Building Interprofessional Teams

Select for teamwork skills, not just technical skills: A team is not simply people co-located with a shared task. Effective teamwork depends on team members possessing specific knowledge, skills, and attitudes (KSAs) — things like the ability to monitor teammates' performance, understanding of role responsibilities, and a genuine disposition toward working collaboratively, not just technical competence at the individual task.

• In practice: Evaluate potential team members on both task skills ["can do the technical work"] and team skills [can they communicate effectively, back up other team members appropriately, offer and accept feedback, etc.)

Design the work itself for interdependence - don't assume structure creates teamwork: Implementing a team structure does not ensure effective team function. Teamwork depends on a genuine willingness to cooperate toward a shared goal, not on formal reporting lines. Teams whose members understand how their tasks depend on one another's — for example, a surgeon who cannot proceed until anesthesia is complete — perform better than groups where each person's task is treated as independent.

• In practice: Map out where one person's task depends on another's before finalizing workflow. Build in explicit handoff points where such dependencies exist so the interdependence is visible and managed, not assumed.

Build competencies deliberately: The teamwork literature clusters effective team behavior into eight core competencies: team leadership, mutual performance monitoring, backup behavior, adaptability, shared mental models, communication, team/collective orientation, and mutual trust.

• In practice: Translate these competencies into concrete habits: 
  • Team leadership - Clear common purpose; roles that are defined but not rigid; thoughtful task assignment
  • Mutual performance - monitoring Members regularly check in on each other's actions and flag lapses early
  • Backup behavior - Redistribute workload when someone is overloaded; build in structured debriefs
  • Adaptability - Practice reallocating roles under simulated stress before it happens for real
  • Shared mental models - Brief the team on the plan up front so coordination doesn't require constant talk
  • Communication - Require closed-loop communication, i.e. confirm messages were received and understood
  • Team orientation - Select and reinforce people who value the team's goal over individual credit
  • Mutual trust - Normalize admitting mistakes without punishment

Train the team together, not the individuals separately: Team training - using simulators, structured scenarios, and remedial feedback — has been the most effective and widely applied strategy for improving team performance, and simulation-based crisis training is a proven model for building these skills under realistic pressure. Members of clinical teams are rarely trained together, despite depending on each other daily — this is a structural gap worth addressing, not an unavoidable feature of how healthcare training works.

• In practice: When possible, prioritize joint scenario-based sessions over individual skills training.  Include everyone who will actually work together on a shift — physicians, nurses, techs, and any other role in the workflow. Use structured debriefs to reinforce learning and identify issues.

Build routines that operationalize the principles of high-reliability organizations on a day-to-day basis: High-reliability organizing is described as a mindset with five characteristics: preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience, and deference to expertise.

• In practice: Pair each principle with a concrete team routine:
  • Preoccupation with failure - treat near-misses as information, not embarrassments; make it normal to report them.
  • Reluctance to simplify - when something goes wrong, resist the first easy explanation ("someone wasn't trained enough") and ask what else contributed.
  • Sensitivity to operations - run shift-start briefings that cover the whole unit's workload, not just individual patient handoffs. One nursing unit's practice of briefing overall unit status (who needs help, where the vulnerable patients are) is a simple, replicable example.
  • Commitment to resilience - build structured "what do we do if this goes wrong" planning into routine work, not just after-incident response (See the "premortem" as an example).
  • Deference to expertise - explicitly establish that the person closest to the problem, regardless of hierarchical rank, has standing to be heard and acted on.Build routines that operationalize the five HRO principles day-to-day: High-reliability organizing is described as a mindset with five characteristics: preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience, and deference to expertise. Crucially, this mindset is sustained through *talk* — everyday practices like active listening, openness, and willingness to be vulnerable — not through a policy statement.

Deliberately counteract hierarchy - it can often be the biggest threat to team function: Extreme hierarchical differentiation can contribute to dysfunctional communication and hinder patient care. Teams with genuine mutual trust and assertiveness training reduce this effect by making it safe for any team member to raise a concern regardless of rank.

• In practice: Use a structured communication tool, e.g. the SBAR (Situation, Background, Assessment, Recommendation), to give all team members a scripted, legitimate way to escalate a concern without it reading as insubordination. Structured tools like SBAR and the "Stop, Think, Act, Review" (STAR) technique exist precisely to lower the social cost of speaking up.

Don't rely on a single leader to sustain this approach -  build the habit into the system: Team and safety culture can be established quickly under the right leader but can collapse just as quickly when that leader leaves, reverting to the prior, less-functional pattern. A team is not genuinely high-performing if its function depends entirely on one person's continued presence.

• In practice: Once a leader establishes new team routines (briefings, deference to frontline expertise, structured debriefs), formalize them by writing them into onboarding, building them into shift-change checklists, and ensure they are modeled by more than one person so they survive leadership turnover.

Measure progress: It's a lot easier to say we have implemented high-reliability practices than to have actually done so. Meaningful indicators can include catching more near-misses earlier (a sign of psychological safety and preoccupation with failure) and sustained, harm-free performance over time.

• In practice: Track near-miss reporting rates along with adverse events. Pair this with a short, validated survey of team members' shared perception of how the team is functioning, administered on a periodic basis.