TeamSTEPPS Fundamentals Course: Module 3. Evidence-Based: Communication

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.

At the heart of successful teams lies communication.1 Mesmer-Magnus and DeChurch (2009) conducted a meta-analysis that synthesized 72 studies and provided additional empirical evidence indicating the importance of information sharing (i.e., communication) for effective team performance.2 Simply defined, communication is "the exchange of information between a sender and a receiver."1

Effective communication is achieved through mechanisms such as information exchange protocols and closed-loop communication. Information exchange protocols are processes that structure communication systematically to facilitate presentation and recall.3 Closed-loop communication is the process of acknowledging the receipt of information and clarifying with the sender of the communicated message that the information received is the same as the original, intended information.4 In essence, it is the process of confirming and cross-checking information for accuracy. This style of communication fosters the ability to ensure that the entire team has shared goals, expectations, awareness, and plan execution.5

Unquestionably, communication is one of the key defining features of successful medical teams and quality clinical care.6 In fact, communication is particularly invaluable within the health care context, because no single medical specialty or discipline can meet all of a patient's needs, thus, necessitating that team members communicate with one another.7 One study stated that communication is one of the most important factors for enhancing clinical effectiveness.8 Simply stated, "lack of communication creates situations where medical errors can occur."9

Leveraging the communication tools provided by TeamSTEPPS® enhances communication, as well as other fundamental team processes and states, such as team structure, leadership, situation monitoring, and mutual support. Research has demonstrated that using the communication tools and strategies provided by TeamSTEPPS has repeatedly improved both teamwork and relevant outcomes.10 For example:

  • Weaver, et al.,11 showed an increase in use of handoffs, SBAR, call-outs, and check-backs after training, and reported enhanced outcomes within the operating room.
  • Riley, et al.,12 focused on SBAR and closed-loop communication, and showed improved perinatal outcomes and safety culture.
  • Deering, et al.,13 reported reduced rates of needle stick injuries and medication and transfusion errors, and identified the use of SBARs, call-outs, check-backs, and handoffs as contributing factors in mitigating patient safety events.

In particular, these authors attributed handoffs as being more influential than the other communication tools and strategies combined. In fact, the importance of adopting a structured handoff procedure in order to improve communication among team members during transitions in care has gained support throughout the literature.14-18

In sum, communication is a critical skill possessed by team members and required for effective teamwork. Team members with effective communication skills can:

  • Communicate accurate and complete information in a clear and concise manner.
  • Seek information from all available sources.
  • Readily anticipate and share the information needs of other team members.
  • Provide status updates.
  • Verify information received.


  1. Salas E, Wilson KA, Murphy CE, et al. Communicating, coordinating, and cooperating when lives depend on it: tips for teamwork. Jt Comm J Qual Patient Saf 2008;34(6):333-41.
  2. Mesmer-Magnus JR, DeChurch L. Information sharing and team performance: a meta-analysis. J Appl Psychol 2009;94:535-46.
  3. Herschel RT, Nemati H, Steiger D. Tacit to explicit knowledge conversion: knowledge exchange protocols. J Knowl Manag 2001;5(1):107-16.
  4. Baker DP, Salas E, King H, et al. The role of teamwork in the professional education of physicians: current status and assessment recommendations. Jt Comm J Qual Patient Saf 2005;31(4):185-202.
  5. 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: Taylor and Francis Group; 2009. p. 39-79.
  6. Nijhuis BG, Reinders-Messelink HA, de Blécourt ACE, et al. A review of salient elements defining team collaboration in paediatric rehabilitation. Clin Rehabil 2007;21(3):195-211.
  7. Ellingson LL. Communication, collaboration, and teamwork among health care professionals. Communication Res Trends 2002;21(3):3-21.
  8. Flin R, Fletcher G, McGeorge P, et al. Anaesthetists' attitudes to teamwork and safety. Anaesthesia 2003;58(3):233-42.
  9. O'Daniel M, Rosenstein AH. Professional communication and team collaboration. In: Hughes RG, ed. Patient safety and quality: an evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008. AHRQ Publication No. 08-0043-CD.
  10. 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;37(8):365-74.
  11. Weaver SJ, Rosen MA, DiazGranados D, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010;36(3):133-42.
  12. Riley W, Davis S, Miller K, et al. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf 2011;37:357-64.
  13. 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 2010;37(8):350-6.
  14. Gakhar B, Spencer AL. Using direct observation, formal evaluation, and an interactive curriculum to improve the sign-out practices of internal medicine interns. Acad Med 2010;85:1182-8.
  15. Johnson JK, Barach P. Patient care handovers: what will it take to ensure quality and safety during times of transition? Med J Aust 2009;190(11 Suppl):S110-2.
  16. Clarke CM, Persaud DD. Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. J Patient Saf 2011;7(1):11-8.
  17. Mistry K, Jaggers J, Lodge AJ, et al. Using Six Sigma® methodology to improve handoff communication in high-risk patients. In: Henriksen K, Battles JB, Keyes MA, et al., eds. Advances in patient safety: new directions and alternative approaches. Vol. 3: Performance and tools. Rockville, MD: Agency for Healthcare Research and Quality; 2008. AHRQ Publication No. 08-0034-3. Select for more information. Accessed August 20, 2013.
  18. Chu ES, Reid M, Schulz T, et al. A structured handoff program for interns. Acad Med 2009;84:347-52.

Additional Resources

Arora V, Johnson J, Lovinger D, et al. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care 2005;14:401-7.

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.

Dickinson TL, McIntyre RM. A conceptual framework for teamwork measurement. In: Brannick MT, Salas E, Prince C, eds. Team performance assessment and measurement. Mahwah, NJ: Lawrence Erlbaum Associates; 1997. p. 19-43.

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.

Patterson ES, Roth EM, Woods DD, et al. Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care 2004;16(2):125-32.

Salisbury M, Hohenhaus SM. Know the plan, share the plan, review the risks: a method of structured communication for the emergency care setting. J Emerg Nurs 2008;34(1):46-8.

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

Page last reviewed October 2014
Page originally created September 2012
Internet Citation: TeamSTEPPS Fundamentals Course: Module 3. Evidence-Based: Communication. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.