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In 2000, The Institute of Medicine ([IOM], now The National Academy of Medicine) identified that the U.S. health care system is a system that is prone to errors; it calculated that 44,000 to 98,000 preventable deaths occur in U.S. hospitals each year. Error in health care continues to be a concern, as 2013 statistics indicate that as many as 400,000 deaths occur as a result of preventable errors (James, 2013; Landrigan et al., 2010). The IOM's follow-up report, Health Professions Education, identified team-work as one of the five necessary competencies for all members of the health care team (IOM, 2003). Continuing to train nurses in the skills necessary for effective teamwork in health care remains important to the priority of making health care safer. Improving teamwork in health care improves the overall safety of health care.
Teamwork in health care is inherently a complex phenomenon, as the systems in which care is provided are complex. Breaking teamwork down into discrete knowledge, skills, and attitudes facilitates effective assessment of the competency, as educators can use identified knowledge, skills, and attitudes in evaluation tools. Furthermore, breaking the competency into knowledge, skills, and attitudes expedites the development of targeted education for continued development in this competency. Soon after the IOM's Health Professions Education report, the nurse-led initiative, Quality and Safety Education for Nurses (QSEN), operationalized the recommended competencies into distinct knowledge, skills and attitudes (Cronenwett et al., 2007). The QSEN knowledge, skills, and attitudes for quality and safety competencies can be found on the QSEN website (http://www.qsen.org), as well as in Table 1.
Current Thinking About Teamwork in Health Care
A common focus in the current health care teamwork literature is the vital role of effective communication on health care teams, and the many barriers to successful development of strong team communication practices. Leonard, Graham, and Bonacum (2004) estimated that 70% of all errors in health care stem from a miscommunication etiology. A widely cited 2010 study estimates that only 21% to 31% of nurses speak up when they have concerns about dangerous shortcuts, mistakes, or disrespect because of the hierarchy of team structure and the fear of punishment (Maxfield, Grenny, Lavandero, & Groah, 2011). Current evidence suggests a significant mismatch in team members leading interprofessional...