Table 1.

Summary of Key Discoveries and Future Directions

Discovery	Description/state of the science	Future directions
Structure and context matter to understanding the quality of teamwork	The structure of the team and task, in addition to the context in which the team works and the task is conducted, have important implications on what constitutes effective teamwork processes that lead to desired outcomes.	Explore teamwork over longer periods of time in complex organizational structures like multiteam systems. In addition, examine how patient care can benefit from more macro-level patterns of teamwork via team and MTS models.
	Research has demonstrated the influence of structural and contextual changes on improved quality measures. For example, the use of multidisciplinary rounds to improve patient outcomes or the influence of leadership culture on team learning.
The KSAs underlying teamwork in health care settings are identifiable	Undergraduate, graduate, and continuing education competency models in healthcare include teamwork-oriented domains (e.g., communication, situation monitoring, mutual support, a team orientation), though most evaluation has occurred in acute, rather than chronic care, contexts.	Identifying and assessing competencies necessary for multiteam systems, virtual teams, and with health information technology, as well as managing disciplinary/other fault lines, and impact on patient and provider outcome
Teamwork processes in healthcare include rapid learning, listening intently, adapting, and speaking up among clearly defined team members and loose collaborators	Observational and interventional studies reinforce that many of the affective, cognitive, behavioral processes that matter for other types of teams operating in high-risk, dynamic environments also matter for teams delivering clinical care (e.g., adaptive coordination, group-level learning while executing, translating and synthesizing new information, explicit reasoning, and speaking up	Identifying interventional strategies beyond training that facilitate these processes among larger MTSs and looser collaborators over time
Team performance can be validly measured across complex settings	Content and construct validity have been established for team performance measurement tools in a wide range of care settings using survey and observational measurement methods.	Determine what attributes of the measurement system produce the most valid and reliable ratings with the lowest level of logistical costs.
		Explore the potential of unobtrusive and sensor-based methods of measuring teamwork.
Health care team training competencies can be systematically improved	Both formal training and on-the-job tools can be leveraged to strategically and purposefully improve team competencies.	Examine HIT, including EHRs and telemedicine, as possible on-the-job tools reinforce competencies and behaviors targeted in training to help teams better coordinate, communicate, and develop accurate shared mental models throughout distributed, asynchronous performance.
	Leadership and sustainment strategies are chief among the conditions that influence the effectiveness of team interventions. Leadership must model and support desired team competencies within health care workers. Furthermore, organizational policies, reward structures, and culture all must be aligned to achieve long-term team improvement solutions.
Teamwork quality impacts patient, staff, and organizational outcomes	Failures in teamwork are associated with a large proportion of the high rate of preventable patient harm, the quality of care provided by organizations, and staff fatigue, burnout, and turnover.	A more precise understanding of how within team, and between team processes interact to impact outcomes.

Note. MTS = Multi-Team System; KSA = Knowledge, Skills, Attitudes; HIT = Health Information Technology; EHR = Electronic Health Record.