Table 2.

Evaluative studies

Author	Setting	Research aim/question/hypothesis	Design	Intervention	Sample size	Outcome measures	Tools	Results
Bleakley et al., 2006 [34]	OT	Whether a sustained complex educational intervention would result in incremental, longitudinal improvement in attitudes and values towards interprofessional teamwork	Quasi-experimental, pre-test and post- test measures (findings from round 2 of the intervention)	Three strands: 1) data-driven iterative education in human factors; 2) establishment of a local, reactive ‘close call’ incident-reporting system; 3) team self-review (briefing and debriefing across all teams)	All general, trauma, and orthopedic theaters within one teaching hospital and two small satellite units	Teamwork climate	Validated SAQ	Intervention group had a higher aggregate teamwork climate score
Bleakley et al., 2012 [35]	OT	Whether a sustained complex educational intervention would result in incremental, longitudinal improvement in attitudes and values towards interprofessional teamwork	Pre-interventino and post-intervention (findings from round 3 of the intervention)	Three strands: 1) data-driven iterative education in human factors; 2) establishment of a local, reactive ‘close call’ incident = reporting system ; 3) team self-review (briefing and debriefing across all teams	All general, trauma, and orthopedic theaters within one UK teaching hospital and two small satellite units	Teamwork climate	Validated SAQ	Mean ‘teamwork climate’ scores improved incrementally and significantly
Brock et al., 2013 [40]	Medical, nursing, pharmacy and physician assistant students at one university	For students to acquire effective interprofessional team communication skills	Pre-test/post-test	Didactic instruction on patient safety and TeamSTEPPS communication skills. Students divided into IP teams for three simulated exercises and debriefing (observer/participant role) (4 hour training block)	149 students completed pre-test and post-test assessments	Attitudes towards team communication; attitude/knowledge/motivation/utility/SE towards IP skills; key communication behaviors; understanding; program evaluation	Validated TeamSTEPPS TAQ, AMUSE, self-report/Likert scale	Significant differences across all outcome measures
Capella et al., 2010 [41]	Level 1 trauma center	Does trauma team training improve team behaviors in the trauma room? If so, does improved teamwork lead to more efficiency in the trauma room and improved clinical outcomes?	Pre-training/post-training intervention design	2 hour didactic instruction (roles, responsibilities, TeamSTEPPS essentials (that is, communication tools)) and simulation in a learning center/simulation laboratory	33 trauma resuscitations pre-training, 40 post-training	Assessment of team performance; clinical outcome and clinical timing data	Validated TPOT	Significant improvement in all teamwork domains. Significant improvements in some clinical timing/outcome measures
Catchpole et al., 2010 [33]	Surgery (maxillofacial, vascular and neurosurgery)	The effects of aviation-style training on three surgical teams from different specialties	Prospective study before and after an intervention	1 to 2 days class-based series of interactive modules (including teamwork, communication, leadership, basic cognition, SA, decision-making, briefing, and debriefing) followed by team coaching (value of briefing/debriefing)	112 operations (51 before and 61 after the intervention)	Attitudes to safety and cultural context. Frequency of pre-list briefings, pre-incision time-outs/stop checks, post-case debriefing, and dimensions of team skills	SAQ; structured observations and validated NOTECHS method to classify team skills	Significantly more briefings, debriefings, and stop checks. No improvement in teamwork
Mayer et al., 2011 [36]	Pediatric and surgical ICU’s	Implementation of TeamSTEPPS	Pre-training/post-training intervention design	Change team trained/coached front-line staff, comprising 2.5 hour training sessions and group training in practice (ad hoc rather than intact teams)	12 attending physicians, 157 nurses, 90 respiratory therapists	Staff interviews, observations of teamwork, clinical timing data, clinical infection data, perception of safety culture, strengths/weaknesses of the unit, job satisfaction	TENTS, EOS, HSOPC, NDNQI	Significant improvements in team performance/perception of teamwork (12 month follow-up). Significant decrease in clinical timing
Miller et al., 2012 [37]	Level 1 trauma center/ academic tertiary care center	An ISTSP could be implemented in the ED and this would improve teamwork and communication in the clinical setting	Pre-training/post-training intervention design involving all members of the trauma team	Standardized lecture that specified roles, responsibilities, order of tasks, andposition in resuscitation area followed by simulation (ad hoc teams)	39 real trauma activations observed	Teamwork and communication	Validated clinical teamwork scale	Teamwork and communication improved, but effect not sustained after the program
Nielson et al., 2007 [38]	Obstetrics	To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery	Cluster randomized controlled trial	Instructor training session: standardized teamwork training curriculum based on CRM, which emphasized communication and team structure. Instructor created ad hoc workplace teams	1,307 personnel trained and 28,536 deliveries analyzed	Adverse maternal/neonatal outcomes; clinical process measures	Adverse outcome index	Training had no significant effect
Wallin et al., 2007 [43]	Trauma	To evaluate the outcome of a CRM target-focused instructional strategy on team behavior and attitude	Prospective study	Simulation	15 medical students; observations of 8 trauma scenarios in simulation classroom	Behavior performance, team attitude	Structured observation schedule	Improvement in observed team behavior. No attitude change
Weaver et al., 2010 [44]	OR	Does TeamSTEPPS training meaningfully affect teamwork behavior in OR teams? Does this teamwork positively affect important outcomes such as patient safety culture?	Mixed model design with one between-groups factor and two within-groups factors	TeamSTEPPS training curricula, including a 4 hour didactic session (competency-based), including interactive role-playing activities	Three surgeons and their teams	Trainee reactions, trainee learning, behavior on the job, results (degree to which training affected safety/quality)	Questionnaire survey; TeamSTEPPS learning benchmark test; CATS observation tool; HSOPS; ORMQ	Positive results at all levels of evaluation
Wolf et al., 2010 [42]	OR	MTT has been touted as a way to improve teamwork and patient safety in the OR	Post-training data collection	1 day didactic modules for all staff, with video and role-play. Topics included human factors, communication, fatigue recognition, briefing/debriefing training	4,863 MTT debriefings analyzed	Team functioning, case delays, case scores	Debriefing/briefing checklist	Case delays decreased and case scores increased; sustained at 24 months. Improved perception of patient safety and teamwork
Wisborg et al., 2006 [39]	Trauma	To describe a team intervention and assess the feasibility of the intervention	Pre-training/post- training; intervention design	3.5 hour didactic session (teamwork/cooperation/ communication skills) and practical training session for all trauma team members in practice using simulation and debriefing	28 Norwegian hospitals and 2,860 trauma team members participated in the training	Evaluation of experience	Questionnaire	High perception of learning

AMUSE, Attitude, Motivation, Teamwork, Self Efficacy; CRM, crew resource management; ED, emergency department; EOS, Employee Opinion Survey; HSOPC, Hospital Survey on Patient Safety Culture; ICU, Intensive Care Unit; IP, interprofessional; ISTS, In situ Trauma Simulation; MTT, medical team training; NDNQI, National Database of Nursing Quality Indicators; NOTECHS, no technical skills; OR, operating room; OT, operating theater; POT, Trauma Team Performance Observation Tool; SAQ, Safety Attitudes Questionnaire; SA, situational awareness; SE, self efficacy; TAQ, Teamwork Attitude Questionnaire; TeamSTEPPS, Team Strategies and Tools to Enhance Performance and Patient Safety; TENTS, Team Evaluation of Non-technical skills.