TeamSTEPPS Fundamentals Course: Module 2

Evidence-Base: Team Structure

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

Team structure is an important consideration for TeamSTEPPS®. Without the proper teamwork structure, teams are less effective and cannot offer quality patient care. A team consists of two or more individuals who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership. Teams within health care must learn to communicate, coordinate, and effectively think and feel as a team by enacting necessary teamwork processes.

Teamwork processes in particular have been defined as interrelated knowledge, skills, and attitudes (KSAs) that allow teams to work together to accomplish interdependent goals, such as problem solving or providing optimal care to a patient. A team with the proper teamwork structure can anticipate the needs of other team members; dynamically adjust to a changing environment, including changing behaviors of team members; and have a shared understanding of what should happen.

Specifically, the health care team often consists of six components: the core team; contingency teams; coordinating teams; ancillary and support services; administration; and the patient. This team of teams is considered a multi-team system (MTS). MTSs are a collection of two or more teams that work interdependently toward a common goal.1 These teams work toward at least one shared goal, in addition to achieving individual team goals.

The emergence of the MTS in organizations has been in response to a need to accomplish multifaceted tasks in challenging environments.2 Furthermore, MTSs are subject to the same principles of team effectiveness as individual teams, in that they also rely on effective planning for coordination critical to synchronizing actions to achieve goals.3-4

As noted, an important component of an MTS is the patient. Patients and their families should not only be considered part of the health care team, but also be empowered to take an active role in their care.5 Research on patient engagement has shown that interventions designed to provide patients with knowledge and understanding of health information; improve patients’ abilities to work with clinicians to make shared decisions about care; and allow patients and families to provide feedback on processes and outcomes have positive benefits. Such benefits include improvements in patients’ knowledge and understanding of their condition; greater ability to cope with the effects of illness; improved adherence to treatment recommendations; improved health behaviors and health outcomes; improved quality of decisions; better understanding of treatment options; and greater patient satisfaction.6

To achieve the overarching goals of an MTS, communication and interdependency among several health care teams is crucial. Each of the teams within the MTS must work together in order to improve patient safety and optimize patient outcomes. For example, the administration can influence safety climate (i.e., the extent to which the organization is perceived to prioritize safety) by the policies and procedures it implements, which will influence the safety-related practices that leaders of core, coordinating, and contingency teams emphasize.7 In summary, by sharing an overall common goal, communicating plans, and coordinating actions, the teams within an MTS can provide the most efficient patient care.

Baker, Day, and Salas8 speak to the criticality of MTS effectiveness in hospitals, yet little work has been done to study and relate MTS effectiveness to patient outcomes. Inputs that have demonstrated effectiveness in general domain MTSs include having loosely interdependent goals between component teams of MTSs2 and having a homologous leadership structure across such teams.9 Despite the lack of evidence for health care-specific MTSs, MTSs have shown effectiveness at preventing loss in other complex organizations operating in challenging environments, such as Brigade Combat Teams in Army infrastructures.10 Extrapolating these findings to health care and hospital systems shows promise for future health care MTS research.


1. Mathieu JE, Marks MA, Zaccaro SJ. Multiteam systems. In: Anderson N, Ones DS, Sinangil HK, et al., eds. Handbook of Industrial, Work and Organizational Psychology. Thousand Oaks, CA: Sage; 2001. p. 289-313.

2. Marks MA, DeChurch LA, Mathieu JE, et al. Teamwork in multiteam systems. J Appl Psychol. 2005;90(5):964-71.

3. Leggat SG. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health Serv Res 2007;7(1):17.

4. Ancona D, Chong CL. Cycles and synchrony: the temporal role of context in team behavior. In: Mannix E, Neale M, eds. Research on Managing Groups and Teams Vol. 2. Greenwich, CT: JAI Press;1999;2:33-48.

5. Adams JR, Drake RE. Shared decision-making and evidence-based practice. Comm Mental Health J 2006;42(1):87-105.

6. Coulter A. Patient engagement—What works? J Ambul Care Manage 2012;35:80-9.

7. Zohar D, Luria G. A multilevel model of safety climate: cross-level relationships between organization and group-level climates. J Appl Psychol 2005;90:616-28.

8. Baker DP, Day R, Salas E. Teamwork as an essential component of high‐reliability organizations. Health Serv Res 2006;41(4 Pt 2):1576-98.

9. Kozlowski SW J, Klein KJ. A multilevel approach to theory and research in organizations: contextual, temporal, and emergent processes. In: Klein KJ, Kozlowski SWJ, eds. Multilevel theory, research, and methods in organizations: foundations, extensions, and new directions. San Francisco, CA: Jossey-Bass; 2000. p. 3-90.

10. Brinkerhoff JR. The brigade-based new army. Parameters 1997;27:60-72.

Additional Resources

Fleishman EA, Mumford MD, Zaccaro SJ, et al. Taxonomic efforts in the description of leader behavior: a synthesis and functional interpretation. Leadership Quart 1991;2(4):245-87.

Harris TC, Barnes-Farrell JL. Components of teamwork: impact on evaluations of contributions to work team effectiveness. J Appl Soc Psychol 1997;27:1694-1715.

Kozlowski SW, Bell BS. Work groups and teams in organizations. In: Borman WC, Ilgen DR, Klimoski R, eds. Comprehensive handbook of psychology. Vol. 12: Industrial and organizational psychology. New York: Wiley; 2003. p. 333-75.

Maurer M, Dardess P, Carman KL, et al. Guide to patient and family engagement: environmental scan report. (Prepared under Contract No. HHSA 290-200-600019). Rockville, MD: Agency for Healthcare Research and Quality; 2012. AHRQ Publication No. 12-0042-EF.

Salas E, Burke CS, Stagl KC. Developing teams and team leaders: strategies and principles. In: Demaree RG, Zaccaro SJ, Halpin SM, eds. Leader development for transforming organizations. Mahwah, NJ: Lawrence Erlbaum Associates; 2004. p. 325-55.

Salas E, Sims DE, Burke SC. Is there a "Big Five" in teamwork? Small Gr Res 2005;36(5):555-99.

Sundstrom E. Supporting work team effectiveness: best management practices for fostering high performance. San Francisco, CA: Jossey-Bass; 1999.

Tjosvold D. Flight crew collaboration to manage safety risks. Group Organ Stud 1990;15:177-91.

Zaccaro SJ, Rittman AL, Marks MA. Team leadership. Leadership Quart 2001;12:451-83.

Return to Index

Current as of March 2014
Internet Citation: TeamSTEPPS Fundamentals Course: Module 2: Evidence-Base: Team Structure. March 2014. Agency for Healthcare Research and Quality, Rockville, MD.