Team-training in healthcare: a narrative synthesis of the literature

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Abstract

Background

Patients are safer and receive higher quality care when providers work as a highly effective team. Investment in optimising healthcare teamwork has swelled in the last 10 years. Consequently, evidence regarding the effectiveness for these interventions has also grown rapidly. We provide an updated review concerning the current state of team-training science and practice in acute care settings.

Methods

A PubMed search for review articles examining team-training interventions in acute care settings published between 2000 and 2012 was conducted. Following identification of relevant reviews with searches terminating in 2008 and 2010, PubMed and PSNet were searched for additional primary studies published in 2011 and 2012. Primary outcomes included patient outcomes and quality indices. Secondary outcomes included teamwork behaviours, knowledge and attitudes.

Results

Both simulation and classroom-based team-training interventions can improve teamwork processes (eg, communication, coordination and cooperation), and implementation has been associated with improvements in patient safety outcomes. Thirteen studies published between 2011 and 2012 reported statistically significant changes in teamwork behaviours, processes or emergent states and 10 reported significant improvement in clinical care processes or patient outcomes, including mortality and morbidity. Effects were reported across a range of clinical contexts. Larger effect sizes were reported for bundled team-training interventions that included tools and organisational changes to support sustainment and transfer of teamwork competencies into daily practice.

Conclusions

Overall, moderate-to-high-quality evidence suggests team-training can positively impact healthcare team processes and patient outcomes. Additionally, toolkits are available to support intervention development and implementation. Evidence suggests bundled team-training interventions and implementation strategies that embed effective teamwork as a foundation for other improvement efforts may offer greatest impact on patient outcomes.

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Most cited references 78

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Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

T. Manser (2009)

This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.

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Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

John C Morey, Robert A. Simon, Gregory Jay … (2002)

To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Nine teaching and community hospital EDs. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.

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Promoting a culture of safety as a patient safety strategy: a systematic review.

Sallie J Weaver, Lisa H Lubomksi, Renee Wilson … (2013)

Developing a culture of safety is a core element of many efforts to improve patient safety and care quality. This systematic review identifies and assesses interventions used to promote safety culture or climate in acute care settings. The authors searched MEDLINE, CINAHL, PsycINFO, Cochrane, and EMBASE to identify relevant English-language studies published from January 2000 to October 2012. They selected studies that targeted health care workers practicing in inpatient settings and included data about change in patient safety culture or climate after a targeted intervention. Two raters independently screened 3679 abstracts (which yielded 33 eligible studies in 35 articles), extracted study data, and rated study quality and strength of evidence. Eight studies included executive walk rounds or interdisciplinary rounds; 8 evaluated multicomponent, unit-based interventions; and 20 included team training or communication initiatives. Twenty-nine studies reported some improvement in safety culture or patient outcomes, but measured outcomes were highly heterogeneous. Strength of evidence was low, and most studies were pre-post evaluations of low to moderate quality. Within these limits, evidence suggests that interventions can improve perceptions of safety culture and potentially reduce patient harm.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Qual Saf

Journal ID (iso-abbrev): BMJ Qual Saf

Journal ID (hwp): qhc

Journal ID (publisher-id): bmjqs

Title: BMJ Quality & Safety

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 2044-5415

ISSN (Electronic): 2044-5423

Publication date (Print): May 2014

Publication date (Electronic): 5 February 2014

Volume: 23

Issue: 5

Pages: 359-372

Affiliations

[1 ]Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality , Baltimore, Maryland, USA

[2 ]Department of Health Policy & Management, Oncology, and Medicine, Johns Hopkins University , Baltimore, Maryland, USA

Author notes

[Correspondence to ] Sallie J Weaver, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety & Quality, 750 E. Pratt St., 15th Floor, #1544, Baltimore, MD 21202, USA; sjweaver@ 123456jhu.edu

Article

Publisher ID: bmjqs-2013-001848

DOI: 10.1136/bmjqs-2013-001848

PMC ID: 3995248

PubMed ID: 24501181

SO-VID: 55615948-1af4-4433-b7a2-2194ac8c90d0

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

History

Date received : 22 January 2013

Date revision received : 6 December 2013

Date accepted : 12 January 2014

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ScienceOpen disciplines: Public health

Keywords: team training,teamwork,patient safety

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ScienceOpen disciplines: Public health

Keywords: team training, teamwork, patient safety

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Team-training in healthcare: a narrative synthesis of the literature

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Abstract

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Chinese Journal of School Health

Most cited references 78

Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

Promoting a culture of safety as a patient safety strategy: a systematic review.

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Cited by 119

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