Medical Teamwork and Patient Safety

The Evidence-based Relation

Literature Review

Prepared by:
American Institutes for Research, University of Central Florida, University of Miami Center for Patient Safety

Investigators:
David P. Baker, Ph.D. (AIR)
Sigrid Gustafson, Ph.D. (AIR)
Jeff Beaubien, Ph.D. (AIR)
Eduardo Salas, Ph.D. (UCF)
Paul Barach, M.D. (UMCPS)

The science of team performance and training can help the medical community improve patient safety. This report, commissioned by the Agency for Healthcare Research and Quality (AHRQ), assesses the status of relevant team training research from aviation and other domains and applies this research to the field of medicine. It additionally provides a comprehensive review and evaluation of current medical team training initiatives and their effectiveness. 

Contents

Front Matter (PDF File, 30 KB)
Abstract
Summary

Report
Chapter 1. Introduction (  PDF version - 35.07 KB )
   Background
   The Structure of the Evaluation
   Methodology
Chapter 2. Training Teams (  PDF version - 62.42 KB )
   Definitional Issues Concerning Teams and Teamwork
   What is a "Team"?
   Training Teams
   Summary
Chapter 3. Team Training in High-risk Contexts (  PDF version - 26.2 KB )
   Team Training in Commercial Aviation
   Evolution of the Crew Resource Management (CRM) Model in Commercial Aviation
   CRM Summary
   Team Training in the Military
   Summary
Chapter 4. Medical Team Training (  PDF version - 103.94 KB )
   The Case for Medical Team Training
   The Donabedian Model of Patient Safety
   Structure of Review
   Anesthesia Crisis Resource Management
   The MedTeams™ Program
   The Medical Team Management (MTM) Program
   Additional Medical Team Training Programs
   Summary
Chapter 5. Conclusions and Recommendations (  PDF version - 28.8 KB )
   Conclusion 1: The medical field lacks a theoretical model of team performance
   Conclusion 2: The science of team performance and training can help the medical community to improve patient safety
   Conclusion 3: Research has already identified many of the competencies necessary for effective teamwork in medical environments
   Conclusion 4: A number of proven instructional strategies are available for promoting effective teamwork
   Conclusion 5: Team training strategies must be further adapted to suit medical needs
   Conclusion 6: The medical community has made considerable progress in designing and implementing team training across a number of settings
   Conclusion 7: The impact of medical CRM training on patient safety outcomes has not been determined
   Conclusion 8: The institutionalization of medical team training across different medical settings has not been addressed
Chapter 6. Research Needs: Where Do We Go From Here? (  PDF version - 23.33 KB )
   Research Need 1: A medical team performance model
   Research Need 2: Teamwork process and outcome measures, relative to medicine
   Research Need 3: More efficient practices for evaluating medical team training programs
   Research Need 4: Team performance diagnostics
   Research Need 5: Simulation-based training applications
References (  PDF version - 48.59 KB )

Tables and Figures
Table 1. Primary teamwork competencies (  PDF version - 17.08 KB )
Table 2. Individual and team-level training strategies (  PDF version - 15.78 KB )
Figure 1. Framework for designing an effective team training program (  PDF version - 23.72 KB )
Figure 2. The Donabedian Model of Patient Safety (  PDF version - 57.71 KB )