Interventions to improve team effectiveness: A systematic review

Abstract

Objectives

To review the literature on interventions to improve team effectiveness and identify their ‘evidence based’-level.

Methods

Major data bases (PubMed, Web of Science, PsycInfo and Cochrane Library) were systematically searched for all relevant papers. Inclusion criteria were: peer-reviewed papers, published in English between January 1990 and April 2008, which present empirically based studies focussing on interventions to improve team effectiveness in health care. A data abstraction form was developed to summarize each paper. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence.

Results

Forty-eight papers were included in this review. Three categories of interventions were identified: training, tools, and organisational interventions. Target groups were mostly multidisciplinary teams in acute care. The majority of the studies found a positive association between the intervention and non-technical team skills. Most articles presented research with a low level of evidence. Positive results in combination with a moderate or high level of evidence were found for some specific interventions: Simulation training, Crew Resource Management training, Team-based training and projects on Continuous quality improvement.

Conclusions

There are only some studies available with high quality evidence on interventions to improve team effectiveness. These studies show that team training can improve the effectiveness of multidisciplinary teams in acute (hospital) care.

Introduction

The well-known publication of To Err is Human: Building a Safer Health System prompted a considerable rethinking of safety in health care [1]. The authors argued that 3–4% of patients hospitalized in the United States were harmed by care received and 44,000–98,000 patients died as a result of medical errors. Their conclusion was that effective teamwork and better communication between caregivers could have prevented half of them. “To promote effective team functioning” became one of the five principles in the 1999 IOM report to create safe hospital systems [1]. The assumption is that effective teamwork leads to higher-quality decision making and medical intervention and, in turn, better patient outcomes [2]. Since the publication of the report, research on team effectiveness in health care has significantly increased.

Research in health care has focused particularly on identifying characteristics of effective teams and developing instruments for measuring their effectiveness [3], [4], [5]. Cohen and Bailey define a team as: “A collection of individuals who are interdependent in their tasks, who share responsibility for outcomes, who see themselves and who are seen by others as an intact social entity embedded in one or more larger social systems (for example, business unit or corporation), and who manage their relationships across organizational boundaries” [6, p. 241].

Several models have been developed to conceptualize the aspects of teamwork that influence team effectiveness [3], [4], [7]. These models can be useful in understanding how interventions effect teams. For example, Lemieux-Charles and McGuire have presented ‘The Integrated (Health Care) Team Effectiveness Model’ (ITEM) [3]. This model shows that the organizational context in which a team operates (e.g. goals, structure, rewards, training environment) indirectly influences its effectiveness. This particularly has an effect on team processes (e.g. communication, leadership, decision-making), psycho-social traits (e.g. cohesion, norms) and task design (e.g. team composition, autonomy, interdependence). These aspects do have a direct influence on team effectiveness. Finally, team effectiveness can be measured by looking at objective outcomes (e.g. patient satisfaction, quality of care) and subjective outcomes (e.g. effectiveness as perceived by team members).

With respect to measuring team effectiveness, Heinemann and Zeiss have presented an overview of nine state-of-the-art instruments specific to health care teams that measure aspects such as team climate, collaboration, meeting effectiveness, attitude towards teams, team integration, and development of teams [5].

However, there are no (general) overviews of studies on different interventions to improve team effectiveness. Therefore, information on the effectiveness of these interventions is scattered. We do not know which interventions are most effective for which target group and for which outcomes. Nevertheless, health care organisations are spending an increasing amount of money and energy on programs and projects to improve team effectiveness.

To assist health care organisations in their endeavour to improve team effectiveness, synthesise scientific knowledge on relevant interventions, and identify gaps in this research, we performed a systematic review with a focus on two research questions: (1) Which types of interventions to improve team effectiveness in health care have been researched empirically, for which target groups and for which outcomes? (2) To what extent are these findings evidence based?

This article presents the findings of this systematic review.