Institutional members access full text with Ovid®

Share this article on:

Promoting Learning and Patient Care Through Shared Reflection: A Conceptual Framework for Team Reflexivity in Health Care

Schmutz, Jan B. PhD; Eppich, Walter J. MD, MEd

doi: 10.1097/ACM.0000000000001688

Health care teams are groups of highly skilled experts who may often form inexpert teams because of a lack of collective competence. Because teamwork and collaboration form the foundation of effective clinical practice, factors that promote collective competence demand exploration. The authors review team reflexivity (TR), a concept from the psychology and management literatures, and how it could contribute to the collective competence of health care teams. TR captures a team’s ability to reflect collectively on group objectives, strategies, goals, processes, and outcomes of past, current, and future performance to process key information and adapt accordingly. As an overarching process that promotes team functioning, TR builds shared mental models as well as triggering team adaptation and learning.

The authors present a conceptual framework for TR in health care, describing three phases in which TR may occur: pre-action TR (briefing before patient care), in-action TR (deliberations during active patient care), and post-action TR (debriefing after patient care). Depending on the phase, TR targets either goals, taskwork, teamwork, or resources and leads to different outcomes (e.g., optimal preparation, a shared mental model, adaptation, or learning). This novel conceptual framework incorporates various constructs related to reflection and unites them under the umbrella of TR. Viewing reflection through a team lens may guide future research about team functioning, optimize training efforts, and elucidate mechanisms for workplace learning, with better patient care as the ultimate goal.

J.B. Schmutz is researcher and lecturer, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.

W.J. Eppich is associate professor of pediatrics–emergency medicine and medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: A previous form of this article was presented at the 9th International Workshop on Behavioural Sciences Applied to Surgery and Acute Care Settings, October 10, 2015, Bonn, Germany, and at the annual meeting of the Society in Europe for Simulation Applied to Medicine, June 16, 2016, Lisbon, Portugal.

Supplemental digital content for this article is available at

Correspondence should be addressed to Jan B. Schmutz, ETH Zurich, Department of Management, Technology, and Economics, Weinbergstr, 56/58, 8092 Zürich, Switzerland; telephone: (+41) 44-632-78-40; e-mail:

© 2017 by the Association of American Medical Colleges