The importance of teamwork in health care delivery and patient safety is increasingly being recognized and has benefitted substantially by adopting a human factors’ perspective and approach. The scientific field of human factors can be defined in many ways, but the commonality across definitions and applications is the focus on those components within an interactive system related to human functionality and fallibility. By recognizing human-centric and human-driven strengths and flaws in a complex system, we may be able to better understand their root causes to maintain performance-enhancing behaviors and improve or support error-generating behaviors. As systems increase in complexity, consequences of suboptimal performance become more severe, demands become excessive and time-sensitive, and human lives are at stake, relying on teams represents a natural solution to enhance perspective, decision-making, and global knowledge beyond the individual level.

In a system as complex as health care, optimal teamwork requires collaboration within and across organizational, disciplinary, technical, and cultural boundaries. Although recent literature has indicated a substantial role of cognitive errors in the occurrence of adverse events in health care, teamwork and communication combined were identified as human performance deficiencies contributing to adverse events in more than 17% of cases.

 According to Salas and colleagues’ teamwork model, effective teamwork is based on the quality of team leadership, mutual performance monitoring, back-up behavior, adaptability, and a team orientation at its core. In addition, mutual trust, closed-loop communication, and shared mental models underlie and coordinate the 5 core dimensions in this model. Of these features, the shared mental model serves as the cornerstone for effective teamwork in health care and has been ranked as one of the most essential teamwork factors in cardiac surgery in particular.

A shared mental model refers to the shared cognition in a team as a collectivity and may be described as the extent to which individuals possess a similar cognitive representation of some situation. Effective shared mental models produce mutual awareness, with which team members can reason about not only their own situation but also the status of team members in the pursuit of joint goals. Shared mental models are proposed to explain certain coordinated team behaviors. Common knowledge (beliefs) of the domain problem under concern, communication protocols to use, and assumptions to take (eg, sincerity, communication reliability) establishes a common basis for agents to understand and respond to each other’s behaviors. A team structure may specify such information as team membership, subteam relations, predetermined leader, roles each member can play, capability requirements, and so forth. To have a shared team structure enables an individual to develop a higher-level abstraction about the capabilities, expertise, and responsibilities of other team members.

Among high-performing medical teams, interdisciplinary teamwork has been associated with improved patient outcomes in emergency medicine, critical care medicine, and internal medicine through various settings. Effective teamwork skills have also been documented as significant predictors for patient outcomes, demonstrated through medical simulation involving participants across health professions.

In surgical departments, poor communication and information sharing, both critical teamwork behaviors, have been associated with higher occurrences of complications and death.

Meanwhile, discrepancies exist between perceived teamwork levels in operative settings, complicating the ability to accurately measure and improve teamwork.

Additional barriers to effective teamwork in the operating room (OR) environment exist on individual, environmental, institutional levels, and cultural levels.

Examples range from how an individual copes with cognitive demands, to environmental barriers associated with uneven lighting and excessive noise, to institutional burdens associated with teaching requirements in academic hospital settings, to the cultural implications of a deeply rooted hierarchical system with an inherent imbalance among power dynamics. Highly functioning teams are tasked with overcoming these and additional barriers under oftentimes adverse and time-sensitive conditions during a patient’s hospital stay. Additionally, patient care and interdisciplinary team interaction continue beyond the OR, where effective and dynamic teamwork is critical in both the handover process and the patient’s intensive care stay.

In surgery, recent initiatives have been adopted in the United States and worldwide, aiming to train surgical providers, from novices to senior levels, on important nontechnical skills, such as situational awareness, leadership, decision-making, communication, and teamwork. In fact, in 2016, the American College of Surgeons adopted and recommended nontechnical skills training beginning during undergraduate medical education and continuing through surgical residency and postgraduate training as a requirement of ongoing Maintenance of Certification.
 Furthermore, the Non-Technical Skills for Surgeons framework has implemented and validated to the US surgical context as a team-training platform.