Table 1

Three approaches to improve teamwork in healthcare

Approach	Strengths	Weaknesses	Future use and research needs
Comprehensive, generic curricula (eg, TeamSTEPPS, comprehensive training offered by former aviation trainers and other consultants)	Based on extensive experience in other industries Comprehensive Generalisable Widely available Endorsed by expert groups and some malpractice insurers	Time and labour intensive Weak evidence for improved patient outcomes Not specific enough for some healthcare processes	Delivered in segments during health professional training and can serve as foundation for future team training and quality improvement efforts Continued intermittent use by healthcare organisations Need research to assess overall costs and benefits
Relatively brief team training curricula for specific tasks and activities that often use simulation (eg, training for surgery, resuscitations, handoffs/signouts, procedures (line insertion), multidisciplinary daily rounds)	Based on experience in other industries but modified to apply to specific healthcare processes Can be briefer than comprehensive and generic training Easier to study with rigorous research methods (randomisation, blinding, etc.), especially if using simulation Some evidence for improving teamwork and patient outcomes	Very few studies demonstrate evidence for improved patient outcomes Not generalisable to multiple care processes	The foundation for continuing education (eg, recertification for resuscitation curricula would include team training) Need more research to determine impact on patient outcomes Need research such as task analyses of processes to customise the team training Need to develop curricula for many more healthcare processes
Ongoing quality improvement efforts that require teamwork (eg, checklist for postoperative complications, prevention of catheter-associated blood-stream infections and ventilator-associated pneumonia, improving the care of patients with chronic disease)	Strongest evidence for improving patient outcomes Serve a dual purpose: to improve processes and outcomes and improve teamwork	May be more focused on compliance with a process than teamwork	Need more research on the precise types of team behaviours that are useful for quality improvement