Transforming Health Care One Team at a Time: Ten Observations and the Trail Ahead

Abstract

The present review synthesizes existing evidence and theory on the science of health care teams and health care team training. Ten observations are presented that capture the current state of the science, with applications to both researchers and practitioners. The observations are drawn from a variety of salient sources, including meta-analytic evidence, reviews of health care team training, primary investigations, and the authors' collective expertise in developing and implementing medical team training. These observations provide insight into the team (e.g., psychological safety) and organizationallevel (e.g., culture for teamwork) factors that drive effective health care teamwork, as well as advancements and best practices for designing and implementing team training initiatives (e.g., multilevel measurement). We highlight areas where new knowledge has emerged, and offer directions for future research that will continue to improve our understanding of health care teams in the future.

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

“…Likewise, teamwork research has focused on the social relationships needed for good teamwork in isolation from teams' tasks and the context in which they work [22,23]. Salas et al [51] argue that this narrow understanding of teamwork behavior has contributed to a lack of sustained improvement from teamwork interventions. Finally, the study's method can potentially fill a gap in the quantitative and qualitative data required for needs-based, multi-professional workforce planning [52,53].…”

Reporting Complex Multidisciplinary Healthcare Team Training Interventions: Development and Validation of a Checklist

“…This fragmentation may indicate the significance of TT in providing professionals with adequate knowledge, skills, and attitudes for optimal functioning in their fast-paced and fluid network-based interactions and collaborations (Zwarenstein et al, 2009). Second, delivering TT into professionals' relatively chaotic daily (clinical, organizational, and educational) activities also conveys a scholarly challenge: to apply a crosspollination of scientific views to the field of TT (Salas et al, 2018).…”

“…Practically, these considerations concur with the tendency of TT-based initiatives to progressively develop into complex, longitudinal programs, often focusing on (continuous) organizational change or practice improvement (Dixon-Woods et al, 2011; Romijn et al, 2019). Scientifically, modern studies on the development of teams (and the multi-team and -unit settings they often occur in), need input from a larger variety of scholarly traditions and viewpoints, also introducing mixed methodologies that can enrich medicine's historical bio-medical approach (Salas et al, 2018). This implies that those reporting TT-based studies should strive for comprehensive (qualitative) descriptions of valuable experiences that are often concealed after (mere quantitative-type) investigations.…”

“…Evidence from the last two decades indicates positive associations among elements and effects of TT interventions, even at the level of patient mortality (Buljac-Smaradzic et al, 2010; Weaver et al, 2014; Hughes et al, 2016;Rosen et al, 2018;Salas et al, 2018). However, meta-analytic studies cannot be performed satisfactorily due to the great variability in the 'what,' 'how,' 'when,' and 'who' in the reports on TT, nor can the studied interventions be easily replicated (Cook et al, 2011a;Golub & Fontanarosa, 2015).…”

“…Notwithstanding the gradual opening up of TT's 'black box,' disclosing various underpinnings of effective and safe teamwork, such as psychological safety and effective team leadership, much of the context of described TT interventions tends to remain unclear. This is because the scholarly publication reports are often inadequate regarding the content, settings, and implementation processes of TT interventions (Salas et al, 2018). Facing the challenge of conveying the particulars of a given TT suitably, we embarked on designing a checklist for such reporting.…”