TeamSTEPPS Fundamentals Course: Module 4

Evidence Base: Leading Teams

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.

Leadership has been identified by team researchers as an important component for effective teamwork 1 by facilitating and progressing team development and performance.2,3 Leadership is defined by McGrath (p. 365) as a responsibility "to do, or get done, whatever is not adequately handled for the group needs."3 It can take the form of one or several individuals internal or external to the team, and it can be established through formal avenues or by leaders informally serving in that role when it is necessary.4 Both external and internal leaders provide guidance and support to assist team members accordingly.2,4,5

Effective leadership manages resources and facilitates team actions6 to ensure that team members are seeking information, planning and refining team duties, coordinating team actions, resolving conflict among themselves, and providing coaching and feedback.1 Furthermore, effective leadership must balance the role of handing down solutions to problems with that of facilitating team problem solving.

Specifically, leadership helps to resolve problems by offering guidance in difficult situations through direction setting, role modeling, sense making, and framing.7 Leaders may also increase team effectiveness by facilitating team problem solving through developing a shared vision or plan; facilitating coordination and collaboration; and motivating team members to succeed.8

Development of this culture of shared understanding and awareness is initiated through briefs, debriefs, and huddles. The effectiveness of these strategies continues to be evident. Increases in individual and team performance 9 as well as more effective outcomes 10 have been associated with effective team debriefs. The use of huddles has been found to increase satisfaction with working relationships between interprofessional teams;11 and the use of structured briefs 12 has been linked to a reduction of communication errors.

Proper leadership has been demonstrated to be effective within the health care context. That is, several systematic reviews have suggested that proper leadership promotes team performance,13 safety,13 and well being.14 Conversely, researchers have posited that subpar leadership negatively influences teamwork and increases patient risks.15

As expected, attaining effective leadership is accomplished through training. Specifically, Hynes, et al.,16 suggest that insufficient training in leadership can hinder leadership behaviors and ultimately the team. Thus, it is imperative to use leadership training to achieve the desired leadership behaviors, team performance, and patient outcomes.

Research has demonstrated that using TeamSTEPPS® can enhance core teamwork competencies, including leadership, and patient outcomes (e.g., decreased time to care) within health care environments, such as the trauma bay.17 Others suggest that TeamSTEPPS is beneficial beyond the practicing environment. That is, McCoy and Carty18 summarize the results of studies that examined the integration of TeamSTEPPS in medical and nursing education. The positive results indicated by these studies are noteworthy, given that clinicians typically perform the role of designated leaders within the health care team; however, in older education models, there is no formal training for these leadership roles.

To some, "leadership is the glue connecting all the TeamSTEPPS elements."19 Leadership is crucial for sustaining trained behaviors and desired outcomes. For example, one study indicated that team and department leaders served as champions to a TeamSTEPPS initiative implemented within the pediatric and surgical ICUs.19 Because leaders were actively supporting and encouraging the team training, clinical outcomes improved for as long as 8 months posttraining, and team performance was sustained even longer (i.e., 12 months posttraining).

In summary, the evidence suggests that effective team leaders:

  • Are responsible for ensuring that team members are sharing information, monitoring situational cues, resolving conflicts, and helping each other when needed.
  • Manage resources to ensure the team's performance.
  • Facilitate team actions by communicating through informal information exchange sessions.
  • Develop norms for information sharing.
  • Ensure that team members are aware of situational changes to plans.


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

2. Hackman JR. Wageman R. A theory of team coaching. Acad Manag Rev 2005;30(2):269-87

3. Kozlowski S, Watola D, Jensen J, et al. Developing adaptive teams: a theory of dynamic team leadership. In: Salas E, Goodwin GF, Burke CS, eds. Team effectiveness in complex organizations: cross-disciplinary perspectives and approaches. New York, NY: Routledge/Taylor & Francis Group; 2009. p. 113-55.

4. Morgeson FP, DeRue DS, Karam EP. Leadership in teams: a functional approach to understanding leadership structures and processes. J Manag 2010;36(1):5-39.

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

6. McGrath JE. The influence of quasi-therapeutic relations on adjustment and effectiveness in rifle teams. J Abnorm Soc Psychol 1962;65:365-75..

7. Baran BE, Scott CW. Organizing ambiguity: a grounded theory of leadership and sensemaking within dangerous contexts. Mil Psychol 2010;22(1):S42-69.

8. 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. 325-58.

9. Tannenbaum SI, Cerasoli CP. Do team and individual debriefs enhance performance? A meta-analysis. Human Factors 2013;55(1):231-45.

10. Smith-Jentsch KA, Cannon-Bowers JA, Tannenbaum SI, et al. Guided team self-correction impacts on team mental models, processes, and effectiveness. Small Gr Res 2008;39(3):303-27.

11. Chapman KB. Improving communication among nurses, patients, and physicians. Am J Nurs 2009;109(11 Suppl):21-5.

12. Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg 2008;143(1):12-7.

13. Kunzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behavior: a literature review. Saf Sci 2010;48(1):1-17.

14. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009;53(2):143-51.

15. Pollack MM, Koch MA; NIH-District of Columbia Neonatal Network. Association of outcomes with organizational characteristics of neonatal intensive care units. Crit Care Med 2003;31(6):1620-9.

16. Hynes P, Kissoon N, Hamielec C, et al. Dealing with aggressive behavior within the health care team: a leadership challenge. J Crit Care 2006;21(2):224-8.

17. Capella J, Smith S, Philp A, et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ 2010;67(6):439-43.

18. McCoy KL, Carty SE. There is no I in team. Arch Surg 2012;147(8):766-7.

19. Clapper TC, Kong M. TeamSTEPPS: the patient safety tool that needs to be implemented. Clin Simul Nurs 2011;8(8):e367-73.

Additional Resources

Burke CS, Stagl KC, Klein C, et al. What type of leadership behaviors are functional in teams? A meta-analysis. J Appl Psychol 2006;91(6):1189-1207.

DeChurch LA, Marks MA. Leadership in multi-team systems. J Appl Psychol 2006;91:311-29.

DeRue DS, Nahrgang JD, Wellman N, et al. Trait and behavioral theories of leadership: an integration and meta-analytic test of their relative validity. Person Psychol 2011;64(1):7-52.

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

Hackman JR. Collaborative intelligence: using teams to solve hard problems. San Francisco, CA: Berrett-Koehler Publishers; 2011.

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; 2001.

Mayer CM, Cluff L, Lin WT, et al. Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. Jt Comm J Qual Patient Saf 2011;38(8):365-74.

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 Stud1990;15(2):177-91.

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Current as of March 2014
Internet Citation: TeamSTEPPS Fundamentals Course: Module 4: Evidence Base: Leading Teams. March 2014. Agency for Healthcare Research and Quality, Rockville, MD.