TeamSTEPPS Fundamentals Course: Module 5

Evidence-Base: Situation Monitoring

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.

Situation monitoring is the process of actively scanning and assessing elements of the "situation" to gain or maintain an accurate awareness or understanding of the situation in which the team is functioning.

One aspect of situation monitoring is systems monitoring. Systems monitoring includes tracking both internal systems components (e.g., human resources and equipment) and environmental conditions (e.g., number of OR rooms available, or status of other patients on the unit). These monitoring activities contribute to team cognition, which includes the concepts of shared mental models1 and shared situation awareness.2

SMMs and situation awareness have been empirically linked to improved communication,3-5 team coordination,6-7 and awareness of teams’ surroundings for effective problem solving.8 Similarly, situation awareness is the aspect of individual and team cognitive states when an individual or team is aware of what is going on around them regarding the environment and patient state, and how those conditions affect the team’s work.2 Knowing the degree to which a team is "on the same page" can aid in determining how well the team will perform.1

Teams working in dynamic environments, such as health care, need to monitor and assess internal and external systems, allowing for identification of changes that can affect tasks or the final goal. Engaging in effective situation monitoring allows team members to have a better grasp of the state of the patient and situation, thereby contributing to situation awareness. In fact, poor situation monitoring has been considered a contributor to clinical errors,9 whereas high situation awareness has been linked to increased team performance needed for patient care.10 Fortunately, situation awareness is a learnable skill, and health care providers can increase their understanding and perceived usefulness of situation awareness through training programs.11

TeamSTEPPS® trains health care providers on situation monitoring. In fact, some consider situation monitoring to be the TeamSTEPPS component most likely to prevent a patient safety event.12 Sawyer, et al.,13 found that health care providers gained significant improvements in situation monitoring on a simulated neonatal resuscitation after being trained with TeamSTEPPS tools. Similarly, Capella, et al.,14 found significant pre- and post-training change in situation monitoring within a trauma team after being trained with TeamSTEPPS.

Situation monitoring is an important aspect of TeamSTEPPS. It allows health care providers to increase awareness of the patient condition, the environmental state, and their fellow team members. This can serve to reduce errors and thus enhance patient safety. In summary, situation monitoring embodies a set of behaviors taken by an individual to perform a variety of functions that help the team:

Actively scan critical elements of the surrounding environment or situation to assess these important elements:15

  • Facilitate strategy implementation.16
  • Engage in team learning and regulation.17-18
  • Correct problems before they occur.6


  1. Klimoski R, Mohammed S. Team mental model: construct or metaphor?. J Manag1994;20(2):403-37.
  2. Endsley MR. Theoretical underpinnings of situation awareness: a critical review. In: Endsley MR, Garland DJ, eds. Situation awareness analysis and measurement. Mahwah, NJ: Lawrence Erlbaum Associates; 2000. p. 3-32.
  3. Cannon-Bowers JA, Salas E. Reflections on shared cognition. J Organ Behav 2001;22:195-202.
  4. DeChurch LA, Mesmer-Magnus JR. The cognitive underpinnings of effective teamwork: a meta-analysis. J Appl Psychol 2010;95(1):32-53.
  5. Hollingshead AB. Cognitive interdependence and convergent expectations in transactive memory. J Pers Soc Psychol 2001;81(6):1080-9.
  6. Burke CS, Lum HC, Scielzo SA, et al. Examining measures of cognition in virtual teams. In: Schmorrow D, Cohn J, Nicholson D, eds. The PSI handbook of virtual environments for training and education: developments for the military and beyond. Westport, CT: Praeger Security International; 2009. p. 267-83.
  7. Mathieu JE, Heffner TS, Goodwin GF, et al. The influence of shared mental models on team process and performance. J Appl Psychol 2000;85(2):273-83.
  8. Salas E, Rosen MA, Burke CS, et al. The wisdom of collectives in organizations: an update of the teamwork competencies. In: Salas E, Goodwin GF, Burke CS, eds. Team effectiveness in complex organizations: cross-disciplinary perspectives and approaches. New York, NY: Psychology Press; 2009. p. 39-79.
  9. Risser DT, Rice MM, Salisbury ML, et al. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med 1999;34:373-83.
  10. Gaba DM, Howard SK, Small SD. Situation awareness in anesthesiology. Hum Factors 1995;37(1):20-31.
  11. Flin R, Yule S, Paterson-Brown S, et al. Teaching surgeons about non-technical skills. Surgeon 2007;5(2):86-9.
  12. Deering S,Rosen MA, Ludi V, et al. On the front lines of patient safety: implementation and evaluation of team training in Iraq. Jt Comm J Qual Patient Saf 2011;37:350-6.
  13. Sawyer T, Laubach VA, Hudak J, et al. Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training. Neonatal Netw 2013;32(1):26-33.
  14. Capella J, Smith S, Philp A, et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ 2010;67:439-43.
  15. Salas E, Prince C, Baker DP, et al. Situation awareness in team performance: implications for measurement and training. Hum Factors 1995;37(1):123-36.
  16. Mohammed S, Ferzandi L, Hamilton K. Metaphor no more: a 15-year review of the team mental model construct. J Manag 2010;36(4):879-910.
  17. Cannon-Bowers JA, Salas E. Team performance and training in complex environments: recent findings from applied research. Curr Dir Psychol Sci 1997;7(3):83-7.
  18. Osman ME, Hannafin MJ. Metacognition research and theory: Analysis and implications for instructional design. Educ Technol Res Dev 1992;40(2):83-99.

Additional Resources

Katzenbach JR, Smith DK. The wisdom of teams: creating the high-performance organization. New York: Collins; 2003.

Langan-Fox J, Anglim J, Wilson JR. Mental models, team mental models, and performance: process, development, and future directions. Hum Factor Ergon Man 2004;14(4):331-52.

Marks MA, Mathieu JE, Zaccaro SJ. A temporally based framework and taxonomy of team processes. Acad Manage Rev 2001; 26(3):356-76.

McIntyre RM, Salas E. Measuring and managing for team performance: emerging principles from complex environments. In: Guzzo RA, Salas E, eds. Team effectiveness and decision making in organizations. San Francisco: Jossey-Bass; 1995. p. 9-45.

Mohammed S, Dumville BC. Team mental models in a team knowledge framework: expanding theory and measurement across disciplinary boundaries. J Organ Beh 2001;22(2):89-106.

Rouse WB, Cannon-Bowers JA, Salas E. The role of mental models in team performance in complex systems. IEEE Transact Syst Man Cybernet 1992;22(6):1296-1308.

Salas E, Cannon-Bowers JA, Blickensderfer EL. Team performance and training research: emerging principles. J Wash Acad Sci 1993;83(2):81-106.

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

Stout RJ, Cannon-Bowers JA, Salas E, et al. Planning, shared mental models, and coordinated performance: an empirical link is established. Hum Factors 1999;41(1):61-71.

Current as of March 2014
Internet Citation: TeamSTEPPS Fundamentals Course: Module 5: Evidence-Base: Situation Monitoring. March 2014. Agency for Healthcare Research and Quality, Rockville, MD.