Table 1

Three approaches to improve teamwork in healthcare

ApproachStrengthsWeaknessesFuture 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 teamworkNeed more research on the precise types of team behaviours that are useful for quality improvement