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Teamwork is a skill – it must be practiced
How do you talk to a colleague who is clearly making mistakes in their work? And how would you like to receive feedback yourself?
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For a patient to recover, they are often dependent on healthcare workers collaborating well. If staff are trained in teamwork, there is less risk that they make mistakes.
“As health services become more specialised, it’s even more important for healthcare providers to be good at working together. But to get good at this, you need training and education,” says Tore Karlsen.
He is an associate professor and study programme leader for the master’s degree in specialist nursing at NTNU's Department of Health Sciences.
What did the students learn?
Karlsen implemented an evidence-based training programme for teams in the education. The research team followed a cohort of nursing students for three years.
Teamwork skills were a topic in all relevant courses. What did the students learn, and what were the teachers' experiences?
Patients died due to adverse events
The focus on patient safety increased significantly after the 1999 US report To Err Is Human. It showed that nearly 100,000 patients died each year in American hospitals due to adverse events.
Poor communication and teamwork were among the most important causes.
This led to the development of the training programme Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). It was created by the healthcare system and the military in the US.
The purpose is to strengthen teamwork and is based on four skills:
- Communication
- Leadership
- Situation monitoring
- Mutual support
TeamSTEPPS was translated into Norwegian in 2015 and is currently used in education and clinical practice.
22 students participated
A cohort of nursing students at NTNU in Gjøvik used TeamSTEPPS throughout their bachelor’s education.
They carried out the team training using simulations, and studied practices and theory. The programme included reflection exercises, short lectures, films, and digital learning resources.
While only 22 students participated in interviews, the entire cohort answered a questionnaire about attitudes towards teamwork.
They did this before the programme started, after 10 months, and after 24 months. The researchers compared the students' responses with a group of students on another campus that did not receive this training.
They also interviewed 12 teachers.
It takes time to learn to work together
The students said it took time to learn good cooperation. At the start of their education, they found it difficult to understand why teamwork was important.
It was both theoretical and complicated.
As they were able to practice their team skills in various learning activities at school and in practice, they gained a better understanding of its relevance and importance.
“Getting good at teamwork takes time, but it can be learned – and should be part of the education from start to finish,” says Karlsen.
Teamwork is about more than communication and leadership. The students and teachers increased their awareness of the complexity of the healthcare system and the importance of teamwork for patient safety. This was a key lesson throughout the project.
Many types of teams in healthcare
There are several examples of teams in healthcare. It can be the patient, a nurse, and relatives. Or a nutritionist, kitchen staff, and a nurse. Or an oncologist and a palliative care team. Occupational therapists and home care staff are other examples.
We find many combinations of all these and other professions, both in hospitals and in municipalities, says Karlsen.
Many educational programmes have initiatives or projects where nursing students participate in interprofessional teamwork. These may last from a few days to several weeks.
“However, there is often a general lack of emphasis on teamwork throughout educational programmes,” says Karlsen.
It can also be difficult to coordinate the various health education programmes to carry out activities and trainin across professions over time. This may be due to differences in course structure, timetables, collegial relationships, and location.
How they carried out the training
Teamwork is based on the same principles regardless of how the team is composed. And team training works just as well whether the team consists of people from the same profession or from several different professions.
This is how the nursing students practiced the four teamwork skills:
1. Communication
Good communication within the team is fundamental to all other team skills. The students started by practising clear communication. This was followed up in all simulations throughout the education.
2. Leadership
The students used simulations to train for leadership roles. At the beginning, it involved leading their own work and including the 'patient' as an active participant in the team, for example in connection with transfers or personal hygiene.
An important part of the leadership role was to prepare the team through a briefing before the task started. Afterwards, the team leader was responsible for conducting a debriefing: What worked well, what could be improved?
3. Situation monitoring
This is not only about monitoring the patient and having background knowledge about them, but also about observing the behaviour and competence of colleagues and fellow students.
Examples included whether hygiene is taken care of, assessing whether the team’s actions are having the desired effect, and helping to ensure that errors are detected quickly.
4. Mutual support
Giving each other both positive and constructive feedback to improve practice and patient safety was demanding. Addressing disagreements and resolving conflicts in the team was also difficult to train through simulation.
The teachers therefore made a video in which they themselves played roles in a team that had professional disagreements. The video was used as a starting point for reflection on how conflicts can be resolved in a way that does not weaken teamwork or patient safety.
“In all of this, psychological safety is important. Without this, it's difficult for the students to use teamwork skills in practice,” Karlsen says.
“National guidelines for nursing education place great emphasis on learning outcomes in health, illness, and nursing. Unfortunately, there is a vaguer description of the learning outcomes of teamwork skills,” he adds.
References:
Hughes et al. Saving lives: A meta-analysis of team training in healthcare (Abstract), Journal of Applied Psychology, 2016. DOI: 10.1037/apl0000120
Karlsen et al. Bachelor of nursing students' attitudes toward teamwork in healthcare: The impact of implementing a teamSTEPPS® team training program — A longitudinal, quasi-experimental study, Nurse Education Today, 2022. DOI: 10.1016/j.nedt.2021.105180
Karlsen et al. Bachelor of nursing students' experiences of a longitudinal team training intervention and the use of teamwork skills in clinical practice —A qualitative descriptive study, Nursing Open, vol. 10, 2023. DOI: 10.1002/nop2.1806
Karlsen, T. Learning teamwork is not an event; it's a journey, Doctoral thesis at NTNU, 2026.
Stomlien et al. Implementering av teamtreningsprogrammet TeamSTEPPS® for bachelorstudenter i sykepleie: lærernes erfaringer (Implementation of the team training program TeamSTEPPS® for bachelor’s nursing students), Nordisk tidsskrift for helseforskning, 2025. DOI: 10.7557/14.7370
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Read the Norwegian version of this article on forskning.no
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