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.

Select to download print version (PDF File, 259 KB). PDF Help.

Contents

Front Matter (PDF File, 30 KB; PDF Help)
Abstract
Summary

Report
Chapter 1. Introduction (PDF File, 32 KB; PDF Help)
   Background
   The Structure of the Evaluation
   Methodology
Chapter 2. Training Teams (PDF File, 59 KB; PDF Help)
   Definitional Issues Concerning Teams and Teamwork
   What is a "Team"?
   Training Teams
   Summary
Chapter 3. Team Training in High-risk Contexts (PDF File, 23 KB; PDF Help)
   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 File, 101 KB; PDF Help)
   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 File, 25 KB; PDF Help)
   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 File, 20 KB; PDF Help)
   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 File, 45 KB; PDF Help)

Tables and Figures
Table 1. Primary teamwork competencies (PDF File, 14 KB; PDF Help)
Table 2. Individual and team-level training strategies (PDF File, 12 KB)
Figure 1. Framework for designing an effective team training program (PDF File, 20 KB)
Figure 2. The Donabedian Model of Patient Safety (PDF File, 54 KB)

AHRQ Publication No. 05-0053
Current as of July 2005

Internet Citation:

Baker DP, Gustafson S, Beaubien J, Salas E, Barach P. Medical Teamwork and Patient Safety: The Evidence-based Relation. Literature Review. AHRQ Publication No. 05-0053, April 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/medteam/