Improving team training in acute health care : critical synthesis of seven mixed-methods studies

Background: Research had previously shown that practical team rehearsals in acute health care are beneficial, but subsequent work suggested that further improvement is possible. We critically synthesised seven studies aiming to identify the characteristics of effective teams and inform and guide better team training. Methods: Two studies aimed to identify successes and challenges in a unit with improvements in outcome after the introduction of team training. The studies were a staff safety attitudes survey and an interrupted time-series of the effect of training on the management and outcome of an emergency. Mixed-methods research was used in five further studies to identify the characteristics of effective maternity teams in simulation and experiences of real life. Findings: The introduction of team training improved the management and outcome in the index emergency, but there remained persistent variation in team performance managing an emergency. The staff survey demonstrated a positive safety culture yet identified a perceived need for improved senior presence. Analysis of simulation established that some teams were significantly better than others in managing the emergency, and this variation was correlated with their teamwork, not their individual knowledge, skills, or attitudes. Declaring the emergency early, structured handover, and closed-loop communication were associated with significantly better team performance. Better teamwork, including the clear verbalisation of crucial information, was also associated with better patient perception of care. The focus groups corroborated these findings and agreed that the behaviours of a leader are more important than seniority rank. Simple practical methods for teaching those behaviours were explored and agreed. Triangulation of focus group and simulation data using an established framework revealed similarities (convergence and complementarity), differences (dissonance), and issues requiring further research to corroborate or refute findings. Interpretation: The effectiveness of acute health-care teams is related to simple behaviours that can be taught, with methods appropriate for different learners