TeamSTEPPS Fundamentals Course: Module 1
Teamwork has been studied extensively over the past 30 years. Research suggests teamwork is defined by a set of interrelated knowledge, skills, and attitudes (KSAs) that facilitate coordinated, adaptive performance, supporting one's teammates, objectives, and mission.1-4 Although teamwork differs from taskwork (i.e., operational skills), both are required for teams to be effective in complex environments.5 However, knowledge and skill at the task level are not enough. Teamwork depends upon team members' ability to:
- Anticipate needs of others.
- Adjust to each other's actions and the changing environment.
- Have a shared understanding of how a procedure or plan of care should happen.
In health care, there has been significant progress in defining team requirements since the release of the Institute of Medicine (IOM) report in 19996 and the early research that led to TeamSTEPPS®.7 This body of research has yielded a significant evidence base for a set of core KSA competencies that Salas and colleagues contend apply to almost all teams.8 Further, Salas, et al.'s (2008) meta-analysis on the science of team training illustrated that positive relationships exist between team training interventions like TeamSTEPPS and their associated outcomes. Importantly, such training has been found to account for 20 percent of the variance in team performance.9
The critical aspects of teamwork that must be targeted in training include: team leadership, mutual performance monitoring (i.e., situation monitoring), backup behavior (i.e., mutual support), and communication. These core skills lead to important team outcomes, such as enabling the team to adapt to changing situations, achieve compatible shared mental models among team members, and maintain a stronger orientation toward teamwork (refer to Exhibit 1).
Exhibit 1. TeamSTEPPS Skills
|Teamwork Skill||Definition||Behavioral Examples||Selected Citation|
|Team Leadership||The ability to direct and coordinate the activities of other team members, assess team performance, assign tasks, develop team knowledge, skills, and attitudes (KSAs), motivate team members, plan and organize, and establish a positive atmosphere.||
||Cannon-Bowers, et al., 19952; Salas, et al., 200410; Barach & Weingart, 200411; Sharma, et al., 201112; Woodhead, 201113; Collins & Holton, 200414; DeRue, et al., 201115|
|Mutual Performance Monitoring (aka., Situation Monitoring)||The ability to develop a common understanding of the team environment and apply appropriate task strategies in order to accurately monitor teammate performance.||
||McIntyre & Salas, 199516; Porter, et al., 200317; Carney, et al., 201018; Hobgood, et al., 201019|
|Back-up Behavior (aka., Mutual Support)||The ability to anticipate other team members' needs through accurate knowledge about their responsibilities. The ability to shift workload among members to achieve balance during periods of high workload or pressure.||
||Robertson, et al., 201020; McIntyre & Salas, 199516; Porter, et al., 200317|
|Communication||The exchange of information between a sender and a receiver, irrespective of the medium.||
||Capella, et al., 201021; Halbesleben, et al., 201122; Haskard, et al., 200923; Mayer, et al., 201124; Mesmer-Magnus & DeChurch, 200925; Robinson, et al., 201026; Shea-Lewis, 200927; McIntyre & Salas, 199516; Salas, Wilson, et al., 200828|
|Overall Teamwork Improvement||The demonstrated improvement in teamwork across multiple teamwork skills.||Carney, et al., 201018; Capella, et al., 201021; Mayer, et al., 201124; Neily, et al., 201029; Salas, et al., 20089; Salas, et al., 200630|
In addition to studies of how teams perform, there has been a burgeoning interest in the effectiveness of team training interventions in health care. In a recent review, more than 40 peer-reviewed articles detailing health care team training evaluations were identified.31 It is evident from these recent examinations that team training is being implemented across a wide spectrum of providers and is targeting important competencies such as communication, leadership, role clarity, and situational awareness.31 In addition to improving team performance, team training has been found to improve the use of appropriate medical technical skills in health care professionals.32
There has also been a growing body of research focused directly on the effectiveness of TeamSTEPPS. Research has shown that TeamSTEPPS leads to increases in desirable teamwork and safety attitudes, as well as increased communication, teamwork behaviors, clinical process compliance, efficiency, and overall performance in a variety of medical settings.31, 33-39
2. Cannon-Bowers JA, Tannenbaum SI, Salas E, et al. Defining competencies and establishing team training requirements. In: Guzzo RA, Salas E, eds. Team effectiveness and decision making in organizations. San Francisco: Jossey-Bass; 1995. p. 333.
3. Salas E, Dickinson TL, Converse SA, et al. Toward an understanding of team performance and training. In: Swezey RW, Salas E, eds. Teams: their training and performance. Norwood, NJ: Ablex; 1992. p. 3.
6. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press; 1999.
10. 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.
12. Sharma B, Boet S, Bould D, et al. Kirkpatrick evaluation of interprofessional simulation-based education for peroperative crisis resource management. Surgical Forum Abstracts—2011 Clinical Congress. J Am Coll Surg 2011 Sep;213(3)(Suppl):S129.
13. Woodhead V. How does coaching help to support team working? A case study in the NHS. Int J Evidence-Based Coach Mentor 2011 June (Special issue 5):102-19. Available at: http://business.brookes.ac.uk/commercial/work/iccld/ijebcm/documents/spe.... Accessed August 8, 2013.
16. 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.
18. Carney BT, Mills PD, Bagian JP, et al. Sex differences in operating room care giver perceptions of patient safety: a pilot study from the Veterans Health Administration Medical Team Training Program. Qual Saf Health Care 2010;19(2):128-31.
19. Hobgood C, Sherwood G, Frush K, et al. Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration. Qual Saf Health Care 2010;19(6):e25. Published online first: 27 April 2010.
22. Halbesleben RB, Cox KB, Hall H. Transfer of crew resource management training: a qualitative study of communication and decision making in two intensive care units. Leadersh Health Serv 2011;24(1):19-28.
26. Robinson LD, Paull DE, Mazzia LM, et al. The role of the operating room nurse manager in the successful implementation of preoperative briefings and postoperative debriefings in the VHA medical team training program. J Perianesth Nurs 2010;25(5):302-6.
30. 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: Routledge; 2006. p. 39-79.
36. Neily J, Mills PD, Lee P, et al. Medical team training and coaching in the Veterans Health Administration: assessment and impact on the first 32 facilities in the programme. Qual Saf Health Care 2010;19(4):360-4.
37. Paull DE, Mazzia LM, Wood SD, et al. Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program. Am J Surg 2010;200(5):620-3.
Adams KA, Goodwin GF, Searcy CA, et al. Development of a performance model of the medical education process. Technical report commissioned by the Association of American Medical Colleges. Washington, DC: American Institutes for Research; 2003.
Amalberti R, Auroy Y, Berwick D, et al. Five system barriers to achieving ultrasafe health care. Ann Intern Med 2005;142(9):756-65.
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.
DiMeglio KS, Lucas C, Padula C, et al. Group cohesion and nurse satisfaction. J Nurs Admin 2005;35(3):110-20.
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Kotter J, Rathgeber H. Our iceberg is melting: changing and succeeding under adverse conditions. New York: St. Martin's Press; 2006.
Kozlowski SW, Gully, SM, Nason ER, et al. Developing adaptive teams: a theory of compilation and performance across levels and time. In: Ilgen DR, Pulakos ED, eds. The changing nature of performance: implications for staffing, motivation, and development. San Francisco, CA: Jossey-Bass; 1999. p. 240.
Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA 2005;293:2384-90.
Mann S, Marcus R, Sachs B. Lessons from the cockpit: how team training can reduce errors on L&D (Grand Rounds). Contemp Ob/Gyn 2006 Jan;51:34-45.
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.
Morey JC, Simon RJ, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37(6):1553-81.
Morey JC, Simon R, Jay GD, et al. A transition from aviation crew resource management to hospital emergency departments: the MedTeams story. In Jensen RS. Proceedings of the 12th International Symposium on Aviation Psychology. Dayton, OH: Wright State University Press; 14 April 2003. p. 1-7.
Pisano GP, Bohmer RMJ, Edmondson AC. Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery. Manage Sci 2001;47(6):752-68.
Pronovost P, Berenholtz S, Dorman T, et al. Improving communication in the ICU using daily goals. J Crit Care 2003;18(2):71-5.
Quality Interagency Coordination Task Force. Doing what counts for patient safety: Federal actions to reduce medical errors and their impact. Report of the Quality Interagency Coordination Task Force (QuIC) To the President. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
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Roberts KH. Managing high reliability organizations. Calif Manage Rev 1990;32(4):101-14.
Sexton JB. Teamwork climate and postoperative sepsis in the surgical operating room. Association for Psychological Science Symposium. 27 May 2006; New York, NY.
Shapiro M, Morey J, Small S, et al. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care 2004;13(6):417-21.
Stout RJ, Cannon-Bowers JA, Salas E. The role of shared mental models in developing team situational awareness: implications for team training. Training Resource J 1996;2:85-116.
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