To deliver greater value in the accountable care context, the Institute of Medicine argues for a culture of teamwork at multiple levels—across professional and organizational siloes and with patients and their families and communities. The logic of performance improvement is that data are needed to target interventions and to assess their impact. We argue that efforts to build teamwork will benefit from teamwork measures that provide diagnostic information regarding the current state and teamwork interventions that can respond to the opportunities identified in the current state.
We identify teamwork measures and teamwork interventions that are validated and that can work across multiple levels of teamwork. We propose specific ways to combine them for optimal effectiveness.
We review measures of teamwork documented by Valentine, Nembhard, and Edmondson and select those that they identified as satisfying the four criteria for psychometric validation and as being unbounded and therefore able to measure teamwork across multiple levels. We then consider teamwork interventions that are widely used in the U.S. health care context, are well validated based on their association with outcomes, and are capable of working at multiple levels of teamwork. We select the top candidate in each category and propose ways to combine them for optimal effectiveness.
We find relational coordination is a validated multilevel teamwork measure and TeamSTEPPS® is a validated multilevel teamwork intervention and propose specific ways for the relational coordination measure to enhance the TeamSTEPPS intervention.
Health care systems and change agents seeking to respond to the challenges of accountable care can use TeamSTEPPS as a validated multilevel teamwork intervention methodology, enhanced by relational coordination as a validated multilevel teamwork measure with diagnostic capacity to pinpoint opportunities for improving teamwork along specific dimensions (e.g., shared knowledge, timely communication) and in specific role relationships (e.g., nurse/medical assistant, emergency unit/medical unit, primary care/specialty care).
Jody Hoffer Gittell, PhD, is Professor, Executive Director, Relational Coordination Research Collaborative, Brandeis University, Waltham, Massachusetts. E-mail: firstname.lastname@example.org.
Joanne Beswick, MS, MA, is Research Program Manager, Brandeis University, Waltham, Massachusetts.
Don Goldmann, MD, is Chief Medical and Scientific Officer, Institute for Healthcare Improvement, Cambridge, Massachusetts.
Stanley S. Wallack, PhD, is Professor, Executive Director, Schneider Institutes for Health Policy, Brandeis University, Waltham, Massachusetts.
The authors are grateful to Mary Dixon-Woods, University of Leicester; Sara Singer, Harvard School of Public Health; and James Battles, Agency for Health Research and Quality, for their comments on an earlier version of this paper.
The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.