Do Team Processes Really Have an Effect on Clinical Performance? A Systematic Literature Review

Abstract

Editor's key points † This review has examined the impact of team process behaviours on clinical performance. † Twenty-eight studies, which reported at least one relationship between team process or an intervention and outcome, were reviewed. † Team process behaviours have been shown to influence performance. † Training in team behaviours results in improved performance.Summary. There is a growing literature on the relationship between team processes and clinical performance. The purpose of this review is to summarize these articles and examine the impact of team process behaviours on clinical performance. We conducted a literature search in five major databases. Inclusion criteria were: English peer-reviewed papers published between January 2001 and May 2012, which showed or tried to show (i) a statistical relationship of a team process variable and clinical performance or (ii) an improvement of a performance variable through a team process intervention. Study quality was assessed using predefined quality indicators. For every study, we calculated the relevant effect sizes. We included 28 studies in the review, seven of which were intervention studies. Every study reported at least one significant relationship between team processes or an intervention and performance. Also, some non-significant effects were reported. Most of the reported effect sizes were large or medium. The study quality ranged from medium to high. The studies are highly diverse regarding the specific team process behaviours investigated and also regarding the methods used. However, they suggest that team process behaviours do influence clinical performance and that training results in increased performance. Future research should rely on existing theoretical frameworks, valid, and reliable methods to assess processes such as teamwork or coordination and focus on the development of adequate tools to assess process performance, linking them with outcomes in the clinical setting.

Challenges in out-of-hospital cardiac arrest – A study combining closed-circuit television (CCTV) and medical emergency calls

“…In-hospital studies show that non-technical skills, such as situation awareness, decision-making, leadership, communication and teamwork, enhance performance. 21,22 Basic life-support courses could focus on gathering a team and the various tasks for bystanders: resuscitation, communication with dispatcher, quality CPR, receiving the ambulance, retrieving an AED and calling out for help from any healthcare professionals among the bystanders. We should think of the dispatcher and the bystanders as "the first resuscitation team" at the scene, the ambulance personnel are the second team and the receiving team at the hospital as the third-essentially a chain of resuscitation teams performing many of the same tasks.…”

Factors relating to the perceived management of emergency situations: A survey of former Advanced Life Support course participants’ clinical experiences

“…Despite increased efforts to link quality of team performance and patient outcomes in emergency situations 2,6,7 there is little knowledge of the characteristics associated with successful and unsuccessful management of emergency situations. However, knowledge about such characteristics -including factors related to the individual, the team, and the setting -may help improving the design of simulation-based strategies in order to increase the ability to apply skills in clinical settings.…”

How to implement an enhanced recovery program? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE)

“…For the ERP to be successful, each member of the team should be aware of as many aspects of management as possible, which means that team spirit should be a daily preoccupation. Team spirit is undeniably associated with improved quality of care and risk management [9]. Likewise, and perhaps, even more so than for ambulatory surgery (because major surgery is involved), team spirit, daily communication and collaboration are necessary for the success of all ERP.…”