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Table 1 Summary of results

From: Interventions to improve team effectiveness within health care: a systematic review of the past decade

Authors (year) Intervention Setting Outcome(s) GRADE
Principle-based training: CRM-based training
Allan et al. 2010 [29] A simulation-based in situ CRM training: game play, didactics, video review, hands-on high-fidelity simulation-based training and video-based debriefing Paediatric cardiac intensive care Improvement in participants’ perceived ability to function as a code team member and confidence in a code, likeliness to raise concerns about inappropriate management to the code leader C
Ballangrud et al. 2014 [30] Simulation-based CRM team training: introductory theory inputs on safe team performance based on CRM and a team training in a simulation laboratory Intensive care Training increases awareness of clinical practice and acknowledges the importance of structured work in teams D
Bank et al. 2014 [31] Needs-based paediatric CRM simulation training with post activity follow-up: plenary educational session, simulation and debriefing Paediatric emergency medicine residents (postgraduate year 1–5) Improvement in the ability to be an effective team leader in general, delegating tasks appropriately, and ability to ensure closed loop communication, and identification of CRM errors C
Budin et al. 2014 [32] CRM training: train-the-trainer programme and CRM training including videos, lecture, and role playing Perinatal care Improvement in nurse and physician perceptions of teamwork and safety climate C
Carbo et al. 2011 [33] CRM-based training focusing on appropriate assertiveness, effective briefings, callback and verification, situational awareness, and shared mental models Inpatient internal medicine Improvement in the percentage of correct answers on a question related to key teamwork principles, reporting “would feel comfortable telling a senior clinician his/her plan was unsafe” C
Catchpole et al. 2010 [34] Aviation-style team training: classroom training of interactive modules including lectures and discussions, and coaching in theatre Surgery More time-outs, briefings, and debriefings B
Clay-Williams et al. 2013 [35] CRM-based classroom training, CRM simulation training or classroom training followed by simulation training Doctors, nurses and midwives Improvement in knowledge, self-assessed teamwork behaviour and independently observed teamwork behaviour when classroom-only trained group was compared with control, these changes were not found in the group that received classroom followed by simulation training A
Cooper et al. 2008 [36] Simulation-based anaesthesia CRM training Anaesthesiology No difference between the trained and untrained cohorts C
France et al. 2008 [37] CRM training: CRM introductory training course (i.e. lectures, case studies, and role playing) and perioperative CRM training (i.e. e-learning models and toolkit consisting of CRM process checklist, briefing scripts, communication whiteboard, implementation training) Surgery Shows potential to improve team behaviour and performance D
Gardner et al. 2008 [38] Simulation-based CRM training with debriefing Obstetrics department Reduction in annual obstetrical malpractice premiums; improvement in teamwork and communication in managing a critical obstetric event in the interval C
Gore et al. 2010 [39] CRM training: educational seminar (i.e. lectures and role-play exercises), development and expansion of time-out briefing, educational video on briefing, posters on content briefing Operating room Improvement in teamwork, error reporting, and safety climate C
Haerkens et al. 2017 [40] CRM training: CRM awareness training (i.e. lectures and multiple interactive sessions using case studies and video footage), implementation of tools Emergency department Improvement in teamwork climate, safety climate and stress recognition. Increase in patient length of stay B
Haller et al. 2008 [41] CRM training: video, discussion, (interactive) lectures, workshops, play roles, interactive course Obstetrical setting in hospital Improvement in knowledge of teamwork, shared decision making, team and safety climate, stress recognition B
Hefner et al. 2017 [42] CRM training: day-long retreats, during which participants underwent developed and tailored CRM safety tools and participated in role playing, development of system-wide internal monitoring processes Medical centre consisting of multiple hospitals and two campuses Improvement in (1) organizational learning and continuous improvement, (2) overall perceptions of patient safety, (3) feedback and communication about errors, and (4) communication openness. B
Hicks et al. 2012 [43] Crisis Resources for Emergency Workers (CREW): a simulation-based CRM curriculum: precourse learning and a full-day simulation-based exercise with debriefing Emergency department Believe that CREW could reduce errors and improve patient safety; no improvement toward team-based attitudes C
Hughes et al. 2014 [44] CRM adapted to Trauma Resuscitation with new cultural and process expectation: CRM course of 15 sessions Trauma resuscitation Improvement in accuracy of field to medical command information, accuracy of emergency department medical command information to the resuscitation area, team leader identity, communication of plan, role assignment, likeliness to speak up when patient safety was a concern B
de Korne et al. 2014 [45] Team Resource Management (TRM) programme (based on CRM concepts): safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback Eye hospital Observations suggests increase safety awareness and safety-related patterns of behaviour between professions, including communication D
Kuy and Romero 2017 [46] CRM training: didactics, group discussions, and simulation training Surgical service staff at a VA Hospital At T1 participants reported improvement in all 27 areas assessed. At T2 his improvement was sustained in 85% of the areas studied. Areas with largest improvement: briefing, collaboration, nursing input, and patient safety. Areas with regression: speaking up, expressing disagreement, level of staffing, and discussing errors C
LaPoint et al. 2012 [47] CRM training: core skills workshops Perioperative staff Improvement in supervisor expectations, communication openness, teamwork within units, non-punitive response to error, hospital management support for safety, handoffs. No significant improvement in organizational learning, feedback communication about errors, teamwork across hospital units, number of events C
Mahramus et al. 2016 [48] Teamwork training based on CRM and TeamSTEPPS: simulations, debriefing, teamwork education Hospital Improvement in perceptions of teamwork behaviours C
McCulloch et al. 2009 [49] Classroom non-technical skills training based on CRM: mixed didactic and interactive teaching (e.g. role play), follow-up feedback by trainers Operating room Improved technical and non-technical performance: improvement in attitudes to safety, team non-technical performance and technical error rates C
Mehta et al. 2013 [50] Multidisciplinary simulation course: CRM teaching, simulation with debriefing, closing session with feedback Operating room Improvement in clinical knowledge, teamwork, leadership and non-technical skills, as well as the mutual understanding and respect between related medical and non-medical team members D
Morgan et al. 2015a [51] CRM-based training and improving working processes through implementing morning briefing and WHO Surgical Safety Checklist Operating room conducting elective orthopaedic surgery Improvement in non-technical skills and WHO compliance; no significant improvement in clinical outcomes C
Morgan et al. 2015b [52] Teamwork training course CRM-based interactive classroom teaching and on the job coaching Operating rooms Improvement in non-technical skills, but also with a rise in operative glitches B
Muller et al. 2009 [53] CRM training (i.e. psychological teaching including theoretical exercises and simulator scenarios and video-assisted debriefing) versus classic simulator training (MED) Hospital Improvement in clinical and non-technical performance after both training, but no difference between training C
Parsons et al. 2018 [54] Simulation-based CRM training: didactic presentation, series of simulation scenarios and structured debriefs Emergency medicine No significant improvement in leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills D
Phipps et al. 2012 [55] CRM-based training: didactic sessions, simulation and debriefing Labour and delivery Improvement in patient outcomes (adverse outcomes), perceptions of patient safety including the dimensions of teamwork and communication B
Ricci et al. 2012 [56] CRM training: Training (i.e. didactics, case study discussions, team-building exercises, simulated operating room brief and debrief sessions) and CRM techniques (e.g. pre-operative checklist and brief, post-operative debrief, read and initial files, feedback tools) Perioperative personnel Wrong site surgeries and retained foreign bodies decreased, but increased after 14 months without additional training. B
Robertson et al. 2009 [57] Obstetric Crisis Team Training: online module, training session (standardized, simulated crisis scenarios with simulator mannequin), and debriefings Multidisciplinary obstetric providers in hospital Improvement in attitude; perception of individual and team performance, and overall team performance C
Savage et al. 2017 [58] CRM safety programme: CRM training (i.e. didactic seminars, role playing), systematic risk assessments, and improving work practices (i.e. checklists, huddles or structured communication and meeting tools) Paediatric surgery Improvement in non-technical skills, the use of safety tools, adherence to guidelines, safety culture (i.e. teamwork across and within units, supervisors’ expectations and actions, non-punitive response to adverse events, perceptions of overall patient safety); unplanned readmissions following appendectomy declined A
Sax et al. 2009 [59] CRM training: video, team building exercises, open forum, and development and implementation of perioperative checklist Hospitals Increased self-initiated error reports and perceived self-empowerment B
Shea-Lewis et al. 2009 [60] CRM-based training: real-life examples, feedback, SBAR, team meetings, briefing, and debriefing Obstetric department Improvement in patient outcome, patient satisfaction, employee satisfaction C
Schwartz et al. 2018 [61] Clinical Team Training (CTT) based on CRM principles: training (e.g. simulation) and implementation of improvement projects (e.g. briefing, huddles, checklists) Veterans Health Administration facilities Improvement in communication, teamwork and situational awareness for patient safety. Also decreased between T1 and T2 detected. B
Sculli et al. 2013 [62] Nursing CRM: interactive didactic training curriculum, features high-fidelity simulation, ongoing consultation, improvement project, refreshment Nursing units Improvement unit climate, teamwork, medication errors, HAPU, glucose control, FTR events, and care processes C
Steinemann et al. 2011 [63] Crisis Team Training-based in situ team training: web-based didactic, simulations, and debriefing Emergency department Improvement in teamwork ratings, clinical task speed and completion rates, teamwork scores, objective parameters of speed and completeness of resuscitation B
Stevens et al. 2012 [64] CRM-based educational programme based on high realism acute crisis simulation scenarios and interactive workshop Cardiac surgery Survey: improvement in the concept of working as a team. Interview: improvement in personal behaviours and patient care, including speaking up more readily and communicating more clearly D
Suva et al. 2012 [65] CRM training: introductory course, interactive workshops, lecture, role play Operating room Improvement in learning, knowledge regarding teamwork, safety climate, and stress recognition; improvement varies with participant specialty C
Tschannen et al. 2015 [66] Nursing CRM training: educational sessions, podcasts, simulation and debriefing General medicine telemetry unit No significant improvement in communication openness and environmental values; RNs reported an increase in both synchronous communication and asynchronous communication with physicians whereas physicians noted a reduction in time spent in asynchronous communication D
West et al. 2012 [67] Nursing CRM training: didactic session, simulation, implementation of a CRM technique: sterile cockpit rule Veterans Affairs hospital on nursing units Improvement in efficiency (e.g. quicker follow-up on abnormal vital signs and blood glucose levels, rapid assessment of patients with changes in condition, and faster intervention when the condition was deteriorating) and perceived teamwork, communication, patient safety C
Ziesmann et al. 2013 [68] STARTT (Standardized Trauma and Resuscitation Team Training): lectures (on CRM), discussion based on CRM principles, simulations and debriefing Trauma teams Improvement in overall CRM domains, teamwork, and safety climate D
Principle-based training: TeamSTEPPS
Armour Forse et al. 2011 [69] TeamSTEPPS Operating room Improvement in communications, leadership first case starts, Surgical Quality Improvement Program measures, surgical morbidity and mortality, culture; not all improvement were sustained. No significant effect on PACU communication and teamwork B
Bridges et al. 2014 [70] Educational intervention: adapted TeamSTEPPS curriculum, discussion, practicing standardized communication tools Hospital Intermediate Care Unit serving adult medical cardiac patients Improvement in awareness of teamwork and backup C
Brodsky et al. 2013 [71] Multidisciplinary, small group, interactive workshop based on TeamSTEPPS Neonatal intensive care Improvement in the overall teamwork, communication, situation awareness, support, satisfaction, job fulfilment, respect B
Bui et al. 2018 [72] Video and live observation of TeamSTEPPS skills implementation during surgical briefs and debriefs Operating rooms Low compliance with TeamSTEPPS skills; compliance was under video observation than under live observation D
Capella et al. 2010 [73] TeamSTEPPS (e.g. didactic session, simulation, 5 tools: briefing, STEP (situation monitoring tool), CUS (mutual support tool), call outs, and check backs) Level I trauma centre Improvement in leadership situation monitoring, mutual support, communication, and overall teamwork; decreasing the times from arrival to the CT scanner, endotracheal intubation and the operating room B
Castner et al. 2012 [74] TeamSTEPPS Hospital inpatient bedside RNs Improved perceptions of leadership C
Deering et al. 2011 [75] TeamSTEPPS Combat support hospital Decreases in the rates of communication-related errors, medication and transfusion errors, and needles tick incidents, the rate of incidents coded communication as the primary teamwork skill that could have potentially prevented the event C
Figueroa et al. 2013 [76] TeamSTEPPS-based simulation training: lecture (on TeamSTEPPS principles), simulation, checklist, and debriefing Paediatric cardiovascular intensive care Improving confidence, skills in the role of team leaders, and TeamSTEPPS concepts B
Gaston et al. 2016 [77] Customized TeamSTEPPS training (of 2 instead of 6 h) Oncology acute patient care Improvement in staff perception of teamwork and communication B
Gupta et al. 2015 [78] A selection of TeamSTEPPS tools Academic interventional ultrasound service Improvement in teamwork climate, safety climate, and teamwork C
Harvey et al. 2014 [79] In situ simulation-based training (SBT) versus case study review, both incorporating TeamSTEPPS training Medical-surgical PCUs Improvement in knowledge and teamwork skills in both groups; SBT group showed greater improvement in all areas except knowledge C
Jones et al. 2013 [80] TeamSTEPPS (e.g. TeamSTEPPS tools, fundamentals course) Hospitals Improvement in safety culture A
Jones et al. 2013 [81] TeamSTEPPS (e.g. essentials course) Emergency department Improvement of staff perception related to a culture of safety (e.g. management support for patient safety, feedback and communications about error, communication openness) B
Lee et al. 2017 [82] After TeamSTEPPS, implementation of reinforcement activities regarding leadership and communication (i.e. lectures, self-paced learning programme, 1 page summary, and grand rounds on TeamSTEPPS principles) Orthopaedic surgery Nursing staff: improvement in leadership and communication behaviours. Surgical staff: improvement in leadership behaviours. Anaesthesia staff: no improvement in any teamwork behaviours C
Lisbon et al. 2016 [83] TeamSTEPPS: brief, huddle, DESC (constructive approach for managing and resolving
Conflict) and CUS script
Academic emergency department Improvement in knowledge and improved communication attitudes; adoption of a specific behaviour, the huddle, also was observed B
Mahoney et al. 2012 [84] TeamSTEPPS (variation of tools: flyers, simulations, games, and sustainment tools such as luncheon debriefing, awards) Psychiatric hospital Improvement in team foundation, functioning, performance, skills, climate, and atmosphere B
Mayer et al. 2011 [85] TeamSTEPPS (e.g. fundamental curriculum) Paediatric and surgical intensive care Improvement in experienced teamwork, team performance, communication openness and clinical outcomes (e.g. average time for placing patients on extracorporeal membrane oxygenation, average duration of adult surgery rapid response team events B
Rice et al. 2016 [86] Modified simulation-based TeamSTEPPS training Intensive care Improvement in teamwork attitudes, perceptions, and performance D
Riley et al. 2011 [87] TeamSTEPPS didactic training (e.g. webinar, video of simulated scenarios) versus full TeamSTEPPS training (e.g. series of in situ simulation training exercises including (de)briefing, rapid-cycle follow-through with process improvements, and repetition Hospitals Improvement in perinatal morbidity between the pre- and post-intervention for hospital with simulation programme. No significant changes in safety culture B
Sawyer et al. 2013 [88] TeamSTEPPS training (e.g. fundamental course) with medical simulation Neonatal intensive care Improvement in teamwork skills in team structure, leadership, situation monitoring, mutual support, and communication, the odds of a nurse challenging an incorrect medication dose, and detection and correction of inadequate chest compressions C
Sonesh et al. 2015 [89] Adapted TeamSTEPPS (lecture-based interactive programme) Obstetrical setting Improvement in knowledge of communication strategies, decision accuracy, and length of babies’ hospital length of stay. Knowledge of other team competencies or self-reported teamwork did not significantly improve C
Spiva et al. 2014 [90] Training curriculum based on TeamSTEPPS (e.g. didactic lecture, patient video vignettes, debriefing) Hospital Improvement on fall reduction and teamwork B
Stead et al. 2009 [91] TeamSTEPPS (e.g. redesign meetings, SBAR, coaching) Mental health facility Substantial impact on patient safety culture (i.e. frequency of event reporting, and curriculum learning), teamwork, communication, KSA score, rates of seclusion. Issues around staffing, teamwork across hospital units, and hospital management support remained unchanged D
Thomas et al. 2012 [92] TeamSTEPPS (e.g. master trainer course, fundamentals course, essentials course) Hospital Improvement in feedback and communication about error, frequency of events reported, hospital handoff and transitions, staffing, and teamwork across the units C
Treadwell et al. 2015 [93] TeamSTEPPS (e.g. huddle, debrief, SBAR, briefing checklist) Medical home Improved perception of team collaboration C
Vertino 2014 [94] TeamSTEPPS (e.g. formal presentation, discussion, role-play exercises embodying clinical scenarios) Inpatient (VHA) hospital unit Positive change in staff attitudes toward team structure, leadership, situation monitoring, mutual support, and communication D
Weaver et al. 2010 [15] TeamSTEPPS (e.g. didactic session, interactive role playing, multiple tools) Operating rooms Improvement in quality and quantity of briefings and the use of quality teamwork behaviours during cases B
Wong et al. 2016 [95] Interprofessional education course: adapted TeamSTEPPS curriculum, simulation scenarios, and structured debriefing, and wrap-up session Emergency department Improvement in team structure, leadership, situation monitoring, mutual support, frequency of event reporting, teamwork within hospital units, and hospital handoffs and transitions B
Method-based training: Simulation-based training
AbdelFattah et al. 2018 [96] Trauma-focus simulation training: trauma simulations with video-based debriefing Trauma surgery Improvement in clinical management, leadership, communication, cooperation, professionalism and performance on trauma rotation D
Amiel et al. 2016 [97] One-day simulation- based training with video-based debriefing Emergency department in trauma centre Improvement in teamwork, communication, patient handoff, and shock and haemorrhage control C
Arora et al. 2014 [98] Full-hospital simulation across the entire patient pathway (with integration of teams in prehospital, through-hospital, and post-hospital care) Hospital Improvement in decision making, situational awareness, trauma care, and knowledge of hospital environment. Behavioural skills, such as teamwork and communication, did not show significant improvement C
Arora et al. 2015 [99] Simulation-based training for improving residents’ management of post-operative complications: ward-based scenarios and debriefing intervention Surgery Clinically, improvement in residents’ ability to recognize/respond to falling saturations, check circulatory status, continuously reassess patient, and call for help. Teamwork, improvement in residents’ communication, leadership, decision-making skills, and interaction with patients (empathy, organization, and verbal and nonverbal expression) B
Artyomenko et al. 2017 [100] Simulation training sessions for urgent conditions with debriefing Obstetrical anaesthesiologists Improvement in speed and invasive techniques, teamwork and effectiveness after the fifth session C
Auerbach et al. 2014 [101] In situ interdisciplinary paediatric trauma quality improvement simulation: simulated patient care followed by debriefing Tertiary care paediatric emergency department Improvement in overall performance, teamwork, and intubation subcomponents C
Bender et al. 2014 [102] Simulation-enhanced booster session (after Neonatal Resuscitation Program): orientations session, simulation, and debriefing Paediatric and Family Practice The intervention group demonstrated better procedural skills and teamwork behaviours. The NICU programme demonstrated better teamwork behaviours compared with non-NICU programme B
Bittencourt et al. 2015 [103] In centre simulation-based training (simulation and debriefing) and in situ simulation (simulation and debriefing): comparison of actual paediatric emergencies, in-centre simulations, and in situ simulations Paediatric level 1 trauma centre Mean total TEAM scores were similar among the 3 settings. Simulation-based training improved communication, team interaction, shared mental models, clarifying roles and responsibilities, and task management B
Bruppacher et al. 2010 [104] Training session with either high-fidelity simulation-based training (i.e. orientation session, simulation, and debriefing) or an interactive seminar (i.e. audiovisual aids such as PowerPoint slides, handouts, and face-to-face discussion of paper-based scenarios similar to the simulation training) Anaesthesiology for cardiopulmonary bypass Both groups improved, the simulation group showed significantly higher improvement on situation awareness, team working, decision making, task management, and checklist performance compared with the seminar group B
Bursiek et al. 2017 [105] Interdisciplinary (high-fidelity) simulation training with debriefing Interdisciplinary teams Improvement in team work, perception of work environment and patient safety C
Burton et al. 2011 [106] Simulation-based training: simulation laboratory curriculum with video-assisted debriefings Extracorporeal membrane oxygenation emergencies No improvement in timed responses or percent correct actions. Improvement in teamwork, knowledge, and attitudes C
Chung et al. 2011 [107] Conventional simulation-based training (i.e. lecture, videos, simulations, and debriefing) versus a script-based training Cardiopulmonary resuscitation in emergency departments Both type of training improved leadership scores, but no improvement in performance B
Cooper et al. 2012 [108] Simulation team training: formative questionnaire, team-based videoed scenarios, photo elicitation, and expert feedback sessions Hospital nurse teams Improvement in knowledge, confidence and competence; group debriefing session enhanced learning C
Ciporen et al. 2018 [109] Crisis management simulation training: instructions, simulation, and debriefing Neurosurgery and anaesthesiology No significant differences between groups in situation awareness, decision making, communication and teamwork C
Ellis et al. 2008 [110] High-technology training at a simulation centre versus low-tech training in local units (with and without teamwork theory) Midwives and obstetricians in hospitals Improvement in rates of completion for basic tasks, time to administration of magnesium sulphate, and teamwork. Training in a simulation centre and teamwork theory had no effect B
Fernando et al. 2017 [111] Interprofessional simulation training with debriefing Primary and secondary care doctors Improvement in knowledge, confidence and attitudes. Qualitative data indicates improvement in clinical skills, reflective practice, leadership, teamwork and communication skills C
Fouilloux et al. 2014 [112] Training based on an animal simulation model Cardiac surgery Improvement in management of the adverse events and time spend per certain events D
Fransen et al. 2012 [113] Multiprofessional simulation team training: introduction video, simulation, and debriefing Obstetric departments Improvement in teamwork performance and use of the predefined obstetric procedures A
Freeth et al. 2009 [114] Simulation-based interprofessional training with video-recorded debriefing Delivery Improvement in knowledge and understanding of interprofessional team working, especially communication and leadership in obstetric crisis situations C
Frengley et al. 2011 [115] Simulation-based training: familiarization, teamwork session (presentation, video, and discussions), skills station, simulations or case-based training Critical care Improvement in overall teamwork, leadership, team coordination, verbalizing situational information, clinical management; no difference between simulation-based learning and case-based learning B
George and Quatrara 2018 [116] Interprofessional simulation training: introduction session, simulation, and debriefing Surgical trauma burn intensive care unit Improvement in perceptions of teamwork and knowledge D
Gettman et al. 2009 [117] High-Fidelity Operating Room Simulation: introduction, simulation, and video-based debriefing Orology, operating room Improvement in teamwork, communication, laparoscopic skills, and team performance C
Gilfoyle et al. 2017 [118] Simulation-based training: lecture, group discussions, simulations, and debriefing Paediatric resuscitation Improvement in clinical performance and clinical teamwork (role responsibility, communication, situational awareness and decision making) B
Gum et al. 2010 [119] Interprofessional simulation training with video-based debriefing Maternity emergency Ability for collaboration in team building (i.e. personal Role Awareness, interpositional knowledge, mutuality and leadership) D
Hamilton et al. 2012 [120] High-fidelity simulated trauma resuscitation with video-assisted debriefing Surgery Improvement in team function score and the feeling of being more competent as team leaders and team members B
Hoang et al. 2016 [121] Training course: classroom didactic sessions and hand-on simulation sessions (U.S. Navy Fleet) surgery Improvement in time to disposition and critical errors D
James et al. 2016 [122] Simulation-based interprofessional team training: simulation followed by debriefing and performance feedback Oncology Acquired new knowledge, skills, and attitudes to enhance interprofessional collaboration C
Kalisch et al. 2015 [123] Virtual simulation training with introduction session Medical–surgical patient care unit Improvement in overall teamwork, trust, team orientation, and backup D
Khobrani et al. 2018 [124] Boot camp curriculum with high-fidelity paediatric simulations with debriefing (Paediatric) emergency medicine Improvement in teamwork performance (leadership, cooperation, communication, assessment and situation) and basic knowledge D
Kilday et al. 2012 [125] Team intervention: didactic curriculum with skill lab practice sessions, simulations, debriefing Hospitals Improvement in team performance, knowledge, and emergency teamwork C
Kirschbaum et al. 2012 [126] Multidisciplinary team training: assessments, high-fidelity simulation sessions, and debriefing Obstetricians and anaesthesiologists Improvement in teamwork cultural attitudes and perceptions, communication climate; decreases in autonomous cultural attitudes and perceptions C
Koutantji et al. 2008 [127] Simulations with debriefing and in between an interactive workshop on briefing, check-listing methods and protocol Surgery Improvement in technical skills and no or negative effect on non-technical skills D
Kumar et al. 2018 [128] Simulation-based Practical Obstetric Multi-Professional Training (PROMPT): interactive lectures, scenarios based drills, debriefing Obstetric care in hospitals Improvement in clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritization in an emergency situation. No significant change in clinical outcomes B
Larkin et al. 2010 [129] Simulation-Based curriculum: video demonstrations, triggers, and simulated scenarios Surgery Improvement in empathic communication. Higher levels of stress. No significant improvement in teamwork attitudes C
Lavelle et al. 2018 [130] Multidisciplinary simulation-based training designed to address Medical Emergencies in Obstetrics: lecture, orientation session, simulation, debriefing, didactic teaching Healthcare staff across organizations Improvement in clinical skills and non-technical skills including teamwork, communication and leadership skills D
Lavelle et al. 2017 [131] In situ, simulation training: introduction, simulation, and debriefing Psychiatric triage wards Improvement in knowledge, confidence, and attitudes toward managing medical deterioration. Based on reflection: improved confidence in managing medical deterioration, better understanding of effective communication, improved self-reflection and team working, and an increased sense of responsibility for patients’ physical health. Incident reporting increased by 33% C
Lee et al. 2012 [132] Interdisciplinary high-fidelity simulation-based team training with debriefing Urology Urology resident training correlated with technical performance but not with non-technical performance; anaesthesia resident training level did correlate with non-technical performance D
Lorello et al. 2016 [133] Mental practice training (versus ATLS training) and simulation with debriefing Trauma resuscitation Improvement in teamwork behaviour, compared to traditional simulation-based trauma instruction B
Mager et al. 2012 [134] Expanded Learning and Dedication to Elders in the Region (ELDER): simulated patient scenarios using mid-fidelity human patient simulators and debriefing Long-term care facilities and home care agency Encouraging communication and teamwork C
Maxson et al. 2011 [135] Interdisciplinary simulation team training with high-fidelity simulation scenarios, pre- and debriefing session Inpatient surgical ward Improvement in collaboration between nurses and physicians and patient care decision making process C
McLaughlin et al. 2011 [136] Intensive trauma team training course (ITTTC): didactic lectures, case studies, and clinical simulations Military healthcare personnel Creates self-reported confidence D
Meurling et al. 2013 [137] Simulation-based team training: interactive seminars, simulation with debriefing Intensive care Improvement in self-efficacy. Improvement in nurse assistants’ perceived quality of collaboration and communication with physician specialists, teamwork climate, safety climate (also for nurses) and working conditions D
Miller et al. 2012 [138] In situ trauma simulation programme: didactic session, simulation, and debriefing Emergency department Improvement in teamwork and communication, this effect was not sustained after the programme was stopped D
van der Nelson et al. 2014 [139] Multidisciplinary simulation training with team debriefing (with emphasizes on using clinical tools) Surgery Improvement in safety culture, teamwork climate; deterioration in perceptions of hospital management and adequacy of staffing levels C
Nicksa et al. 2015 [140] Simulation of high-risk clinical scenarios followed by debriefings with real-time feedback General surgery, vascular surgery, and cardiothoracic surgery Improvement in communication, leadership, teamwork, and procedural ability. No significant improvement in decision making, situation awareness, and skills C
Niell et al. 2015 [141] Simulation-based training: didactic instruction, simulation, and debriefing Radiology Improvement in their ability to manage an anaphylactoid reaction, their ability to work in a team, and knowledge B
Oseni et al. 2017 [142] Training: video-based feedback and low-fidelity simulation Research unit clinics and hospital (in low resource settings) Improvement in clinical knowledge, confidence and quality of teamwork (leadership, teamwork and task management) C
Paige et al. 2009 [143] Repetitive training using high-fidelity simulation: Module 1 targeted teamwork competencies and Module 2 included a pre-operative briefing strategy Operating room Improvement in the effectiveness of promoting attitudinal change toward team-based competencies C
Paltved et al. 2017 [144] In situ simulation: information, simulation, and debriefing Emergency department Improvement in teamwork climate and safety climate C
Pascual et al. 2011 [145] Human patient simulation training: introduction, simulation, and video-based debriefing Intensive care Improvement in leadership, teamwork, and self-confidence skills in managing medical emergencies C
Patterson et al. 2013a [146] Multidisciplinary in situ simulations with debriefing Paediatric emergency department Ability to identify latent safety threats, but changes in non-technical skills C
Patterson et al. 2013b [147] Simulation-based training: introduction (lectures, videotapes of simulated resuscitations and case studies), simulation, and video-assisted debriefing Paediatric emergency department Sustained improvement in knowledge of and attitudes toward communication and teamwork behaviours C
Pennington et al. 2018 [148] Long distance, remote simulation training with Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) Interdisciplinary teams in emergency situations Improvement in global team performance: “team’s ability to complete tasks in a timely manner” and in the “team leader’s communication to the team” C
Rao et al. 2016 [149] Simulation team tasks: presentation, live-demonstration, and simulations Operating room Improvement in mean non-technical skills and concomitant increase in technical skills D
Reynolds et al. 2011 [150] Multidisciplinary simulation-based team training: introduction, presentation, simulation, and debriefing Obstetrical emergencies Improvement in knowledge, dealing with teamwork related issues, and (technical) skills (particularly relevant for obstetric nurses and for those who witness all trained obstetrical emergencies) C
Roberts et al. 2014 [151] Team communication, leadership and team behaviour training: didactic presentations, simulation, and debriefing Emergency department (ad hoc emergency teams) Changed teamwork and communication behaviour C
Rubio-Gurung et al. 2014 [152] In situ simulation training: briefing, simulation, and debriefing Delivery room Improvement in the technical skills and teamwork B
Sandahl et al. 2013 [153] Simulation team training: lectures, simulation, and debriefing Intensive care Increased awareness of the importance of effective communication for patient safety, created a need to talk, led to reflection meetings C
Shoushtarian et al. 2014 [154] Practical Obstetric Multi-Professional Training (PROMPT): lectures, scenario-based simulation training Maternity Improvement in Safety Attitude (teamwork, safety and perception of management) and clinical measures (Apgar 1, cord lactates and average length of baby’s stay in hospital) B
Siassakos et al. 2011 [155] Interprofessional training programme: updates on evidence-based guidelines and simple practical means of implementing them, high-fidelity simulation Maternity unit Positive safety culture, teamwork climate, and job satisfaction. Perceptions of high workload and insufficient staffing levels were the most prominent negative observations D
Siassakos et al. 2011 [156] Multiprofessional simulation training Maternity unit Reduction in median diagnosis–delivery interval (as indicator of teamwork) C
Silberman et al. 2018 [157] High-fidelity human simulation training: briefing, simulation, and debriefing Intensive care Facilitates teamwork, collaboration, and self-efficacy for ICU clinical practice D
Stewart-Parker et al. 2017 [158] Simulation-based S-TEAMS course: lectures, case studies, interactive teamwork exercises, simulated scenarios, debriefing Operating room Increase in confidence for speaking up in difficult situations, feeling the S-TEAMS had prevented participants from making errors, improved patient safety and team working C
Stocker et al. 2012 [159] Multidisciplinary in situ simulation programme (SPRinT) with debriefing Paediatric intensive care Impact on non-technical skills (teamwork, communication, confidence) and overall practice; less impact is perceived in technical skills C
Sudikoff et al. 2009 [160] High-fidelity medical simulation: didactic teaching, hands-on skills stations, case simulation, video-enhanced debriefing (with and without supplemental education) Paediatric emergency care Improved performance and teamwork skills; reduction in harmful actions D
Thomas et al. 2010 [161] Teamwork training: information session with examples and SBAR model, video clips, role playing, simulation, debriefing Paediatric Improvement in frequent teamwork behaviours, workload management and time to complete the resuscitation B
Weller et al. 2016 [162] Multidisciplinary Operating Room Simulation (MORSim) intervention: simulation, debriefing, and discussion Operating room Improvement in communication, culture and collaboration. But difficulties with uninterested colleagues, limited team orientation, communication hierarchies, insufficient numbers of staff exposed to MORSim and failure to prioritize time for team information sharing D
Willaert et al. 2010 [163] Patient-specific virtual reality (VR) simulation Operating room Improvement in sense of teamwork, communication, and patient safety; procedure time took longer in reality C
Yang et al. 2017 [164] Simulation-based interprofessional education course: preparation course, simulation, benchmarking, e-learning Medical centre Improvement in interprofessional collaboration attitude, self-reflection, workplace transfer and practice of the learnt skills D
General team training
Acai et al. 2016 [165] Educational creative professional development workshop: various interactive team building games, activities rooted in the dramatic arts, creative printmaking session, debriefing sessions Mental health and social care Positive impact on teams with low team cohesion prior to the intervention. Helps staff to bond, communicate, get to know each other better and accept each other’s mistakes D
Agarwal et al. 2008 [166] McMaster Interprofessional Mentorship and Evaluation (MIME) programme to increase interprofessional interactions, learn more about the roles of other healthcare professionals and improve work-life satisfaction through intentional conversations at mutually agreed times Interprofessional family health teams No significant improvement in the QWL Survey, but participant feedback from closing workshop focus groups and evaluations was positive C
Amaya-Anas et al. 2015 [167] Team training: workshops, virtual modules, time-out and checklist training, and institutional actions Operating rooms and obstetrics suites Two or more points of improvement in the average OTAS-S scores in every phase, behaviours and sub-teams C
Barrett et al. 2009 [168] Intervention on lateral violence and team building: interactive groups sessions and skill-building sessions Acute care hospital Improvement in group cohesion and the RN-RN interaction C
Bleakley et al. 2012 [169] Complex education intervention: data-driven iterative education in human factors, establishing a local, reactive close call incident reporting system, and developing team self-review (briefing and debriefing) Operating room Improvement in teamwork climate and reduction in stress recognition. No significant improvement in job satisfaction, perception of management, working conditions, safety climate B
Blegen et al. 2010 [170] Multidisciplinary teamwork and communication training: presentations, videos, role playing, and facilitated discussion Inpatient medical units Improvement in supervisor manager expectations, organizational learning,communication openness, hospital handoffs and transitions, and non-punitive response to error B
Brajtman et al. 2009 [171] Interprofessional educational intervention: interactive sessions consisting of a case study, discussions and presentation Palliative care Improvement in leadership, cohesion, communication, coordination and conflict domains D
Brajtman et al. 2012 [172] Interprofessional educational intervention: self-learning module (SLM) on end-of-life delirium and interprofessional teamwork, team objective structured clinical encounter (e.g. simulation team discussion and debriefing), and a didactic “theory burst” Long-term care facility and hospice Improvement in knowledge and perceptions of IP competence, but does depend on the presences of the module D
Brandler et al. 2014 [173] Team-based learning sessions: preparation reading, tests, and application-oriented activities Pathology Able to solve complex problems and work through difficult scenarios in a team setting D
Chan et al. 2010 [174] Intervention: educational workshop (e.g. case study using role play) and structured facilitation using specially designed materials Primary care Improvement in patient participation, empowerment in the care process, communication and collaboration C
Christiansen et al. 2017 [175] Standardized Staff Development Program: educational session (i.e. lecture) and team building and resiliency session (e.g. simulation game, rounds) Burn centre Contributed to perceived unit cohesion and increasing satisfaction and morale D
Chiocchio et al. 2015 [176] Workshops integrating project management and collaboration: active, learner-centred, practice oriented strategies, feedback, and small group discussions Interprofessional healthcare project teams Improvement in satisfaction, perceptions of utility, self-efficacy for project-specific task work, teamwork, goal clarity, coordination, functional performance of projects C
Cohen et al. 2016 [177] Allied Team Training for Parkinson (ATTP): interprofessional education training on best practices and team-based care Targeted professionals (e.g. medicine, nursing, occupational, physical and music therapies) Improvement in self-perceived, objective knowledge, understanding role of other disciplines, attitudes toward healthcare teams, and the attitudes toward value of teams B
Cole et al. 2017 [178] Elective rotation of operating room management and leadership training: curriculum consisting of leadership and team training articles, crisis management text, and daily debriefings Anaesthesiology Improvement in teamwork, task management and situational awareness D
Eklöf and Ahlborg 2016 [179] Dialogue training: multiple dialogue rounds using standardized flashcards, group discussions Hospital Improvement in participative safety (i.e. information sharing, mutual influence and sense of having a common task) and social support from managers. Qualitative data shows a positive tendency toward trust/openness A
Ellis and Kell 2014 [180] Training: theory, group exercises, presentations Paediatric ward Improvement in team cohesiveness, effectivity, and patient care D
Ericson-Lidman and Strandberg 2013 [181] Intervention to constructively deal with their troubled conscience related to perceptions of deficient teamwork: assist care providers in extending their understanding of the difficult situation and find solutions to the problem through participatory action research Elderly care Support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care D
Fallowfield et al. 2014 [182] Communication skills training: workshop (e.g. presentations, exercises, discussion, role play) Breast cancer teams Improvement in awareness and clarity about the trial(s) discussed during the training C
Fernandez et al. 2013 [183] Computer-based educational intervention: computer-based training module (e.g. presentations, clinical examples, simulation-based assessment) or a placebo training module Emergency care (and medical students) Improvement in teamwork and patient care B
Gibon et al. 2013 [184] Patient-oriented communication skills training module (e.g. information, role play) and team-resource oriented communication skills training module (e.g. information, role play) Radiotherapy Improvement in team members’ communication skills and their self-efficacy to communicate B
Gillespie et al. 2017 [185] Team training programme (TEAMANATOMY): 1-h DVD (i.e. individual and shared situational awareness theory, filmed simulation pre-operative patient sign-in, and filmed simulation of time-out procedure) Operating room Improvement in non-technical skills (communication and interactions, situational awareness, team skills, leadership and management skills and decision making). Most significant improvement observed in surgeons. Improved use of the surgical safety checklist C
Gillespie et al. 2017 [186] Team training programme (TEAMANATOMY): 1-h DVD (i.e. individual and shared situational awareness theory, filmed simulation pre-operative patient sign-in, and filmed simulation of time-out procedure) Operating room Improvement in non-technical skills (communication and interactions, situational awareness, team skills, leadership and management skills and decision making) and the use of the surgical safety checklist. No improvement in perceived teamwork. No significant increase in perceived safety climate C
Halverson et al. 2009 [187] Team training: classroom curriculum, intraoperative coaching on team-related behaviours, and follow-up feedback sessions Operating room Improvement in perception of teamwork C
Howe et al. 2018 [188] Rural interdisciplinary team training programme: didactic mini-lectures, interactive case studies discussions, video presentations, role play demonstrations and the development of an action plan Veteran affairs primary care Improvement in teamwork D
Kelm et al. 2018 [189] Mindfulness meditation training using a meditation device and smartphone application at home (e.g. education, demonstration, and practice in using device, one-page summary) Pulmonary and critical medicine physicians and ICU Improvement in teamwork, task management, and overall performance
Change in how participants responded to work-related stress, including stress in real-code situations
D
Khanna et al. 2017 [190] Training and refresher courses on the principles of the patient-centred care medical homes: participating patient-centred medical home received coaching, learning collaborative for improving teamwork, embedded care manager Primary care No significant difference in perceptions of teamwork D
Körner et al. 2017 [191] Team coaching: identification of the expectations for team coaching (need-specific), definition of the coaching goals (task-related), development of the solution (solution-focused), maintenance of the solution (systemic) Rehabilitation teams Improvement in team organization, willingness to accept responsibility and knowledge integration according to staff. No significant improvement in internal participation, team leadership, and cohesion B
Lavoie-Tremblay et al. 2017 [192] Transforming Care at the Bedside (TCAB) programme: learning modules combined with hands-on learning Multihospital academic health science centre Improvement in patient satisfaction focus, overall perceived team effectiveness, perceived team skill, perceived participation and goal agreement, perceived organizational support. No significant improvement in patient experience C
Lee et al. 2012 [193] Communication and Patient Safety (CASP) training: practical exercises, video clips, small group discussion and other learning techniques Emergency, outpatients, maternity, and special care nursery Changes in behaviour at individual, team, and facility levels C
Ling et al. 2016 [194] BASIC (Basic Assessment and Support in Intensive Care) Patient Safety Course: blended learning course with flipped classroom approach (e.g. lectures, formative assessment, interactive sessions) Intensive care Improvement in teamwork within hospital units and hospital management support for patient safety, but decreased in the frequency of reporting mistakes C
Lundén et al. 2017 [195] Drama Workshop (warm-up activities, improvizations and Forum Theatre, reflective discussions) as a learning medium Radiographers and registered nurses specialized in areas such as radiography, operating room and anaesthesia Enables participants to understand each other’s priorities better and find the best way to co-operate D
Mager et al. 2014 [196] Team-building activities: interactive activities, discussions, case studies, readings, and/or games to promote the application of teamwork skills Long-term and home care Quantitatively: no statistical improvement; qualitatively: better understanding of other provider roles C
Magrane et al. 2010 [197] Learning in Teams model: interactive workshops, daily programme team meetings, conference calls, weekly online correspondence, and colloquium Academic health centres Improvement in team skills (clarifying team charge, exploring team purpose, and evaluating team process)and institutional team performance C
Nancarrow et al. 2015 [198] Interdisciplinary Management Tool (IMT): structured reflection through reflective exercises, facilitated sessions, evaluation conference Community based rehabilitation or community rehabilitation servicesproviding transitional care for older people Empowers to understand and value their own, and others’ roles and responsibilities within the team; identify barriers to effective team work, and develop and implement appropriate solutions to these D
Prewett et al. 2013 [199] Team training: lecture, several role plays, and guided discussion for feedback Trauma resuscitation teams Improvement of behavioural choices for teamwork in the trauma room. More effective responses to teamwork issues , but no affect in case of already a positive attitudes toward teamwork D
Stephens et al. 2016 [200] Interprofessional training course: workshops, simulated a structured debriefing technique, facilitated discussion, and sustainability strategy Perioperative practitioners Improvement in team behaviours (communication, coordination, cooperation and backup, leadership, situational awareness); recognizing different perspectives and expectations within the team; briefing and debriefing D
Webb et al. 2010 [201] Emotional intelligence coaching: homework assignments, coaching sessions, goal setting Family medicine Decline in teamwork rating and no improvement on competences D
Tools: Structuring teamwork: SBAR
Beckett et al. 2009 [202] SBAR Collaborative Communication Education (e.g. didactic content, role play, and an original DVD demonstrating traditional and SBAR communication) Hospital paediatrics/perinatal services department Improvement in communication, collaboration, satisfaction, and patient safety outcomes C
Clark et al. 2009 [203] PACT (Patient assessment, Assertivecommunication, Continuum of care, Teamwork with trust) Project, aimed at improving communication between hospital staff at handover: 2 communication tools based on SBAR: Handover prompt card and reporting template Private hospital improvement in communication, handover, and confidence in communicating with doctors C
Costa and Lusk 2017 [204] SBAR educational session Behaviour health clinicians in correctional facilities Marginal improvement in communication and team structure D
Donahue et al. 2011 [205] EMPOWER project: an interdisciplinary leadership-driven communication programme (Educating and Mentoring Paraprofessionals On Ways to Enhance Reporting) using SBAR Hospital Improvement in communication from paraprofessional staff to professional staff, no significant changes in rapid events reports C
Martin et al. 2015 [206] Huddles structured with SBAR with an educational session Paediatric emergency department Improvement in teamwork, communication, and nursing satisfaction C
Randmaa et al. 2014 [207] SBAR and implementation strategies (e.g. modified SBAR card, in-house training course, information material and observation) Anaesthetic clinics Improvement in between-group communication accuracy, safety climate, the proportion of incident reports due to communication errors C
Renz et al. 2013 [208] SBAR protocol and training Nursing homes Mixed results regarding the nurse satisfaction with nurse-medical provider communication D
Rice et al. 2010 [209] Interprofessional intervention: semi-scripted four-step process during all patient-related interactions (i.e. name, role, issue, and feedback) General internal medicine No changes in communication and collaboration between health professionals D
Sculli et al. 2015 [210] Effective Followership Algorithm: 3Ws (what I see; what I’m concerned about; what I want), 4-Step Assertive Tool, Engage team, Chain of command Paediatric and adult operating rooms Improvement in safety culture, teamwork, team performance C
Ting et al. 2017 [211] SBAR Collaborative Communication Education: educational session, case-based discussion, video demonstration on traditional and SBAR communication Obstetrics department Improvement in teamwork climate, safety climate, job satisfaction, and working conditions D
Weller et al. 2014 [212] Video-intervention teaching SNAPPI tool: Stop the team; Notify of the patient’s status; Assessment of the situation; Plan what to do; Priorities for actions; and Invite ideas Anaesthesiology Improvement in SNAPPI score, number of diagnostic options, information sharing. No significant improvement in information probe sharing and medical management (in intervention group) C
Tools: Structuring teamwork: (De)briefing checklist
 Berenholtz et al. 2009 [244] Standardized one-page briefing and debriefing tool Operating room Improvement in interdisciplinary communication and teamwork C
 Bliss et al. 2012 [213] Comprehensive surgical safety checklist (using pre-operative briefing and post-operative debriefing checklists) and a structured team training curriculum Surgery Decrease in 30-day morbidity. Cases with safety-compromising events (e.g. inadequate communication, decision making), had higher rates of 30-day morbidity B
 Böhmer et al. 2012 [214] Modified perioperative surgical safety checklist Operating room Improvement in interprofessional coordination and communication D
 Böhmer et al. 2013 [215] Perioperative safety checklists Anaesthesiology and traumatology Improvement in verification of written consent for surgery, clear marking of the surgical site, time management, better informed about the patients, the planned operation, and the assignment of tasks during surgery in both short and long terms. Decrease in communication over longer time periods. B
 Boet et al. 2011 [245] Self-debriefing versus instructor debriefing Hospital Improvement in situational awareness, teamwork, decision making, task management, total non-technical skills, regardless of the type of debriefing received B
 Boet et al. 2013 [246] Interprofessional within-team debriefing compared to an instructor-led debriefing Operating room Improvement in team performance regardless of the type of debriefing. No significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing C
 Cabral et al. 2016 [216] Standardized, comprehensive time-out and a briefing/debriefing process using surgical safety checklist Surgery Improvement of nurses’ perception of communication. No significant improvement of surgeons and technologists perception of communication C
 Calland et al. 2011 [220] Surgical safety checklists (intervention group included a basic team training using a pre-procedural checklist) Surgery Improvement in team behaviour, defined as discrete, objective, observable shared communication behaviours; more likely to involve positive safety-related team behaviours such as case presentations, explicit discussions of roles and responsibilities, contingency planning, equipment checks, and post case debriefings; no significant differences in situational awareness A
 Dabholkar et al. 2018 [218] Customized surgical safety checklist Surgery Improvement in verification of patient’s identity, awareness of operating team members’ names and roles, practice of displaying radiological investigation during surgery, pre-check of equipment and communication B
 Dubois et al. 2017 [219] Person-centred endoscopy safety checklist (introduces during seminars and training) Endoscopy unit Improvement in quality of collaboration with nurses and perception. No differences in teamwork D
 Einav et al. 2010 [247] Pre-operative team briefings (briefing protocol and poster) Operating room 25% reduction in the number of non-routine events when briefing was conducted and a significant increase in the number of surgeries in which no non-routine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety C
 Erestam et al. 2017 [220] Revised surgical safety checklist Operating room No significant change in teamwork climate. Lack of adherence to the checklist was detected C
 Everett et al. 2017 [221] Critical event checklists Surgical daytime facility No improvement in medical management or teamwork (during simulation) C
 Gleicher et al. 2017 [248] Standardized handover protocol consisting of a handover content checklist and a “sterile cockpit” time-out Cardiovascular intensive care Improvement in teamwork, content received and patient care planning C
 Gordon et al. 2014 [222] Pre-procedure checklist Cardiac catheterization laboratory No improvement in complication rates, overall team and safety attitudes C
 Hardy et al. 2018 [223] Malignant hyperthermia checklist Anaesthesiology Improvement in non-technical skills in the experiment group. Higher self-reported stress in the experiment group C
 Haugen et al. 2013 [224] Surgical safety checklist Operating room Improvement in frequency of events reported and adequate staffing. No significant improvement in patient safety, teamwork within units, communication on error, hospital management promoting safety B
 Haynes et al. 2011 [225] Checklist-based surgical safety intervention Operating rooms Improvement in teamwork and safety climate C
 Helmiö et al. 2011 [226] Surgical safety checklist Operating room Improvement in verification of the patient’s identity, awareness of the patient’s medical history, medication and allergies, knowledge of the names and roles among the team members, discussion about possible critical events, recording post-operative instructions, communication between team members B
 Howe et al. 2014 [249] Long-term care team talk programme involved regularly scheduled 5-min debriefing sessions at the end of the day shift led by a rotating schedule of certified nurse Transitional care unit in long-term care facility Improvement in co-worker and supervisor support, teamwork and communication, job demands and decision authority, characteristics of the unit and intent to leave/transfer unit C
 Jing and Honey 2016 [227] Robotic-assisted laparoscopic radical prostatectomy checklist Operating room Improvement in teamwork, time efficiency, higher confidence levels and more comprehensive operating room setup D
 Kawano et al. 2014 [228] Surgical safety checklist Surgery Improvement in the Safety Attitude Scores C
 Kearns et al. 2011 [229] Modified surgical safety checklist Obstetric theatre Improvement in interprofessional communication, familiarity with team members, and checklist compliance C
 Kherad et al. 2018 [230] Endoscopy checklist implementation (with lectures by quality officers) Endoscopy Improvement in team work and communication, patient perception of team communication and teamwork. No significant improvement in team perception C
 Khoshbin et al. 2009 [250] “07:35 huddles” (pre-operative OR briefing following 4 elements) and “surgical time-outs” (pre-operative OR briefing following 9 elements) Paediatric hospital Especially for the nursing personnel, change the notion of individual advocacy to one of teamwork and being proactive about patient safety C
 Lepanluoma et al. 2014 [231] Surgical safety checklist Operating room Improvement in communication between the surgeon and the anaesthesiologist. Safety-related issues were better covered. No improvement in awareness. Improvement in unplanned admission rates and number of wound complications D
 Lingard et al. 2008 [251] Team briefing structured by a checklist General surgery Improvement in number of communication failures and proactive and collaborative team communication C
 Low et al. 2013 [232] “Flow checklists” at high-risk points in the patient surgical journey, in addition to the surgical safety checklist Ambulatory surgery centre Improvement in the perception of patient safety D
 McLaughlin et al. 2014 [252] Time-Out Process: (1) team member introductions, (2) safety statement by the time-out leader, (3) addition of two supplemental items to the institutional checklist, and (4) pre-incision Surgical Care Improvement Project measures Neurosurgery in operating room Improvement in the perception of patient safety, team spirit, voice safety concerns. Does not necessarily reinforce teamwork. D
 Merrell et al. 2018 [233] Emergency manual consisting of a set of crisis checklists or cognitive aids Operating room Enabled perceived effective team functioning through reducing stress, fostering a calm working environment and improvement teamwork and communication D
 Mohammed et al. 2013 [234] Obstetric safe surgery checklist Anaesthetists and obstetricians Improvement in communication of caesarean section grade (urgency) between obstetricians and anaesthetists C
 Molina et al. 2016 [235] Surgical safety checklists Operating room Improvement in respect, clinical leadership, assertiveness, coordination, and communication A
 Nadler et al. 2011 [253] Debriefings using video recordings Neonatal resuscitation Improvement in teamwork C
 Nilsson et al. 2010 [236] Pre-operative checklist during time-out Operating room Improvement in “team feeling” D
 Norton et al. 2016 [237] Novel paediatric surgical safety checklist Operating room at paediatric hospital Reduced complications and errors and improved patient safety, communication among team members, teamwork in complex procedures, efficiency in the operating room, prevented or averted an error or a complication C
 Nundy et al. 2008 [254] Pre-operative briefings using a standardized format (with training session) Operating room Reduction in unexpected delays and communication breakdowns leading to delays B
 Paige et al. 2009 [255] Pre-operative briefing protocol Operating room Improvement in pre-operative briefing and overall team interaction; no significant improvement in procedure time D
 Pannick et al. 2017 [256] Prospective clinical team surveillance (PCTS): structured daily interdisciplinary briefings to capture staff concerns, with organizational facilitation and feedback Medical ward Improvement in safety and teamwork climates, reduction in excess length of stay (eLOS) B
 Papaconstantinou et al. 2013 [238] Surgical safety checklist Surgery Improvement in the awareness of patient safety and quality of care, the perception of the value of and participation in the time-out process, surgical team communication, and in the establishment and clarity of patient care needs B
 Papaspyros et al. 2010 [257] Pre-operative briefing with checklist and debriefing Cardiac operating room Improvement in communication D
 Sewell et al. 2011 [239] Educational programme focused on using the surgical safety checklist Orthopaedic surgery Increase in checklist use, believe that the checklist improved team communication; checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery B
 Skåre et al. 2018 [258] Video-assisted, performance-focused debriefings Delivery Improvement in Neonatal Resuscitation Performance Evaluation (NRPE) score: group function/communication, preparation and initial steps and positive pressure ventilation C
 Steinemann et al. 2016 [259] Structured physician-led briefing (using a checklist) Trauma care Improvement in T-NONTECH leadership scale (not the other domains) and task completions (not for all scenarios) C
 Takala et al. 2011 [240] Surgical safety checklist Operating room Improvement in confirming patient’s identity, knowledge of names and roles among team members, discussing critical events, and fewer communication failures A
 Tscholl et al. 2015 [241] Anaesthesia pre-induction checklist, in addition to the surgical safety checklist Anaesthesiology Improvement in information exchange, knowledge of critical information, perception of safety in anaesthesia teams, perceived teamwork A
 Urbach et al. 2014 [242] Surgical safety checklist Operating room Implementation is not associated with significant reductions in operative mortality or complications B
 Wagner et al. 2014 [260] Mental health huddles (similar to safety briefings) to support staff in discussing and managing client responsive behaviours Long-term care improvement in staff collaboration, teamwork, support, and communication D
 Weiss et al. 2017 [261] After events reviews (AER): assertiveness-specific AER (ASAER) versus teamwork-generic AER (TGAER) Healthcare teams Improvement in nurses speaking up following the ASAER in comparison to TGAER and higher levels of hierarchy-attenuating beliefs following the ASAER in comparison to TGAER C
 White et al. 2017 [243] Four-day pilot course for implementation of surgical safety checklist Hospital (low-income setting) Improvement in learning, behaviour and organizational change (not hierarchical culture) D
 Whyte et al. 2009 [262] Structured pre-operative team briefings (using a checklist) Pre-operative teams Five types of negative events: the briefings could mask knowledge gaps, disrupt positive communication, reinforce professional divisions, create tension, and perpetuate a problematic culture D
 Zausig et al. 2009 [263] Two different training groups: one included extensive debriefing of NTS (resource management, planning, leadership and communication) and medical management and the other included a simpler debriefing that focused solely on medical management Anaesthesiology Improvement in non-technical skills; no differences between the groups D
Tools: Structuring teamwork: Rounds
 Genet et al. 2014 [264] Respiratory therapist (RT)-led interdisciplinary rounds using a scripted tool (with education session) Neonatal ICU Improvement in communication, teamwork, and timeliness of completing respiratory orders B
 Henkin et al. 2016 [265] Bedside rounding: inclusion of nurses in morning rounds with the medicine teams at the patients’ bedside, using a checklist General medicine inpatient teaching unit Improvement in the perceptions of nurse–physician teamwork C
 Li et al. 2018 [266] Interprofessional Teamwork Innovation Model (ITIM): structured daily rounds Academic medical centre Improvement in communication among team members and overall time savings. Reduction in 30-day same-hospital readmissions, no impact on 30-day same-hospital ED visits or costs B
 O’Leary et al. 2010 [267] Structured Interdisciplinary Rounds combined a structured format for communication and a forum for regular interdisciplinary meetings Tertiary care teaching hospital Improvement in teamwork climate in intervention group (compared to control group) B
 O’Leary et al. 2011 [268] Structured Interdisciplinary Rounds: combined a structured format for communication with a forum for regular interdisciplinary meetings General medical unit in hospital Improvement in quality of communication and collaboration with hospitalists, teamwork and safety climate C
 O’Leary et al. 2015 [269] Structured Interdisciplinary Rounds and prepared nurse–physician co-leadership General medical units Improvement in teamwork but no reduction in Adverse Events C
 Young et al. 2017 [270] Multidisciplinary Bedside Rounding Initiative, which included creating nursing availability, streamlining provider communication, and performance monitoring and feedback Hospital Improvement in teamwork climate, nurse job satisfaction, and early discharges D
Tools: Facilitating teamwork
Butler et al. 2018 [271] Telemedicine technology in care delivery Emergency care No differences in teamwork between control and experiment groups. Higher workload in experiment group B
Chu-Weininger et al. 2010 [272] Remote monitoring by intensivists using telemedicine technology (tele-ICU) Intensive care Improvement in teamwork climate and safety climate B
Doyle et al. 2016 [273] Remote information technology (education session, teleconferences, web-based team case presentations) Mental health services for older people Improvement in professional development, perceived peer support, team building, cohesion, and reduce travel time D
Foo et al. 2015 [274] Mobile task management tool (digitize patient flow and provide real-time visibility over clinical decision making and task performance) Acute general surgical service Improvement in working efficiency of junior clinical staff C
Letchworth et al. 2017 [275] MedNav; a decision support tool on a tablet or mobile phone with integrated vocal prompts and visual cues Maternity teams Improvement in teamwork based on all domains of Clinical Teamwork Scale and Global Assessment of Obstetric Team Performance B
O’Connor et al. 2009 [276] Using wireless e-mail in order to send information-rich, specific, legible, and time-stamped messages Intensive care Improvement in communication, team relationships, staff satisfaction, and patient care D
Yeh et al. 2016 [277] Ping-pong-type multidisciplinary reflective e-communication (within web-based integrated information platform) Radiation oncology Higher Timeliness, Notating convenience, Information completeness, Feedback convenience, Communication confidence, Communication effectiveness, Review convenience and overall satisfaction C
Tools: Triggering teamwork
Aberdeen and Byrne 2018 [278] Concept mapping visually representing a patient’s situation Residential aged care facilities Improvement in effectiveness of care planning and knowledge increase of dementia care D
Ainsworth et al. 2013 [279] Door Communication Card (DCC) to improve goal alignment Surgical ICU academic military medical No improvement in goal alignment D
Bennett et al. 2015 [280] Sharing clinical cases and stories about patients (during workshops) Primary care clinical setting Helped in bonding around their shared mission of patient-centred care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale D
Daley et al. 2012 [281] Clinical dashboard system Acute elderly care Improvement in access to information, communication and information sharing, staff awareness, and data quality D
O’Neil et al. 2017 [282] Thought for the Day (TOD) intervention; a short reflection on a piece of poetry, music, or religious writing Inpatient palliative care Improvement in perception of teamwork. Coming together as an interdisciplinary team for a time to reflect is valued D
Siegele 2009 [283] The Daily Goals Tool (DGT) and Daily Goals Tool Reference (DGTR) Surgical intensive care Helps in simplifying complex tasks, improving teamwork, promoting effective communication and shared decision making, and enhancing patient safety D
Stoller et al. 2010 [284] Respiratory therapy (RT) business scorecard that compared target goals with actual monthly performance Respiratory therapy departments Improvement in teamwork among RT departments and outcomes D
Organizational (re)design
Barry et al. 2016 [285] Behavioural Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery, include holding daily huddles and longer weekly interdisciplinary team meetings Veterans Health Administration mental health care Improvement in teamwork and patient care and has potential to improve staff working relationships, communication, collaboration, morale, and veteran treatment consistency D
de Beijer et al. 2016 [286] Clinical pathways: standardizing treatment and communication methods, delegating tasks from medical specialists to nurses, and providing nurses with their own consultation room Orthopaedic hand unit outpatient clinic Improvement in the actual communication and collaborative problem-solving skills concerning standard patients D
Clements et al. 2015 [287] Allocating the most senior nurse as team leader of trauma patient assessment and resuscitation Emergency department Improvement in understanding of their role, “intimidating personality”, and nursing leadership C
Deneckere et al. 2013 [288] Care pathways: (1) Formative evaluation of the teams’ performance before implementation, (2) Evidence-based KI, and (3) Training in pathway development Acute hospital Improvement in conflict management, team climate for innovation, level of organized care, risk of burnout, emotional exhaustion, and competence. No significant improvement in relational coordination B
Fernandez et al. 2010 [289] Two models: The multifaceted Shared Care in Nursing (SCN) model of nursing careinvolved team work, leadership and professional development. In the Patient Allocation (PA) model one nurse was responsible for the care of a discrete group of patients General medical and surgical wards in tertiary teaching hospital The two models of care support most aspects of interdisciplinary and intra-disciplinary communication C
Fogel et al. 2016 [290] Patient-focused primary care redesign Continuity clinic settings Improvement in teamwork training, teamwork among residents, perception of overall quality of care in clinic, and that physicians, nurses, and administrative staff worked together to optimize patient flow C
Frykman et al. 2014 [291] Multiprofessional teamwork involving changes in work processes, with task-generated feedback, managerial feedback, aimed at increasing interprofessional collaboration Emergency department Enabled teamwork C
Greene et al. 2015 [292] Innovative compensation model: replaced fee-for-service payment with a largely team based, quality-focused payment, 40% of compensation was based upon the clinic-level quality performance, and an additional 10% was based upon the clinic-level patient’s experience Primary care Mixed results: quality improvement for the team and less patient “dumping,” or shifting patients with poor outcomes to other clinicians, but also lack of control and colleagues riding the coattails of higher performers. mixed results: greater interaction with colleagues, but also an increase in tension C
Hern et al. 2009 [293] Quality improvement intervention: creation of team structures linking faculty advisors and residents with patients, intra-team management of office tasks, and the implementation of multidisciplinary team meetings Family medicine Improvement in perceptions of continuity of patient care, office efficiency, and team communication C
Hung et al. 2018 [294] Redesign consisting of multiple workflow changes: (1) “5S” standardization of medical equipment, supplies and education materials in patient exam rooms, (2) redesign of call centre functions, (3) co-location of existing care teams and (4) redesign of care team roles and workflows Ambulatory care primary care departments Improvement in teamwork, participation in decisions to improve care by physicians, engagement among physicians and motivation among Non-physicians staff C
O’Leary et al. 2009 [295] Localizing physicians to specific patient care units Hospital Nurses and physicians wereable to identify one another and communicated more frequently B
Pan et al. 2017 [296] An operating room (OR) assistant using an instructional supervision programme Operating room Improvement in first cases that started on time, percentage of teamwork score and patient satisfaction B
Parush et al. 2017 [297] Employ technological cognitive aids at ED Emergency Department Improvement in teamwork; overall communication, situational awareness (as measured by CTS and not SAGAT), and decision making D
Pati et al. 2015 [298] Decentralized unit operations and the corresponding physical design Inpatient units Potentially improvement in quality of work D
Stavroulis et al. 2013 [299] Integrated theatre environment: a superior operating environment in which the laparoscopic equipment and multiple flat-screen monitors are permanently installed to be operational on demand inside the theatre Operating room Improvement in perceived efficiency, teamwork and stress levels C
Stepaniak et al. 2012 [300] Fixed operating room (OR) teams for a day instead of OR teams that vary during the day Operating room (bariatric surgery) Reduced procedure durations and improved teamwork and safety climate, without adverse effects on patient outcomes B
Programme
Basson et al. 2018 [301] Multifaceted intervention consisting of monthly walking rounds by the director and an interactive learning session focused of feedback of culture data, educational training programme, and unit-based programme for safety Veterans administration hospital leaders No improvement on most items of the SAQ and AHRQ Hospital Safety Survey. Improvement in responding to errors and expressing disagreement with physicians. Decrease of perception of leadership’s safety efforts and levels of staffing D
Bunnell et al. 2013 [302] For each identified risk area, agreements about roles, responsibilities and behaviours of each team member were made. Tools were developed and systems modified to enhance situational awareness and a shared mental model among team members, and to support implementation of the agreements Ambulatory clinical oncology practice Improvement in patient satisfaction scores regarding coordination of care, efficiency safety of care, more respectful behaviour, relationships among team members. No significant improvement in non-communication C
Braithwaite et al. 2012 [303] System-wide intervention promoting interprofessional collaboration; implementing educational workshops and seminars, feedback sessions, project, and other initiatives Health professionals across entire health system Most agreement on improvement in sharing of knowledge between professions and improved quality of patient care, and least agreement that between-professional rivalries had lessened and communication and trust between professions improved B
Carney et al. 2011 [304] Medical team training programme: preparations, learning sessions, implementing projects including briefing and debriefing, coaching Operating room in Veterans Health Administration Improved perceptions of safety climate B
Carney et al. 2011 [305] Medical team training programme: preparations, learning sessions, implementing projects including briefing and debriefing, coaching Veterans Health Administration Improvement in teamwork climate B
Costello et al. 2011 [306] OR Transformation Project: OR day redesign, workflow, human resources analysis, supply and technology, and quality of work life Operating room Improvement in work practices, recognition/ compensation, communication, commitment, physical/environmental safety, teamwork, and respect C
Ginsburg and Bain 2017 [307] Multifaceted intervention programme to promote speaking up and teamwork consisting a role-playing simulation workshop, discussion briefings and other department-led initiatives such as 10-min staff huddles Emergency department and intensive care Improvement in team climate score at follow-up B
Hilts et al. 2013 [308] The Quality in Family Practice (QIFP) programme encompasses clinical and practice management using a comprehensive tool of family practice indicators Academic primary care clinics Improvement in understanding of team roles and relationships, teamwork, flattening of hierarchy through empowerment D
Hsu et al. 2015 [309] Multifaceted intervention included Comprehensive Unit-based Safety Program (CUSP), the daily goals communication tool, and 5 evidence-based practices (i.e. hand washing, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site, and removing unnecessary catheters) Adult intensive care Improvement in safety climate, job satisfaction, and working conditions B
Hsu et al. 2014 [310] Team Resource Management (TRM) programme: simulative learning workshop (e.g. lectures, videos, case-based interactive discussions), focus group interviews, develop TRM-based checklists, working sheets, and re-designed organ procurement and transplantation processes, video skill demonstration and training, case reviews and feedback activities Hospital No significant improvement on teamwork (i.e. teamwork framework, leadership, situational awareness, communication, mutual support); no error in communication or patient identification was noted C
Je et al. 2013 [311] Hospital-wide quality improvement programme: forming committee to review the system, implemented a dedicated communication system, standardizationon of role, training, implementing a standard reporting system Hospital Improvement in safety attitude (i.e. sharing information, training, medical error reporting, safety climate, job satisfaction, communication, hospital management quality) B
Kotecha et al. 2015 [312] Quality Improvement Learning Collaborative Program: learning sessions, action periods to develop improvement plans, and summative congresses supported by QI coaches, teleconferences, and a web-based virtual office Primary care Improvement in trust and respect for each other’s clinical, administrative roles, collegial relationships, collapse professional silos, communication, and interdisciplinary collaboration D
Lin et al. 2018 [313] Safety Program for Surgery: Comprehensive Unit-based Safety Program (CUSP) and individualized bundles of interventions Hospitals Improvement in overall perception/patient safety, teamwork across units, management support for patient safety, non-punitive response to error, communication openness, frequency of events reported, feedback/communication about error, organizational learning/continuous Improvement, supervisor/manager expectations and actions promoting safety, and teamwork within units B
McArdle et al. 2018 [314] Safety Program for Perinatal Care (SPPC, adapted CUSP): TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects), and establishing an in situ simulation programme Labour and delivery Improvement in the se of shoulder dystocia safety strategies, in situ simulation, teamwork and communication, standardization, learning from defects, and independent checks B
McCulloch et al. 2017 [315] Four-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean qualityimprovement, SOP + TT combination, or Lean+TT combination Operating room TT: improvement in non-technical skills and WHO compliance, but not technical performance. Systems interventions (Lean and SOP): improvement in non-technical skills and technical performance, WHO compliance. Combined interventions: improvement in all performance measures except WHO time-out attempts, whereas single approaches improved WHO compliance less and failed to improve technical performance B
Neily et al. 2010 [316] Medical team training programme: preparation, learning session, implementing briefings, debriefings and other projects (i.e. SBAR, Interdisciplinary rounds, Fatigue management), follow-up coaching Surgical care in Veterans Health Administration Improvement in teamwork, efficiency, avoiding an undesirable event C
Neily et al. 2010 [5] Medical team training programme: preparation, learning session, implementing projects, follow-up coaching Operating room in Veterans Health Administration Lower surgical mortality and improvement in open communication and staff awareness A
Pettker et al. 2011 [317] Comprehensive Obstetrics Patient Safety Program: (1) obstetrics patient safety nurse, (2) protocol-based standardization of practice, (3) CRM training, (4) oversight by a patient safety committee, (5) 24-h obstetrics hospitalist, and (6) anonymous event reporting system Hospital Improvement in proportion of staff members with favourable perceptions of teamwork culture, safety culture, job satisfaction, and management. No significant improvement in stress recognition B
Pitts et al. 2017 [318] Comprehensive Unit-based Safety Program (CUSP): training, safety assessment, select safety priorities Primary care No significant improvement in safety climate and teamwork D
Pronovost et al. 2008 [319] Comprehensive Unit-based Safety Program including implementing CUSP (i.e. 6-step iterative process), daily goals communication strategy, and toolkit included materials for staff education, redesign of work processes, support of local opinion leaders, and evaluation of performance Intensive care Improvement in teamwork climate B
Sexton et al. 2011 [320] Comprehensive Unit-based Safety Program (CUSP): educate teams, identify, prioritize, and eliminate patient safety hazards, senior leader’s role, tools for learning and improving communication Intensive care Improvement in safety climate B
Stapley et al. 2017 [321] The Situation Awareness For Everyone (SAFE) programme: huddle, SBAR, and paediatric early warning systems (PEWS) Clinical wards Improvement in awareness of important issues, communication, teamwork, and a culture of increased efficiency, anticipation and planning on the ward. But added pressure on staff time and workload, and the potential for junior nurses to be excluded from involvement D
Timmel et al. 2010 [322] Comprehensive Unit-Based Safety Program (CUSP) including 6 steps: Science of safety training educational curriculum, Identify safety hazards, Senior executive partnership, Learn from defects, Implement improvement tools, such as team-based goals sheet, including nurses on rounds to form an interdisciplinary team Surgical inpatient units Improvement in safety climate, teamwork climate, and nurse turnover rates B
Wolf et al. 2010 [323] Medical team training programme: preparation, classroom learning session, checklist-guided briefings and debriefings, formation of a problem-solving Executive Committee, follow-up and feedback Operating room in Veterans Health Administration Improvement in case delays, mean case score, frequency of pre-operative delays, handoff issues, equipment issues/delays, perceived management and working conditions. No significant improvement in teamwork climate, safety climate, job satisfaction, stress recognition B