comparison companies. The Five Dysfunctions is one the standards on teamwork .

7 Tangible Ways Artificial Intelligence Boosts Profits in Your Company

Lead from Within

AUGUST 19, 2024

A case study by Harley-Davidson showed that AI-driven marketing increased leads by 2,930% and reduced cost per lead by 60%. AI Optimizes Marketing Campaigns: AI analyzes customer data, including demographics, behavior, and preferences, to create targeted marketing campaigns.

Why Managers Should Care about Employee Loyalty

Brigette Hyacinth

JUNE 19, 2021

According to data drawn from 30 case studies taken from 11 research papers on the costs of employee turnover, it costs at least 20% of their salary when an employee leaves. Ultimately having a culture that promotes open communication, fairness, teamwork , camaraderie and a family atmosphere helps to retain good employees.

When Is Teamwork Really Necessary?

Harvard Business Review

AUGUST 16, 2018

Most leaders assume that they need to foster teamwork among the people whom directly and indirectly report to them. Catherine, a senior marketing director leading a cross-functional product development team at the same company, provides a contrasting case study . Teamwork efforts must be tailored to each group and situation.

The Best Leadership Books of 2021

DECEMBER 15, 2021

But conventional wisdom on teamwork and collaboration has created too much of the wrong kind of collaboration, which hurts our performance, health and overall well-being.

New York Label & Box: A Deming-Inspired Company

Deming Institute

FEBRUARY 4, 2019

At New York Label, this meant removing sales quotas and performance reviews , eradicating “command and control” management practices, promoting teamwork and collaboration, practicing systems thinking, and tying sales and growth directly to improving quality. When they started their efforts.

Knowing and Doing: Closing the Gap

Lead Change Blog

MARCH 23, 2018

” Leading by example – a personal case study . Through it, I developed far more effective relationships, empowered and enabled more staff, by being supportive in this way, which I complemented by “walking the job.”

Drowning in Information While Thirsting for Communication

The Practical Leader

AUGUST 25, 2021

Strengthens teamwork and engagement. Write up collections of case studies illustrating tough decisions, trade-offs, outstanding performance, dealing effectively with changes, etc. Convinces with facts and analysis. Inspires with stories and examples. Easy to send negative/angry messages. Broadcast to large groups.

December 2015 Leadership Development Carnival

DECEMBER 7, 2015

Jesse summarized: “Collaboration is a powerful tool that leads to break-through results, and is different from cooperation, coordination , and teamwork . Using case studies and real life examples from his professional and personal experience, Michael Lee Stallard has written what I deem is the best leadership book of 2015.”

Leaders Can Learn From College RAs

Michael Lee Stallard

JANUARY 29, 2011

In this blog, I consistently describe new research and case studies that collectively prove beyond any reasonable doubt that connection = flourishing and life and disconnection = disfunction and death. Where there is no intentionality, people tend to take relationships for granted.&#.

Expand Your Coaching

Marshall Goldsmith

DECEMBER 23, 2013

This real-life case study shows how an executive can expand a simple coaching assignment to benefit his team and company. Clarkson is trying to increase synergy and teamwork across divisions. They shared information with each other to help improve cross-functional teamwork , synergy, and cooperation.

July 2016 Leadership Development Carnival

JULY 4, 2016

Chris summarizes: “Great bosses inspire growth, ensure accountability, spur teamwork and more. The Institute for Corporate Productivity and ROI Institute have released the results of a new research study , which looks at positive trends and the state of human capital analytics. .” Find Beth on Twitter at @bethbeutler.

Leadership Biz Cafe Podcast #4 – CEO Dave Balter on Humility in Leadership

NOVEMBER 29, 2011

His company has also been the focus of two case studies done by Harvard Business School. Dave is the CEO and founder of the word-of-mouth (WOM) marketing company, BzzAgent , which has been featured on CBS News, the BBC, and the New York Times Sunday Magazine.

Applying W. Edwards Deming’s Ideas in Software Development

JULY 17, 2017

The system itself was actively discouraging cooperation and teamwork . She discusses how the practices that were driven by the management system in the example pitted departments against each other.

Building Organizational Muscle: Why Building Strengths Pay Greater Dividends than Fixing Weaknesses

NOVEMBER 21, 2012

The company was diligently surveying and tracking employee engagement and satisfaction with leadership behaviors, teamwork and cooperation, communication, performance management/coaching, and the like. He and the senior team were looking for ways to boost performance and build a great organization.

Engaging Culture One Conversation At A Time

JANUARY 15, 2013

They fully describe each element, and provide case studies and actionable takeaways. The authors believe that effective organizational conversation always involves a combination of four elements: intimacy, interactivity, inclusion, and intentionality.

Dysfunctional Teams

NOVEMBER 15, 2018

Is your teamwork not working? ” HBR: Too Much Team Harmony Can Kill Creativity by Darko Lovric and Tomas Chamorro-Premuzic — “Consistent with these famous case studies , scientific research shows that creativity and innovation can be enhanced by reducing team harmony.

Why do some talented executives fail?

Coaching Tip

APRIL 30, 2015

In a world overpopulated with enormous egos, 40-year old Paul seemed to be an anomaly," begins the first of Waldroop and Butler's twelve case studies . "He Although the book identifies twelve behavior patterns, here are only five of the behaviors, starting with. 1) Never Feeling Good Enough. "In

The Big Picture of Business- Evergreen Business Strategies. Digest of Take-Aways From 36 Articles.

Strategy Driven

JULY 31, 2015

This review is the basis for most elements that will appear in a strategic plan, including the organization’s strengths, weaknesses, opportunities, threats, actions, challenges, teamwork , change management, commitment, future trends and external forces. Amplify upon philosophies of others. There comes a point when the pieces fit.

Manage Yourself Smart: Ten Guidelines for Making Smart Choices in.

DECEMBER 29, 2010

Foster teamwork . As a leader and manager, you’ll learn how to use these tools to harness social interactions to improve your business and to create your own social nation. The book provides a social assessment for leaders, managers and employees to scientifically evaluate your individual social skills and competencies.

How to Reward Your Stellar Team

AUGUST 1, 2013

But it''s tough to do that, especially when most management systems are so focused on individual performance, undermining the very teamwork you''re hoping to encourage. Ancona says that many companies include teamwork as a core competency in their leadership development models. Case study #1: Set a team purpose and measure against it.

Collaborate Across Teams, Silos, and Even Companies

JULY 25, 2014

Dubai Airports offers a case study . When leaders are “collaborating” they are typically not from the same team – otherwise we would most likely frame it as “ teamwork .” What makes teamwork different from collaboration is the goal. It is proactive and purpose-driven.

Case Study: Challenge the Boss or Stand Down?

FEBRUARY 28, 2011

Editors' Note: This fictionalized case study will appear in a forthcoming issue of Harvard Business Review, along with commentary from experts and readers. You're thinking like a lone-gun account executive when you should be focusing on regional strategy development, teamwork , and clear communications up and down the chain of command.

How Google Has Changed Management, 10 Years After its IPO

AUGUST 20, 2014

gDNA is a longitudinal survey of Google employees on everything from happiness to teamwork to office layout. Earlier this year, Michael Schrage used Glass as a case study of how not to roll out an innovative new product. Lately, lots of talk about the company’s future has revolved around Google Glass.

The Kinds of Teams Health Care Needs

DECEMBER 16, 2015

The solution to these problems is to shift focus from the structure to the activities of teamwork — what I call “teaming.” Think of it as teamwork on the fly. ” (For more, see the case study here.)

When Two of Your Coworkers Are Fighting

JULY 3, 2014

If it’s getting in the way of teamwork , then talk to them,” says Anna Ranieri, a career counselor, executive coach, and coauthor of How Can I Help? Case study #1: Proceed cautiously. Case study #2: Defuse a tense situation. But intervening is not always a straightforward prospect.

0509 | Kathy Kramer: Full Transcript

APRIL 28, 2014

I really harvested a lot of case studies and examined what highly effective leaders see, say, and do and that’s actually the subtitle. Really, the leaders who are taking themselves to the next level. That’s what I do and that’s what my latest book is about. The main title is “Lead Positive.”

Is M&A the Cure for a Failing Health Care System?

DECEMBER 14, 2017

Seamless teamwork is critical to effective care of complex, high-cost patients. But uncertainties remain. In addition to those I’ve mentioned, one of the biggest challenges will be coordinating with traditional care providers, both primary care and specialists.

4 Keys To Successful Crisis Management In Today’s Wired World

OCTOBER 21, 2014

How our principal managed this crisis – being fully aware of how easily her every word and action could be shared through the various online channels – proved to be a great case study on crisis management in today’s wired world.

How to Work with Someone You Hate

JANUARY 30, 2012

Case study #1: Get to know him. He shared with pride the teamwork , the late evenings filled with collaboration, shared success and accomplishment." Case Study #2: Keep a healthy perspective. Commiserate with others who could be unfairly influenced by your negativity or may judge you for your complaints.

Proven Ways to Earn Your Employees’ Trust

JUNE 27, 2014

When they don’t, communication, teamwork and performance inevitably suffer. Case Study #1: Keep the door open. Case Study #2: Meet bad news head on. Most people think about the issue in terms of customers: They have to believe in you and your products and services. There were no questions, no expressions.

How to Choose the Right References

Case study #1: Be honest about your circumstances and provide relevant context. I also reminded her of my responsibilities on an assignment we did together and asked if she could talk about project management skills and my teamwork capabilities. Case study #2: Think deliberately and strategically about whom to ask.

Make Your Work Resolutions Stick

DECEMBER 29, 2014

“It’s important to have focus,” says Joseph Weintraub, the founder and faculty director of the Babson Coaching for Leadership and Teamwork Program. Case study #1: Create a detailed strategy and enlist support. ” Case study #2: Break big goals up into small action items. Be realistic.

How to Ask for a Promotion

JANUARY 29, 2018

.” But, to advance in your career, you’ll need to learn to advocate for yourself, says Joseph Weintraub, the founder and faculty director of the Babson Coaching for Leadership and Teamwork Program. Case Study #1: Create a “ resume of accomplishments” to bolster your argument. Be patient.

When My Business Failed

AUGUST 23, 2012

And then, my company, Pallotta TeamWorks , went out of business. Ten years ago today. I don't have seven bullet points on what to do when the unthinkable happens. The ten-year anniversary of it all just requires its recounting.

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• Corpus ID: 110468570

Successful teamwork:A case study.

• Pina Tarricone , Joseph Luca
• Published 2002

Tables from this paper

126 Citations

A model for successful teamwork, identifying peers to form an effective team in a project-based course innovative practice, power and culture of teamwork, students’ perception on the effectiveness of teamwork based activities in enhancing the learning process, building interdisciplinary teams through student design competitions: a case study, teamwork effectiveness in student's final year project, authentic design and administration of group-based assessments to improve the job-readiness of project management graduates, developing teamwork skills in undergraduate science students: the academic perspective and practice, student perceptions of teamwork within assessment tasks in undergraduate science degrees, conditioning factors and opportunities for teamwork. a case study from a catalan university, 20 references, does emotional intelligence affect successful teamwork, on becoming a team player.

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Team or group? Managers’ perceptions of the differences

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High-performance teams: Lessons from the pygmies

Team performance management, developing e-learning environments that support knowledge construction in higher education, the effect of personality type on team performance, the wolf pack: team dynamics for the 21st century, cooperative learning: making “groupwork” work, related papers.

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The effect of covid-19 on a short-term teacher-education program: the israeli case.

1. Introduction

1.1. teacher-training programs, 1.2. gaining teaching experience as part of the teacher-training process, 1.3. kivun h’adash—the short-term program examined in this study, 1.4. study goals, questions, and hypotheses.

• To learn about the structure of the program and its implementation from the professional and personal points of view of the program’s coordinators and the participants, as they experienced it.
• To examine the contribution of the new short-term program to the participants—the teacher trainees—and the Israeli education system in general.

2. Materials and Methods

2.1. the context of the research, 2.2. participants, 2.3. data analyzing.

• All interviews comprised a recording and transcription of the Zoom conversations.
• Each researcher read the interview and noted his interpretation of everyone’s experiences.
• The researchers identified the similarities and differences between their texts. This process includes the breakdown and reconstruction of the conversations, phenomena, and issues that enable us to study and understand the responses from a holistic perspective.
• The interviews were divided into meaningful units in line with the research questions [ 23 ]. This led to the identification of the themes, extracted into five categories: recruitment of the coordinator; establishing the program; clinical experience; the students of the program; and future initiatives for teacher education.

2.4. Ethical Considerations

3.1. recruitment of the coordinator.

“We did not have enough budget for the project. I worked hard and was paid very little. However, I did not do it for the money. For me, it was a mission.”

“We were called on for this project, and it felt like a calling! We are citizens, and we must see that we are ready to make all the efforts and invest time for the sake of the country and its children to assist people who were laid off due to the pandemic (Ye huda ). ”

3.2. Establishing the Program

“I do not think I had a day or night of summer vacation: I had to contend with many factors as I was involved in conversations with candidates, meetings with lecturers, and answering emails, all within a few days.”

“We had a good experience as a team, especially within the college, with the training team and department heads. Everyone was dedicated and eager for the program to succeed in attracting more and more candidates. They all did it wholeheartedly and earnestly despite the difficulties and working in such a positive atmosphere felt good.”

3.3. Clinical Experience

“My trainees hardly met any students or peers. We could not create such opportunities. We tried internally, we tried with all kinds of schools... it just did not work. They learned the materials but did not interact with the classroom, which was lacking.”

3.4. The Students of the Program

“We had different candidates come to us. Some were not even laid off but had been at home before, and the program created an opportunity for them... Some of them told me they wanted to do this their whole lives, and finally, there was a good opportunity.”

“The students were more mature; they brought some added value–not just the studies and degree. They have experience with people; they have experience with children of all ages... So, these people are already in midlife; they had a good situation, family, and livelihood, and suddenly they found themselves ungrounded.”

3.5. Future Initiatives for Teacher Education

“There are some people I am not sure will make it through the entire transition. I think everyone can be a teacher, but I am not sure everyone will succeed. Some will find it challenging to manage a classroom with children, and some will not face the gap between income and expectation, especially once opportunities open up again in the market.”

4. Discussion

4.1. unique alternative teacher-education programs—contribution, 4.2. circumstances and conditions in the future, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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• Published: 30 August 2024

Safety of adenosine for pediatric tachyarrhythmia treatment in the emergency department: a multi-hospital 10-year cross-sectional study

• Melanie M. Randall 1 ,
• Tristen Burt 2 ,
• Scott Cruise 2 ,
• Michael K. Mesisca 2 &
• Thomas Minahan 2  

International Journal of Emergency Medicine volume  17 , Article number:  103 ( 2024 ) Cite this article

Metrics details

Supraventricular tachycardia is the most common dysrhythmia in children. Initial vagal maneuvers are successful less than half of the time. Adenosine, a potent AV nodal blocker with a short half-life, is recommended as first line pharmacotherapy. Minor side effects from adenosine are common, but report of serious side effects such as sustained ventricular tachycardia, torsades de pointes, syncope or hypotension are confined to small case series or studies greater than 20 years old. We aimed to specifically identify the incidence of serious side effects of adenosine in children in the emergency department.

Between 2002 and 2022, all children less than 18 years old who received adenosine for tachyarrhythmia treatment in two emergency departments were included. The electronic record was reviewed for demographic information, patient history, treatments given, and side effects or complications were observed. Electrocardiograms before, during and after adenosine administration were reviewed.

77 patients met inclusion criteria. There were 74 patients with an initial rhythm of typical SVT. The other three patients included one with a junctional rhythm, one with atrial fibrillation, and one with an undetermined narrow complex tachycardia. 49 patients had cardiac rhythm monitoring during adenosine administration. 17 of these patients had three or more consecutive ventricular beats following adenosine, however no patients required treatment. No patients had syncope. One patient had brief hypotension after adenosine that normalized without intervention. Four patients were electrically cardioverted after adenosine, all for persistent dysrhythmias: two for persistent SVT with hypotension, one for atrial fibrillation and one for an undetermined rhythm. Twelve patients were placed on continuous antiarrhythmic medication for persistent SVT. Age, gender, prior SVT history, initial adenosine dose, and need for additional doses were not significant risk factors for a prolonged sinus pause or greater than two ventricular beats.

Conclusions

Adenosine treatment in typical supraventricular tachycardia in pediatric patients is safe.

Supraventricular tachycardia (SVT) is the most common symptomatic dysrhythmia in children. It can be defined as a group of tachydysrhythmias that originate above or at the level of the atrioventricular (AV) node. The ventricular rate is greater than what is normal for age, usually more than 220 beats per minute (BPM) in infants and more than 180 BPM in children and adolescents. There is usually a narrow QRS complex, measuring less than 120 milliseconds [ 1 , 2 , 3 , 4 ].

In children younger than 12 years of age, accessory pathways are the most common cause of SVT. Patients with congenital heart disease confer the highest risk of occurrence [ 5 , 6 ]. The most common presenting symptoms of SVT are palpitations (96%), anxiety, lightheadedness (75%), chest pain (35%), diaphoresis (17%), fatigue (23%), with less common manifestations of hypotension or syncope (20%). Infants typically manifest with fussiness, irritability, tachypnea, failure-to-thrive, and poor feeding [ 7 , 8 ].

Vagal maneuvers are non-invasive and recommended as initial treatment for stable pediatric patients with SVT. However, they are successful only 27–53% of the time [ 7 , 9 , 10 ]. If vagal maneuvers fail and the patient is still hemodynamically stable, then adenosine is recommended as first line pharmacotherapy [ 7 , 9 ]. Adenosine is an endogenous nucleoside that has a wide variety of effects on the cardiovascular system. It has an extremely short half-life and is a potent AV nodal blocker [ 11 , 12 ]. When treating AV nodal reentrant tachycardia, conversion rates are up to 96% [ 13 ].

Minor side effects with rapid adenosine administration are common. These include chest discomfort, flushing, and dyspnea [ 7 , 14 , 15 , 16 , 17 ]. Serious side effects of adenosine requiring critical interventions have been confined to case reports or small case series. These side effects include sustained ventricular tachycardia, hypotension, and torsades de pointes [ 18 , 19 , 20 , 21 , 22 ]. In a number of papers over 20 years ago, adenosine was shown to be effective in children and results indicated that no serious side effects were observed [ 13 , 16 , 23 , 24 ]. These studies did not have side effects as the primary outcome. However, despite older evidence of minimal risk, we continue to devote a significant number of staff and resources into preventing these “possible” complications in the emergency department (ED).

With this paper, we aimed to determine the incidence of any serious side effects of adenosine requiring intervention in children over a decade of treatment in the ED. Secondary outcomes included the number of patients that required further intervention including repeat adenosine dosages, other anti-arrhythmic or AV nodal blocking medication, or electrical cardioversion.

We performed a retrospective multi-hospital series of all patients less than 18 years of age who received intravenous adenosine for tachyarrhythmia treatment in the ED over the 10-year period between 2002 and 2022. The two participating sites were Loma Linda University Children’s Hospital, a tertiary pediatric referral center, with approximately 38,000 ED visits per year and Riverside University Health System, with approximately 15,000 pediatric ED visits per year.

The electronic medical record was queried for all patients that received adenosine in the emergency department. Using a standardized data collection form and trained data collectors not blinded to the study objective, the following data points were collected: demographic information, past medical and cardiac history, vital signs, ED treatments, and disposition.

The standard age-based formula defining hypotension of less than 70 + 2(age in years) in millimeters of mercury (mmHg) was used to determine hypotension before and after adenosine was given. Systolic blood pressure less than 90mmHg was considered hypotensive for patients older than 10 years. While systolic blood pressure is not a perfect surrogate for pediatric hypotension, it was chosen due to being the closest marker available which is reported regularly in the ED. Weight-based dosing of adenosine was recorded, including dosage and number of repeat doses given.

Troponin lab values when performed were recorded. Troponin levels were ordered at the discretion of the ED provider. We reviewed electrocardiogram and cardiac rhythm strips and recorded the length of the cardiac pause after adenosine administration. The treating physician’s determination of initial cardiac rhythm and rhythm after interventions were recorded. We reviewed documented complications immediately after adenosine administration including hypotension, ventricular arrhythmia greater than two consecutive ventricular beats, prolonged cardiac pause, or syncope.

Data analysis was conducted using STATA (STATA 16, StataCorp LLC, College Station, TX). Logistic regression was used to determine the likelihood of multiple risk factors for side effects. Non-normally distributed data were described using medians and interquartile ranges (IQR). Descriptive statistics were also used. This study was approved by the Institutional Review Boards at both hospital sites.

There were 77 patients that met inclusion criteria. These included 43 males and 34 females. The age range was one week old to 17 years old with a median of nine years (IQR 3–13).

37 patients had a previous history of SVT, including two patients with known Wolff-Parkinson-White syndrome. Six patients had previously diagnosed structural cardiac disease including one with aortic stenosis and ventricular septal defect (VSD), one with right atrial isomerism, total anomalous pulmonary venous return, functional single ventricle and pulmonary atresia, one with double inlet left ventricle status post Fontan procedure, one with right atrial dilation and two with VSD alone.

74 patients had an initial rhythm of SVT. One patient had a junctional rhythm, one patient had atrial fibrillation with rapid ventricular rate, and one patient had an undetermined narrow complex tachycardia (Fig.  1 ).

Diagram of Patients Rhythms and Treatments SVT: supraventricular tachycardia RVR: rapid ventricular response ICU: intensive care unit w/: with PMH: past medical history ROSC: return of spontaneous circulation ECHO: echocardiography VA ECMO: veno-arterial extracorporeal membrane oxygenation LV: left ventricle

For the patients weighing greater than 60 kg (kg), initial dose was 6 milligrams (mg) in 88% of patients, and 12 mg in 12%. For patients weighing less than 60 kg, initial dose ranged from 0.07 to 0.38 mg/kg with a median of 0.11 mg/kg (IQR 0.10–0.12). 34 patients required repeated doses of adenosine including 18 patients who received 1 extra dose, 13 patients who received 2 doses, and 3 patients who received 3 doses (Fig.  1 ).

49 patients had cardiac rhythm monitoring during adenosine administration available to review. 28 patients did not. Of the 49 patients with reviewable rhythm, the cardiac pause immediately after adenosine was a range between 0.4 and 4.2 s, with a median of 1 s (IQR 0.8–1.6 s). There were 13 patients that had three or less consecutive ventricular beats immediately after adenosine. Two patients had four ventricular beats, one patient had six and one patient had nine. Figure  2 shows the rhythm strip of a nine-year old female with new-onset SVT who was given 6 mg of adenosine. She had a brief sinus pause, six ventricular beats, then conversion to sinus rhythm. No patients with ventricular beats required treatment for ventricular tachycardia. One patient had documented hypotension after adenosine cardioversion, however blood pressure normalized without intervention.

ECG showing ventricular beats after adenosine

Using logistic regression, we calculated the risk of multiple factors including age, gender, prior history of SVT, initial dose and repeat adenosine doses for the complications of sinus pause greater than 3 s or ventricular beats three or greater. None of these factors were statistically significant for either complication (Tables  1 and 2 ).

Four patients were electrically cardioverted including two patients that were hypotensive and still in SVT after adenosine. One patient with persistent atrial fibrillation underwent electrical cardioversion three times, but did not convert, and was admitted to the pediatric intensive care unit (ICU). One patient with an undetermined rhythm was electrically cardioverted after adenosine and amiodarone produced no change in rhythm (Fig.  3 ). The patient then required intubation, immediately after which had 15 min of cardiac arrest with return of spontaneous circulation. The patient’s echocardiography (ECHO) showed arrhythmia-induced heart failure, requiring extracorporeal membrane oxygenation for cardiogenic shock. Subsequently, the rhythm was shown to be an ectopic atrial tachycardia. The patient regained normal cardiac function and was weaned off antiarrhythmic medication completely.

Undetermined rhythm ECG

Twelve patients with persistent SVT after adenosine were placed on continuous antiarrhythmic medication including eleven patients on esmolol and one patient on amiodarone. One patient with persistent SVT was admitted and placed back on their home digoxin.

A troponin T level was drawn in five patients. Of these, four were normal. One was significantly elevated at 0.51 nanograms per milliliter (ng/mL) (reference range, <=0.03ng/ml). This increased to 0.77 during admission. The patient’s ECHO showed normal ventricular function with no wall motion abnormality. Per chart review, this patient was likely in SVT for more than 24 h prior to arrival at the hospital.

36 patients were discharged from the ED. 11 patients were admitted to a non-ICU bed, including one patient with acute appendicitis, one patient with a supracondylar humerus fracture, and one patient that was scheduled for cardiac ablation the following day. 29 patients were admitted to the ICU. Two of these patients were admitted to the ICU for bronchiolitis with albuterol-associated SVT. Ultimately, eight patients in the study group were diagnosed with Wolff-Parkinson-White syndrome.

In this study, we found that adenosine treatment in pediatric patients with SVT was safe. This is the largest study of side effects of adenosine in children to date. There were no patients with sustained ventricular tachycardia or prolonged cardiac pauses that required intervention. When excluding undetermined rhythms and atrial fibrillation, the only patients that required electrical cardioversion were those persistently in SVT who then became hypotensive. We discovered that 44% of patients required extra doses, and 22% of patients either required electrical cardioversion or continuous antiarrhythmic medication to maintain sinus rhythm. Adenosine is often thought to induce significant cardiac pause and frequent ventricular beats which may be anxiety-inducing for treating physicians and staff. This study supports the fact that these events are transient and do not require intervention.

There are rare times that additional consideration or precautions may be needed when administering adenosine in children. Patients with difficult-to-determine rhythm or ill-appearing on presentation are more likely to have underlying heart failure. These patients are more likely to have life-threatening events requiring immediate intervention. There are very rare cases in the literature of bronchospasm induced by adenosine [ 25 , 26 , 27 ]. We had no cases of bronchospasm which reiterated the infrequency of this side effect.

When used in atrial fibrillation, adenosine can precipitate ventricular fibrillation due to increased ventricular irritability [ 28 , 29 ]. Giving adenosine to a patient with an accessory conduction pathway such as in Wolff-Parkinson-White syndrome can also be dangerous when paired with atrial tachycardia. Adenosine often does not inhibit conduction through an accessory pathway, causing unopposed conduction through it and ventricular fibrillation [ 29 ]. Given the low number of pediatric patients with atrial fibrillation, potential for complications, and poor conversion rate with adenosine, we recommend against the use of adenosine for treatment of atrial fibrillation.

Multiple case studies have shown patients with long QT syndrome at risk for developing torsades de pointes [ 18 , 20 , 30 ]. It has been proposed as a test to identify patients with long QT syndrome [ 22 ]. There were no patients with long QT syndrome in our cohort, but we advise caution in these patients if the syndrome is known.

The use of adenosine is safe in the vast number of children with typical SVT that is narrow, regular and uniform. More caution is advised if patients have hypotension, signs of heart-failure, long QT syndrome, or other less common atrial rhythms. Without these indications, the authors advise against placing defibrillator pads on the patient. Overall, a practitioner can feel confident when using adenosine in the correct clinical scenario.

Data availability

No datasets were generated or analysed during the current study.

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MR contributed to the conception of the project, the analysis and interpretation of data, the drafting of the manuscript, and reviewing it critically for content. MR approves of the final version to be published and agrees to be accountable for all aspects of the work. TB contributed to the acquisition and analysis of the data, the drafting of the manuscript, and reviewing it critically for content. TB approves of the final version to be published and agrees to be accountable for all aspects of the work. SC contributed to the acquisition and analysis of the data and reviewing it critically for content. SC approves of the final version to be published and agrees to be accountable for all aspects of the work. MM contributed to the conception of the project and reviewed it critically for content. MM approves of the final version to be published and agrees to be accountable for all aspects of the work. TM contributed to the conception of the project and reviewed it critically for content. TM approves of the final version to be published and agrees to be accountable for all aspects of the work.

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Randall, M.M., Burt, T., Cruise, S. et al. Safety of adenosine for pediatric tachyarrhythmia treatment in the emergency department: a multi-hospital 10-year cross-sectional study. Int J Emerg Med 17 , 103 (2024). https://doi.org/10.1186/s12245-024-00683-5

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