Sustaining Teamwork Behaviors Through Reinforcement of TeamSTEPPS Principles

Soo Hoon Lee, Harpal Khanuja, Renee J. Blanding, Jeanne Sedgwick, Kathleen Pressimone, James R. Ficke, Lynne C. Jones

Research output: Contribution to journalArticlepeer-review


Background: Teamwork training improves short-term teamwork behaviors. However, improvements are often not sustained. Question/Purpose: The purpose of this study was to explore the extent to which teamwork reinforcement activities for orthopedic surgery teams lead to sustained teamwork behaviors. Methods: Seven months after 104 staff from an orthopedic surgical unit were trained in Team Strategies and Tools to Enhance Performance and Patient Safety principles, 4 reinforcement activities were implemented regarding leadership and communication: lectures with videos on leadership skills for nursing staff; an online self-paced learning program on communication skills for nursing staff; a 1-page summary on leadership skills e-mailed to surgical staff; and a 1-hour perioperative grand rounds on Team Strategies and Tools to Enhance Performance and Patient Safety principles for anesthesia staff and new staff. Twenty-four orthopedic surgical teams were evaluated on teamwork behaviors during surgery by 2 observers before and after the reinforcement period using the Observational Teamwork Assessment for Surgery tool. Results: After reinforcement, leadership (P = 0.022) and communication (P = 0.044) behaviors improved compared with prereinforcement levels. Specifically, nursing staff improved in leadership (P = 0.016) and communication (P = 0.028) behaviors, surgical staff improved in leadership behaviors (P = 0.009), but anesthesia staff did not improve in any teamwork behaviors. Conclusions: Sustained improvement in teamwork behaviors requires reinforcement.

Original languageEnglish (US)
Pages (from-to)E582-E586
JournalJournal of patient safety
Issue number7
StatePublished - Oct 1 2021


  • TeamSTEPPS
  • reinforcement
  • surgical team
  • teamwork
  • training

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Leadership and Management


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