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Introduction
...It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, each assisting in elucidation of the problem at hand, and each dependent upon the other for support. -William J. Mayo, Commencement speech at Rush Medical College, 1910
Deficiencies in communication and teamwork have long been cited as a frequent contributor to adverse events. Precise estimates of the extent of the problem are difficult to make, given definitional, reporting and measurement inconsistencies. However, a variety of studies support the notion that teamwork and communication are critical components of safe healthcare systems. Previous reviews report linkages between various aspects of teamwork (eg, situational monitoring, communication, leadership, trust, shared mental models) and clinical performance. 1-3 Meta-analytic results suggest the relationship between team processes and clinical performance indicators has generally been characterised by medium to large effect sizes. 4 5 For example, studies in surgery have shown increased odds of complications and death (OR 4.82; 95% CI 1.30 to 17.87) when surgical teams exhibit less frequent teamwork behaviours (eg, less information sharing during intraoperative and handoff phases, and less briefing). 6 Reviews of malpractice claims further underscore that communication problems are major contributing factors in 24% of cases. 7 Other studies found teamwork and communication issues cited as root causes in 52-70% of adverse events. 8 9 Additionally, teamwork and communication dimensions of safety culture have been significantly related to adverse clinical events. 10 11
The 2001 Making Health Care Safer report 12 provided one of the early reviews concerning the topic of healthcare team-training in a chapter entitled 'Crew Resource Management and Its Application in Medicine'. This review discussed early conceptualisations of team-training in other high-reliability industries such as aviation and summarised early studies attempting to translate team-training principles developed elsewhere into healthcare settings. The development and implementation of team-training programmes in acute care settings has grown dramatically in the last decade with improvements in content, methods and evaluation desgins. 13-15 Advances in training content, implementation and evaluation have increasingly drawn on over 30 years of evidence examining team performance processes and team-training across a wide variety of high-risk environments. 16 While previous reviews described the state of team-training in healthcare...