Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties

BMJ Qual Saf. 2019 Apr;28(4):327-337. doi: 10.1136/bmjqs-2018-008260. Epub 2018 Oct 11.


Background: Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations.

Methods: Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Results: The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias.

Conclusions: A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.

Keywords: Performance measures; crisis management; teamwork.

Publication types

  • Systematic Review

MeSH terms

  • Clinical Competence / standards*
  • Delivery of Health Care / standards*
  • Emergencies*
  • Hospital Rapid Response Team / standards*
  • Humans
  • Patient Care Team / standards*
  • Reproducibility of Results
  • Task Performance and Analysis*