Skip to main content
Article thumbnail
Location of Repository

Developing a team performance framework for the intensive care unit

By Tom W. Reader, Rhona Flin, Kathryn Mearns and Brian H. Cuthbertson


Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies investigating the relationship between aspects of teamwork and ICU outcomes, or studies testing factors that are found to influence team working in the ICU. Data Extraction: Teamwork behaviors associated with patient or staff-related outcomes in the ICU were identified. Data Synthesis: Teamwork behaviors were grouped according to the team process categories of "team communication," "team leadership," "team coordination," and "team decision making." A prototype framework explaining the team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature and to guide the development and testing of interventions for improving teamwork. Conclusions: Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others

Topics: R Medicine (General)
Publisher: Lippincott Williams & Wilkins
Year: 2009
DOI identifier: 10.1097/CCM.0b013e31819f0451
OAI identifier:
Provided by: LSE Research Online

Suggested articles


  1. (2002). (Eds.): Incident Command: Tales from the hot seat. doi
  2. (1995). A look into the nature and causes of human errors in the intensive care unit. Crit Care Med doi
  3. (2006). A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The university of Ottawa critical care medicine, high-fidelity simulation, and crisis resource management I study. Crit Care Med doi
  4. (2006). A: Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: Challenges and opportunities for moving forward. Crit Care Med doi
  5. (2004). Acute decompensation after removing a central line: Practical approaches to increasing safety in the intensive care unit. Ann Intern Med doi
  6. (2004). Adaptive leadership in trauma resuscitation teams: a grounded theory approach to video analysis. Cogn Tech Work doi
  7. (2002). al: Building safety into ICU care. doi
  8. (2007). al: Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med doi
  9. al: Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies. doi
  10. (2006). al: Dynamic delegation: Shared, hierachical, and deinidivudalized leadership in extreme action teams. Adm Sci Q
  11. (2003). al: Improving communications in the ICU using daily goals. doi
  12. (1993). al: Improving intensive care: Observations based on organizational case studies in nine intensive care units: A prospective, multicenter study. Crit Care Med doi
  13. (2006). al: Non-technical skills in the intensive care unit.
  14. (2003). al: Predicting unit performance by assessing transformational and transactional leadership. doi
  15. (2006). al: Structured interdisciplinary communication strategies in four ICUs: An observational study. Paper presented at the Human Factors and Ergonomics Society 50 th meeting; doi
  16. al: Teaching teamwork during the neonatal resuscitation program: A raondmized trial.
  17. (2007). al: Team cognition in the intensive care unit. Paper presented at the Society of Industrial and Organizational Society 22 nd annual meeting,
  18. al: Teamwork and quality during neonatal care in the delivery room. doi
  19. (2000). al: The influence of shared mental models on team process and performance. doi
  20. (1994). al: The performance of intensive care units: Does good management make a difference? Med Care doi
  21. (2007). Bench-to-bedside review: Leadership and conflict management in the intensive care unit. Crit Care doi
  22. (2005). Coiera E: Interruptive communication patterns in the intensive care unit ward round. doi
  23. (2007). Communication skills and error in the intensive care unit. Curr Opin Crit Care doi
  24. (2005). Contingent leadership and effectiveness of trauma resuscitation teams. doi
  25. (2002). Developing a method for evaluating crew resource management skills: A European perspective. doi
  26. (2009). Developing teams and team leaders: Strategies and principles. In: Leader development for transforming organizations. Growing leaders for tomorrow. Day doi
  27. (2003). Does organisational culture influence health care performance? A review of the evidence. doi
  28. (2000). E: Establishing aircrew competencies: A comprehensive approach for identifying CRM training needs. In: Aircrew training and assessment. O'Neil H and Andrews
  29. (1995). E: Measuring and managing for team performance: Emerging principles from complex environments. In: Team effectiveness and decision-making in organizations.
  30. (2006). Edmondson AC: Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. doi
  31. (2004). Enhancing collaborative communication of nurse and physician leadership in two intensive care units. doi
  32. (1999). et al: Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med doi
  33. (1991). et al: Critical incidents in the intensive therapy unit. Lancet doi
  34. (2006). et al: Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care doi
  35. (1996). et al: Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of 'open' and 'closed' formats. JAMA doi
  36. (2007). et al: Interdisciplinary communication in the intensive care unit. doi
  37. (2006). et al: Leading to recovery: Group performance and coordinative activities in medical emergency driven groups. Human Performance doi
  38. (2007). et al: Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth doi
  39. (2007). et al: Perceptions of safety culture across the intensive care units of a single institution. Crit Care Med doi
  40. et al: Teams in organizations: From inputprocess-output models to IMOI models. doi
  41. (2003). et al: Use of a fully simulated intensive care unit environment for critical event management training for internal medicine residents. Crit Care Med doi
  42. (2007). Evaluating the management of septic shock using patient simulation. Crit Care Med doi
  43. (2003). Explicit approach to rounds in an ICU improves communication and satisfaction of providers. Intensive Care Med doi
  44. (2007). F: Assessing system failures in operating rooms and intensive care units. Qual Saf Health Care doi
  45. (1988). Group processes : Dynamics within and between groups. doi
  46. (1972). Group processes and productivity.
  47. (2004). Handbook of research methods in industrial and organisational psychology. doi
  48. (1993). Helmreich R: Cockpit resource management. San Diego, doi
  49. (2003). Helmreich RL: Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med doi
  50. (2000). Helmreich RL: Error, stress and teamwork in medicine and aviation: Cross sectional surveys. Br Med J doi
  51. (2003). incidents, leadership, and series summary and review. Emerg Med J doi
  52. (2005). Investigating linear and interactive effects of shared mental models on safety and efficiency in a field setting. doi
  53. Leadership behaviours and safety in the emergency department. In Croskerry
  54. (1995). Leadership for self-managing work teams: A typology and integrative model. Hum Relat doi
  55. (2006). Leadership in organisations. doi
  56. M': Physician team management affects goal achievement in the intensive care unit. Pediatr Crit Care Med doi
  57. (1996). Management of organizational behavior. Upper Saddle River,
  58. (2000). Medicine: To err is human: Building a safer health system. Washington DC, Institute of Medicine, doi
  59. (1996). MW: Teams in organizations: Recent research on performance and effectiveness. Annu Rev Psychol doi
  60. (1997). Naturalistic decision making research and improving team decision making. In: Naturalistic decision making research and improving team decision making. Zsambok C, Klein G (Eds). New Jersey, Lawrence Erlbaum Associates, doi
  61. (2001). Nurse-physician collaboration in an intensive care unit. doi
  62. (1948). Personal factors associated with leadership: A review of the literature.
  63. (2002). Pulling together and pushing apart: Tides of tension in the ICU team. Acad Med doi
  64. (2008). Safety at the sharp end. A guide to non-technical skills.
  65. (2007). Sensemaking, safety, and cooperative work in the intensive care unit. doi
  66. (1964). Social psychology: A brief introduction.
  67. (2003). Team adaptation and postchange performance: Effects of team composition in terms of members cognitive ability and personality J Appl Psychol doi
  68. (1992). Team building and its influence on team effectiveness: An examination of conceptual and empirical developments. doi
  69. (2008). Team performance assessment in healthcare: Facing the challenge. Simulation in Healthcare doi
  70. (2000). Teams: The challenges of cooperative work. In: Introduction to work and organizational psychology. Chanel N (Ed).
  71. Teamwork in multi-person systems: A review and analysis. doi
  72. Teamwork training for patient safety: Best practices and guiding principles. In: Handbook of human factors and ergonomics in health care and patient safety. Carayon P (Ed). New Jersey, Lawrence Erlbaum Associates,2007,
  73. (1997). The causes of human error. In: Human factors in safety critical systems.
  74. The existence of publication bias and risk factors for its occurrence. doi
  75. The Hawthorne effect: A reconsideration of the methodological artefact. doi
  76. (2002). The impact of cross-training on team effectiveness. doi
  77. (2001). The nature of constraints on collaborative decision making in health care settings. In: Linking expertise and naturalistic decision making. Salas E and Klein GA (Eds). New Jersey, Lawrence Erlbaum Associates,
  78. The safety attitudes questionnaire: Psychometric properties, benchmarking data, and emerging research.
  79. (2003). Tilin F: The link between teamwork and patients' outcomes in intensive care units.
  80. Tilting the culture in health care: Using culture strengths to transform organizations. In: Handbook of human factors and ergonomics in health care and patient safety. Carayon P (Ed). New Jersey, Lawrence Erlbaum Associates,2007,
  81. (2006). Toward learning from patient safety reporting systems. doi
  82. (1992). Towards an understanding of team performance and training. In: Teams: their training and performance.
  83. (1993). Why crew resource management? Empirical and theoretical bases of human factors training in aviation. In: Cockpit crew resource management. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.