Team Training Interventions Research Articles

Evaluation of a Brief Team Training Intervention in Surgery: A Mixed-Methods Study

The aim of this study was to evaluate a brief team training program in relation to teams’ observed nontechnical skills (NTSs) in surgery, teams’ perceptions of safety culture, and the training implementation. We used mixed methods to analyze structured observations of 179 surgeries, semistructured interviews with surgical team members from four selected surgical specialties, and a survey. There were significant (P < .001) improvements in surgical teams’ observed NTSs and in the use of the World Health Organization’s Surgical Safety Checklist after participation in the training program. Nonsignificant results included increased perceived safety climate and decreased perceived teamwork climate. From participant interviews, we identified that production pressure and time constraints were the biggest barriers to implementation and the greatest enabler was the organization’s support for staff education initiatives. Most participants perceived the content of the program to be useful. These results highlight the complexities inherent in the development and evaluation of interdisciplinary patient safety interventions.

Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study.

Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.

Reducing Surgery Scheduling Errors in Multihospital System.

The purpose of this study was to assess whether bundled team training interventions for surgeons and office staff could effectively improve the accuracy of surgery scheduling, minimizing scheduling factors that may contribute to occurrence of wrong site surgery. This quasi-experimental observational study used an interrupted time series design to explore surgery scheduling errors (SSEs) and implemented bundled team training interventions intended to reduce SSEs at a Pacific Northwest Regional Surgery Scheduling Department. Each preintervention and postintervention segment consisted of 16 weekly data points. The bundled team training interventions included disclosure of preintervention scheduling errors, a scheduling verification checklist, an updated surgery scheduling policy and procedure, and toolkit to improve office scheduling of surgeries. Improvements in SSEs were observed preintervention to postintervention, with decreased surgery SSE rate from 0.51% to 0.13% (P < 0.001). Reductions were observed in all SSE types. The segmented linear trend demonstrated an observed reduction of 42.70 SSE (P < 0.001). This is the first study conducted at a large healthcare system with a regional surgery scheduling department to demonstrate that statistically significant and clinically important reductions in SSEs can be achieved. The findings demonstrate that SSEs can be minimized and confirm that verification processes must begin in the surgeon's office once a decision has been reached to proceed with surgery. The study confirms the need for additional research targeted at understanding why SSEs occur at the time of scheduling.

From cockpit to operating theatre to drilling rig floor: five principles for improving safety using simulator-based exercises to enhance team cognition

For over 30 years, aviation has conducted training courses to enhance team performance and improve safety involving simulation with observation and directed feedback. Participants’ performance is observed by trained and experienced observers who then provide feedback using behaviour-based evidence noted during the simulator exercise. More recently, in healthcare, operating theatre personnel have adopted simulator-based training (SBT), observation and feedback for learning and practice to reduce the potential for human errors and improve safety. Maritime and nuclear power also incorporate high-fidelity simulators and feedback in team training interventions including technical and non-technical skills. The design and development of drilling rig simulators means that drill crews can now practise and test out their decision-making and receive feedback from observers, with the aim of improving team non-technical skills and consequently reducing the potential for errors. This paper presents five principles gleaned from research and the experiences of both aviation and healthcare to be applied to the development of simulator-based exercising for drilling teams. The principles include: (a) developing learning objectives and expected performance standards; (b) training the team as a whole; (c) using a structured observation tool; (d) providing feedback during a structured debrief; (e) repeat the SBT regularly to enhance expertise and retain performance standards. It is anticipated that these principles can be generalised for simulator-based exercising to benefit team social and cognitive competences in other high-hazard or process industries.

TeamSTEPPS for health care risk managers: Improving teamwork and communication.

Ineffective communication among the health care team is a leading cause of errors in the patient care setting. Studies assessing training related to communication and teamwork in the clinical team are prevalent, however, teamwork training at the administrative level is lacking. This includes individuals in leadership positions such as health care risk managers. The purpose was to determine the impact of an educational intervention on the knowledge and attitudes related to communication and teamwork in the health care risk management population. The educational intervention was an adaptation of a national teamwork training program and incorporated didactic content as well as video vignettes and small group activities. Measurement of knowledge and attitudes were used to determine the impact of the education program. Knowledge and attitudes were assessed pre- and postcourse. Findings indicate that teamwork education tailored to the needs of the specific audience resulted in knowledge gained and improved attitudes toward the components of teamwork. The attitudes that most significantly improved were related to team structure and situation monitoring. There was no improvement in participants' attitudes toward leadership, mutual support, and communication. Team training has been shown to improve safety culture, patient satisfaction, and clinical outcomes. Including risk managers in training on teamwork, communication, and collaboration can serve to foster a common language among clinicians and management. In addition, a measurement related to implementation in the health care setting may yield insight into the impact of training. Qualitative measurement may allow the researcher to delve deeper into how these health care facilities are using team training interventions.

Complex social intervention for multidisciplinary teams to improve patient referrals in obstetrical care: protocol for a stepped wedge study design.

IntroductionIn obstetrics, patients often experience referral situations between different care professionals. In these multidisciplinary teams, a focus on communication and interprofessional collaboration is needed to ensure care of high quality. Crew resource management team training is increasingly being applied in healthcare settings to improve team performance and coordination. Efforts to improve communication also include tools for standardisation such as SBAR (situation, background, assessment, recommendation). Despite the growing adoption of these interventions, evidence on their effectiveness is limited, especially on patient outcomes. This article describes a study protocol to examine the effectiveness of a crew resource management team training intervention aimed at implementing the SBAR tool for structured communication during patient referrals in obstetrical care.Methods and analysisThe intervention is rolled out sequentially in five hospitals and surrounding primary care midwifery practices in the Netherlands, using a stepped wedge design. The intervention involves three phases over a period of 24 months: (1) preparation, (2) training and (3) follow-up with repeated measurements. The primary outcomes are perinatal and maternal outcomes calculated using the Adverse Outcome Index. The secondary outcomes are the reaction of participating professionals to the training programme, attitudes towards safety and teamwork (Safety Attitudes Questionnaire), cohesion (Interprofessional Collaboration Measurement Scale), use of the tool for structured communication (self-reported questionnaire) and patient experiences. These secondary outcomes from professional and patient level allow triangulation and an increased understanding of the effect of the intervention on patient outcomes.Ethics and disseminationThe study was approved by the Medical Ethical Committee of the VU University Medical Centre in the Netherlands and the protocol is in accordance with Dutch privacy regulations. Study findings will be presented in publications in peer-reviewed journals and presentations at scientific conferences.Trial registration numberNTR4256; Pre-results.

Reframing implementation as an organisational behaviour problem.

The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the "black box" of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

Team training in obstetrics: A multi-level evaluation.

Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB. An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick's (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews. Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies' hospital length of stay. These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

BackgroundInterdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation.MethodsConsidering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis.ResultsThe exploration of team members´ and clinical managers´ descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions).ConclusionsThe synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

Social support at the workplace, motivation to transfer and training transfer: a multilevel indirect effects model

Supervisor support, peer support and transfer motivation have been identified as important predictors of training transfer. Transfer motivation is thought to mediate the support–training transfer relationship. Especially after team training interventions that include all team members (i.e. whole‐team training), individual perception of these factors might be shared among team members. However, an integration of the team level in the training transfer process is rare, yet still needed. Analyzing 194 employees from 34 teams in the context of whole‐team training interventions, we found similar relationships and processes at both levels of analysis: social support enhances transfer motivation at the individual and team levels. Furthermore, motivation to transfer increases training transfer and serves as a connecting mechanism in the social support–training transfer link. The results underline the importance of: (1) considering multiple levels in theories and research about the training transfer process; and (2) ensuring the practice of individual‐directed support and a shared, supportive climate within teams.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per-procedure prevalence of surgical fires is not known. Root-cause analyses suggest the need for improved communication. Despite promising approaches and global Universal Protocol evaluations, empirical evidence for interventions is limited.

Board #165 - Research Abstract Transmural Multi-professional Simulation-based Obstetric Team Training and Its Effect on Quality of Care as Perceived by Women Who Recently Gave Birth (Submission #9135)

Hypothesis Several studies have shown that many adverse events in obstetrics can be explained by ineffective teamwork and communication. Recent data has shown that women who had been referred to the hospital reported lower quality of care.1 In the Netherlands, obstetric care is organized in primary care (represented by independent midwives providing care to women with low-risk pregnancies) and secondary care (responsible for high-risk pregnancies). About 65% of all pregnant women are referred from the primary to secondary care during pregnancy or labour,2 resulting in multiple medical handovers. Besides medical outcome, patient-reported outcomes are becoming more important as indicators of care quality.3 If communication and collaboration between and within different care levels improves, the perceived quality of care will increase. We hypothesized transmural multi-professional simulation-based obstetric team training to improve quality of care as perceived by women who gave birth. Methods An experimental study with simulation-based obstetric team training in the area of a hospital in the Netherlands. In five groups, 75 care providers were trained in a medical simulation center. The transmural teams represented the obstetric collaborative network consisting of: ambulance personnel, maternity nurses, community midwives, obstetric nurses, hospital midwives, residents, and obstetricians. The one-day training focused on non-technical skills like teamwork and communication using SBAR communication and crew resource management (CRM). To measure quality of care as perceived by women, the Pregnancy & Childbirth Questionnaire (PCQ) 1 was assessed at six weeks postpartum, before the training (sample I, N=76) and three months after the training (sample II, N=68). The 25-item PCQ consists of three subscales: personal treatment during pregnancy, educational information, and personal treatment during delivery, with higher scores indicating better perceived quality of care. Results At baseline, a PCQ mean total score of 103.5 [11.6] (M[SD]) was measured at six weeks postpartum (N=76). Three months after the team training intervention, a higher PCQ total score of 108.9 [10.9] was reported (N=68), indicating a significant increase in perceived quality of care (t=2.75, p=0.007). The effect size of the increase in PCQ total score was medium (Cohen’s d=0.5). Moreover, the subscales ‘personal treatment during pregnancy’ and ‘educational information’ showed a significant increase after the team training (p<0.01), while the subscale ‘personal treatment during delivery’ did not. The items with the largest significant increase in mean scores included: communication between care providers, clear leadership, involvement in planning, and better provision of information. Conclusion Transmural multi-professional simulation-based obstetric team training improves quality of care as perceived by women who recently gave birth.

Team members' interaction anxiety and team-training effectiveness: a catastrophic relationship?

In the present study, we examined the relationship between team members' interaction anxiety and team-training effectiveness. Training in the context of teams can be focused on either individual or team outcomes. Relatedly, the individual differences of team members can hinder or facilitate the effectiveness of training for both individuals and the team as a collective. Interaction anxiety is an understudied individual difference that has been shown to be negatively related to training effectiveness in individual contexts. However, its effects in team-training contexts are yet to be investigated. A sample of 492 students in 123 four-person teams was trained to operate a complex, computer-based team task Interaction anxiety negatively related to team cohesion and team-training effectiveness. A cusp catastrophe model fit the data and showed that teams with more than one high-interaction-anxiety member were negatively affected. Interaction anxiety inhibits the social activities of team training, in turn reducing team-training effectiveness when there is more than one high-interaction-anxiety individual on the training team. These results highlight the importance of examining interaction anxiety as a training team compositional variable that may inhibit behaviors and team processesnecessary to capitalize on the positive social activities on which team training depends since the interaction anxiety composition of training teams may serve as an important boundary condition on the effectiveness team-training interventions.

Validation of a teamwork perceptions measure to increase patient safety

BackgroundTeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is a team-training intervention which shows promise in aiding the mitigation of medical errors. This article examines the construct...

Endoscopic non-technical skills team training: The next step in quality assurance of endoscopy training

To investigate whether novel, non-technical skills training for Bowel Cancer Screening (BCS) endoscopy teams enhanced patient safety knowledge and attitudes. A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study. Four multi-disciplinary BCS teams constituting BCS endoscopist(s), specialist screening practitioners, endoscopy nurses and administrative staff (A) from English BCS training centres participated. No patients were involved in this study. Expert multidisciplinary faculty delivered a single day's training utilising real clinical examples. Pre and post-course evaluation comprised participants' patient safety awareness, attitudes, and knowledge. Global course evaluations were also collected. Twenty-three participants attended and their patient safety knowledge improved significantly from 43%-55% (P ≤ 0.001) following the training intervention. 12/41 (29%) of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness. The remaining safety attitude items: perceived influence on patient safety, attitudes towards error management, error management actions and personal views following an error were unchanged following training. Both qualitative and quantitative global course evaluations were positive: 21/23 (91%) participants strongly agreed/agreed that they were satisfied with the course. Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training. Limitations of the study include no measure of increased patient safety in clinical practice following training. A novel comprehensive training package addressing patient safety, non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams' knowledge and safety attitudes.

Evaluation of a Computer-Based Educational Intervention to Improve Medical Teamwork and Performance During Simulated Patient Resuscitations

To determine the impact of a low-resource-demand, easily disseminated computer-based teamwork process training intervention on teamwork behaviors and patient care performance in code teams. A randomized comparison trial of computer-based teamwork training versus placebo training was conducted from August 2010 through March 2011. This study was conducted at the simulation suite within the Kado Family Clinical Skills Center, Wayne State University School of Medicine. Participants (n = 231) were fourth-year medical students and first-, second-, and third-year emergency medicine residents at Wayne State University. Each participant was assigned to a team of four to six members (nteams = 45). Teams were randomly assigned to receive either a 25-minute computer-based training module targeting appropriate resuscitation teamwork behaviors or a placebo training module. Teamwork behaviors and patient care behaviors were video recorded during high-fidelity simulated patient resuscitations and coded by trained raters blinded to condition assignment and study hypotheses. Teamwork behavior items (e.g., "chest radiograph findings communicated to team" and "team member assists with intubation preparation") were standardized before combining to create overall teamwork scores. Similarly, patient care items ("chest radiograph correctly interpreted"; "time to start of compressions") were standardized before combining to create overall patient care scores. Subject matter expert reviews and pilot testing of scenario content, teamwork items, and patient care items provided evidence of content validity. When controlling for team members' medically relevant experience, teams in the training condition demonstrated better teamwork (F [1, 42] = 4.81, p < 0.05; ηp = 10%) and patient care (F [1, 42] = 4.66, p < 0.05; ηp = 10%) than did teams in the placebo condition. Computer-based team training positively impacts teamwork and patient care during simulated patient resuscitations. This low-resource team training intervention may help to address the dissemination and sustainability issues associated with larger, more costly team training programs.

A Systematic Review of Simulation for Multidisciplinary Team Training in Operating Rooms

Current simulation training initiatives predominantly occur in uniprofessional silos and do little to integrate different disciplines working in the operating room (OR). The objective of this review was to determine the current status of work describing simulation for full OR multidisciplinary teams including barriers to conducting OR multidisciplinary team training and factors contributing to successful courses. We found a total of 18 articles from 10 research groups. Various scenarios and simulators were used, and training sessions were generally perceived as realistic and beneficial by participants despite rudimentary integration of surgical and anesthetic models. Measures of performance involved a variety of both technical and nontechnical ratings of the simulations. Challenges to conducting the simulations included recruitment, model realism, and financial costs. Future work should focus on how best to overcome the barriers to implementation of team training interventions for full OR teams, particularly on how to engage senior staff to aid recruitment.

Current Concepts of Team Training in Surgical Residency: A Survey of North American Program Directors

The purpose of the present survey was to (1) establish the prevalence of Crew Resource Management (CRM)- and team-training interventions among general surgery residency programs of the United States and Canada; (2) to characterize current approaches to training and assessment of nontechnical skills; and (3) to inquire about program directors' (PDs') recommendations for future curricula in graduate medical education. An online questionnaire was developed by the authors and distributed via email to the directors of all accredited general surgery residency programs across the United States and Canada. After 3 email reminders, paper versions were sent to all nonresponders. PDs of accredited general surgery residency programs in the United States and Canada. One hundred twenty (47%) PDs from the United States and 9 (53%) from Canada responded to the survey. Of all respondents, 32% (n = 40) indicated conducting designated team-training interventions for residents. Three main instructional strategies were identified: combined approaches using simulation and didactic methods (42%, n = 16); predominantly simulation-based approaches (37%, n = 14); and didactic approaches (21%, n = 8). Correspondingly, 83% (n = 93) of respondents recommended a combination of didactic methods and opportunities for practice for future curricula. A high agreement between responding PDs was shown regarding learning objectives for a proposed team-based training curriculum (α = 0.95). The self-reported prevalence of designated CRM- and team-training interventions among responding surgical residency programs was low. For the design of future curricula, the vast majority of responding PDs advocated for the combination of interactive didactic methods and opportunities for practice.

Illusions of team working in health care

The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts. The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams. Underpinned by the input-process-output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork. The paper argues that the prevalence of the term "team" in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo-like groups, are accumulated.

Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress

The publication of To Err Is Human in the USA and An Organisation with a Memory in the UK more than a decade ago put patient safety firmly on the clinical and policy agenda. To date, however, progress in improving safety and outcomes of hospitalized patients has been slower than the authors of these reports had envisaged. Here, we first review and analyse some of the reasons for the lack of evident progress in improving patient safety across healthcare specialities. We then focus on what we believe is a critical part of the healthcare system that can contribute to safety but also to error-healthcare teams. Finally, we review team training interventions and tools available for the assessment and improvement of team performance and we offer recommendations based on the existing evidence-base that have potential to improve patient safety and outcomes in the coming decade.