Table 4.
Summary of qualitative findings: team processes/states & implementation outcomes
| Summary of Review Finding | Studies Contributing | CERQual Assessment of Confidence in the Evidence | Explanation of CERQual Assessment |
|---|---|---|---|
|
Adaptive team functioning, characterized by positive affective states (e.g., trust, mutual respect, belonging), effective behavior processes (e.g., frequent communication and coordination), and shared cognitive states (e.g., clear roles, shared mental models of how to provide care), facilitates implementation and is associated with better implementation outcomes Problems in team functioning, including negative affective states (e.g., tension, lack of trust), problematic behavioral processes (e.g., conflict, competition, poor communication), and a lack of shared cognitive states (e.g., unclear roles, lack of shared awareness, competing goals), act as barriers to implementation and are associated with poor implementation outcomes |
[40,41,56,61,77,83,86,92,94,95,97 85,] |
High confidence | Moderate concerns about coherence and minor concerns about methodology and adequacy do not reduce confidence in this simple descriptive finding |
| Trust, cohesion, and psychological safety within teams facilitate implementation by contributing to team members’ willingness to speak up and openly share experiences and feedback. Negative affective states, fear of judgment, conflict, and lack of safety hinder implementation | [47–49, 78] | Moderate confidence | A small number of studies and limited diversity in settings and interventions leading to moderate concerns about adequacy and relevance |
| Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier | [40, 47, 53, 74] | High confidence | Minor concerns about adequacy do not reduce confidence in this simple descriptive finding |
| Communication beyond the team facilitates implementation by providing opportunities for team learning | [47, 48, 75] | Low confidence | Variations in definitions and limited data from a small number of studies leading to serious concerns about coherence and adequacy |
| Poor coordination among healthcare professionals interferes with providing high-quality care and can be a barrier to implementation of new approaches | [40, 95] | Low confidence | Ambiguous findings and thin data in a small number of studies leading to serious concerns about coherence and adequacy and moderate concerns about relevance |
| Shared goals, mission, and vision within teams facilitate implementation and sustainment | [47, 84] | Low confidence | Only 2 studies in similar settings and only 1 study with adequate data leading to serious concerns about relevance and serious concerns about adequacy |