Susan A Wheelan, Christian N. Burchill and Felice Tilin : The Link Between Teamwork and Patients’ Outcomes in Intensive Care Units AJCC 2003;12:527-534



Links between teamwork and outcomes have been established in a number of fields.
Investigations into this link in healthcare have yielded equivocal results.

<Theoretical perspectives>
In the context of social science literature, levels of teamwork and productivity have been linked to the concept of group development. The accumulated research evidence supports the general conclusion that groups move through 5 stepwise stages of development. Groups functioning at higher stages of development are more productive and more effective than groups at lower stages in accomplishing group goals.
The initial stage of development focuses on issues of inclusion and dependency; during this stage, members attempt to identify behavior acceptable to the leader and other group members.
The second stage described as a period of counterdependency and conflict. During the second stage, issues of power, authority, and competition are debated. Conflict with the leader and adequate resolution establish connection and openness among members. This stage also provides the opportunity to clarify areas of common values.
The third stage is devoted to the development of trust, increased collaboration and teamwork, and
more mature and open negotiation about goals, roles, group structure, and division of labor. 
The fourth, or work, stage is characterized by increases in group effectiveness and productivity. 
Groups that have a distinct ending point experience a fifth stage. Impending termination may cause disruption and conflict. Increased expression of positive feelings also may occur, and separation issues are discussed.

To examine the relationship between the level of self-identified teamwork in the intensive
care unit and patients’ outcomes.

Cohort study with questionnaire.

A total of 394 staff members of 17 intensive care units completed the Group Development
Questionnaire and a demographic survey. The questionnaire is a reliable and valid measure of team
development and effectiveness. Each unit’s predicted(from APACHE III system) and actual mortality rates for the month in which data were collected were obtained. Pearson product moment correlations and analyses of variance were used to analyze the data.

Staff members of units with mortality rates that were lower than predicted perceived their
teams as functioning at higher stages of group development(Table 6). They perceived their team members as less dependent and more trusting than did staff members of units with mortality rates that were higher than
predicted. Staff members of high-performing units also perceived their teams as more structured and
organized than did staff members of lower-performing units.

The results of this study and others establish a link between teamwork and patients’
outcomes in intensive care units. The evidence is sufficient to warrant the implementation of strategies
designed to improve the level of teamwork and collaboration among staff members in intensive care


I think this article is very important because it presented the direct association between teamwork and the patients’ outcome. We must pay attention to the deference of the setting, but the outcome to educate the co-ordination competency is indirectly shown.


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