Table 1

Studies evaluating classroom-based multiprofessional team training for hospital staff. Outline of setting, objective, design and intervention from published studies

SourceLearners and Setting* (programme)*ObjectiveDesignIntervention
Needs assessmentCourse (duration, methods and content)Training transfer
Awad et al18Nurses, surgeons and anaesthesiologists, Surgical Services, Veterans Affairs Hospital, USA. (The VA NCPS Medical Team Training Program)Improvement of communication in the operating roomProspective uncontrolledSAQDay long course with didactic instruction, interactive participation, role play, video and clinical cases on CRM principles and ‘Change management training’14Representatives from surgery, nursing and anaesthesiology formed a work group. Implementation of preoperative briefing policy and -guide.
Fisher et al19700 Crew members of Air Medical-services, USATo compare responses between participants who received training and those who did notRetrospective controlledNot describedCRM-training, team building and communication trainingNot described
France et al2089 members of cardiac- and neurosurgery teams at Vanderbilt University Medical Center, Nashville, Tennessee, USA. (LifeWings)To evaluate the impact of CRM-training on team compliance with safety practicesProspective uncontrolledTAQ.8 h of lectures, case studies and role playing on managing fatigue, creating and managing a team, recognising adverse situations, cross-checking and communication, decision-making and performance feedback21 or E-learning module22Approval of CRM-policy at departmental level. Work group, monthly meetings, customised tools and role models. Development of e-learning module, checklists, briefing script. Communication whiteboards. Feedback on performance. Support by commercial vendor.23
Grogan et al21489 staff members from Vanderbilt University Medical Center, Nashville, Tennessee, USA. (LifeWings)To evaluate participant reactions and attitudesProspective uncontrolledTAQ8 h of lectures, case studies and role playing on managing fatigue, creating and managing a team, recognising adverse situations, cross-checking and communication, decision-making and performance feedbackNot relevant for objective
Haller et al24 25239 nurses, physicians, midwives, technicians and administrators from labour-and-delivery unit at Geneva University Hospital, Switzerland. (Ensemble)To assess the effect of a a specifically designed CRM-programmeProspective uncontrolledAnalysis of a sentinel event in the ward and TAQ2-day seminar of lectures, film, discussions, role plays and selection of team improvement strategies to be implemented in the unitAll specialities represented in work group. Follow-up: 165 workshops aiming at improving participants' communication skills.
Halverson et al261150 operating room-physicians, -nurses, -technicians, pre-, and postoperative care staff, pharmacy, radiology, sterile supply and house keeping staff, Northwestern Memorial Hospital, Chicago, Illinois, USATo develop and implement a team-training curriculumProspective uncontrolledTAQTrain-the-trainer. 20 h course to peer trainers and 4 h course to trainees including lectures, videos, case scenarios, interactive communication exercise on teams, teamwork, communication and implementation of surgical briefings and debriefings‘Coaches’ and ‘Teamwork leadership group’ handled implementation challenges. Training sessions for new staff members.
Leonard et al2712 clinical teams, Kaiser Permanente, USA. Numerical data from 72 patients.To discuss tools and experiences in implementation in successful areasCase studySAQ3-day training programme in human factors, standardised communication tools and behaviours to ensure effective communicationTools adapted to local needs. Site visits, monthly conference calls and education for leaders. Each team worked on how to apply the techniques in their own clinical setting.
McCulloch et al2854 nurses, surgeons and anaesthetists of two (a laparoscopic (A) and a carotid surgical (B)) teams, Oxford Radcliffe Hospital Trust, UKTo reduce the number of potentially significant errors and to observe improvement in clinical outcome measuresProspective uncontrolledSAQ9 h didactic and interactive: safety, situation awareness and error management; self-awareness, communication and assertiveness; decision-making, briefings and debriefings3 months of twice weekly coaching and feedback in operating room by instructors
Morey et al29684 physicians, nurses, clerks and technicians at six case ED's 374 staff members at three control ED's, military and civilian teaching and community hospitals, USA. (ETCC/MedTeams)To evaluate the effectiveness of training and institutionalising teamwork behavioursProspective controlledObservation of ED teamwork and analysis of closed claims8 h of case review, practical exercises, analysis and discussions on maintaining team structure and climate, apply problem-solving strategies, communicate with the team, manage workload and improve team skillsPhysician and nurse from case-units part of work group. Creation of team-based staffing pattern. Four hrs of practicum in teamwork behaviours critiqued by instructor. Coaching and mentoring of teams for 6 months.
Nielsen et al30 311307 obstetricians, nurses and anaesthetists at seven intervention and eight control units at military and civilian hospitals, USA (MedTeams Labor & Delivery)To evaluate the effect of teamwork training on adverse outcomes and process of careProspective cluster randomised controlledAnalysis of a significant adverse event and research on teams including experiences from Morey et al.29 Inputs from local patient safety groups.Standardised teamwork training curriculum. Local trainers trained staff for 4 h in safety culture, communication, situation monitoring, mutual support and leadership.Local trainers received 12 h centralised didactic and interactive training on team structure and processes, planning and problem solving, communication, workload management, team skills, conflict resolution and implementation, and assisted in creation of ‘core work teams,’ ‘coordinating teams’ and ‘contingency teams’
Pettker32289 physicians, nurses and ancillary staff, Department of Obstetrics, Gynaecology and Reproductive Science, Yale New Haven Hospital, Connecticut, USATo implement a comprehensive strategy to track and reduce adverse eventsProspective uncontrolledSAQ, organisational risk and patient safety review by two outside consultants using staff interviews and review of policies and protocols4 h. of CRM-based video, lectures and role playing led by patient safety nurse in shared mental model, structured communication, handover, debriefing techniques, assertion, conflict resolution and chain of commandDevelopment of protocols and guidelines, creating of a patient safety position, anonymous event reporting, in-house on-call attending obstetrician service, obstetric patient safety committee, training, testing and certification of fetal monitoring standards
Pratt et al33220 staff members (staff groups of participants not described), Labour and Delivery, Beth Israel Deaconess Medical Center, Boston, USATo develop, implement and sustain a CRM-based team training processProspective and retrospective uncontrolledAnalysis of a significant adverse event and experiences from implementation of similar programme30 31Standardised teamwork training curriculum in safety culture, teamwork, communication, situation monitoring, mutual support and leadership31Multiprofessional steering committee, core team, coordinating team and contingency team supervised the process. Assignment of coaches to each shift, development of communication templates, information campaign, provision of feedback to staff, team meetings, introduction of new teamwork behaviours every 1–2 weeks and refresher training.
Rivers et al34164 surgical staff members at Methodist University Hospital, Memphis, Tennessee, USA (commercial vendor)To evaluate if safety techniques used in aviation could be applied in healthcareProspective uncontrolledObservation of surgical procedures and environment, interviews with staff12 h of case studies, interactive team activities, videos and knowledge testing on teambuilding, recognising adverse situations, conflict resolution, feedback, stress handling, decision-making and fatigue managementDevelopment of perioperative OR checklist
Sax et al35509 multiprofessional staff members, Strong Memorial Hospital, Rochester, Rhode Island and 349 multiprofessional staff members at The Miriam Hospital, Providence, New York, USA (Indelta Learning Systems LLC)To quantify effects of aviation-based CRM training on patient-safety-related behaviours and perceived personal empowermentProspective uncontrolledPatient safety incident reports and root causes analyses hereof6 h. interactive CRM-based course, using videos, teambuilding exercises and open forums. No further details included about content.Development of perioperative OR checklist. Empowerment of nurses to halt procedure until briefing completed. Counselling of surgeons unwilling to participate. Executive safety walk rounds and patient safety symposia.
Sehgal et al36225 physicians, nurses, pharmacists, clerks, therapists and social workers, UCSF Medical Center, San Francisco, California, USA. (Teamwork for Optimal Patient Safety (TOPS))To develop a teamwork training programmeProspective uncontrolledConducted by multiprofessional planning team. Details not described.4 h of didactic presentations, discussions, videos and small group exercises on effective communication skills and team behavioursMultiprofessional planning and teaching team
Stead et al37∼226* nurses and doctors at five healthcare sites, South Australia. Australia. Evaluation focused on mental health site (TeamSTEPPS)11 *Number not directly indicated in article. Estimate based on evaluation-survey sample size.To evaluate the effectiveness of implementation of a TeamSTEPPS programme at an Australian mental health facilityProspective uncontrolledWillingness to participate, amenability to cultural change and availability of multidisciplinary clinical staffTrain-the-trainer model: 2.5 days of training to local senior clinical staff on evidence base, tools and strategies to support teamwork and communication, coaching and development of site-specific action plans. Local 4 h. course on teamwork competencies, tools and strategies.Peer-trainers formed local change teams to guide implementation. Sustaining phase included refresher training, review of data and support of implementation. Introduction of huddles and team approach to resolve aggression of patients.
Watts et al3879 physicians, nurses, pharmacists, physiotherapists, technicians and others from nine clinical hospital teams, UKTo evaluate an interprofessional learning programme offered to establishes clinical teamsProspective uncontrolledDiscussion of programme goals among participants in the first session2 h session with facilitator every month for 4 months discussing team performance and communication in interprofessional teams and establishing goals for team developmentLocal work groups. Two-hour follow-up-meeting after another 4 months.
Weaver et al39Cases: 29 members of three OR-teams including anaesthesiologists at 112-bed community hospital, USA. Controls: 26 members of OR-teams including anaesthesiologists at 297-bed hospital, USA (TeamSTEPPS)11To describe the results of an evaluation study conducted as part of a quality improvement project aimed at optimising teamwork behaviourProspective controlledSAQ and root cause analysis. Planning team received inputs to training and checklist from frontline providers. Participants selected by administrators.Train-the-trainer model. The three trained teams received 4 h of didactic training including interactive role-playing and tools and strategies to improve teamwork: communication, leadership, mutual support and situation monitoringMultiprofessional intervention planning team

  • CRM, Crew Resource Management; ED, Emergency Department; SAQ, Safety Attitude Questionnaire; TAQ, Teamwork attitude questionnaire.