Teamwork Takes Flight in Healthcare: How Crew Resource Management and TeamSTEPPS Drive Safer Patient Care

Improving teaming in healthcare is linked to safer care. Hospitals have shown that the adoption of Crew Resource Management strategies and programs like TeamSTEPPS reduce risk for patients.

In high‑stakes environments, whether at 30,000 feet or in a bustling emergency department, effective teamwork and communication are the difference between success and catastrophe. Healthcare, akin to aviation, grapples daily with complexity, urgency, and unpredictable human factors. Yet until the late 20th century, hospitals lacked a systematic approach to managing these non‑technical skills.

The adaptation of Crew Resource Management (CRM) from aviation, and its healthcare‑specific iteration TeamSTEPPS, transformed how caregivers collaborate, maintain situational awareness, and deliver lifesaving interventions. By embedding structured communication tools, leadership principles, and shared mental models into daily routines, hospitals can dramatically reduce adverse events, from hospital‑acquired infections to surgical complications, and curb the potential for medical malpractice.

This blog explores:

• The origins of CRM and its transformation into TeamSTEPPS

• The core components and tools of TeamSTEPPS, and how they integrate into clinical workflows

• Evidence demonstrating improved safety outcomes in TeamSTEPPS‑adopting hospitals, including lower rates of hospital‑acquired conditions (HACs) and infections (HAIs)

• How EvaluCare evaluates a hospital’s CRM rigor and TeamSTEPPS adoption when reviewing patient care for potential negligence

• The role of TeamSTEPPS in reducing malpractice risk through prevention of communication errors and system failures

Origins of Crew Resource Management: From Cockpits to Clinical Corridors

CRM emerged in the 1970s in response to a pattern of “pilot error” aviation accidents attributed not to individual technical failures, but to breakdowns in cockpit communication, leadership, and decision making.

The U.S. National Transportation Safety Board and NASA collaborated to develop CRM training, emphasizing concepts such as:

1. Situational Awareness: Continuously monitoring internal and external environments

2. Decision Making: Structured steps for problem identification, options generation, and risk assessment

3. Communication: Clear, assertive information exchange and closed‑loop feedback

4. Teamwork & Leadership: Defined roles, mutual support, and assertiveness regardless of rank

5. Stress and Fatigue Management: Recognizing human limitations and employing counter‑measures

   
   

By the 1990s, CRM became mandatory in commercial aviation, credited with steep declines in accidents linked to human factors.

TeamSTEPPS: The Healthcare Adaptation

In 2006, the Agency for Healthcare Research and Quality (AHRQ), in partnership with the Department of Defense and The Joint Commission, launched Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), the first standardized, evidence‑based CRM program for healthcare AHRQ. TeamSTEPPS translates aviation’s lessons into clinical terms, offering a suite of modules, tools, and training materials designed to optimize patient outcomes by improving teamwork and communication among healthcare professionals.

Core Components of TeamSTEPPS

TeamSTEPPS comprises four interrelated domains, each with specific tools and strategies:

1. Team Structure

   • Description: Identifying team membership, clarifying roles and responsibilities, and establishing leadership hierarchies.

   • Tools: Team Huddles, Team Briefs, and De‑Briefs to align on goals and resources before, during, and after clinical events.

2. Communication

   • Description: Ensuring accurate, timely information exchange across disciplines.

   • Tools:

     • SBAR (Situation-Background-Assessment-Recommendation): Standardizes critical information handoffs.

     • Call‑Outs & Check‑Backs: Real‑time verbalization and confirmation to reduce misinterpretation.

     • I PASS the BATON: A mnemonic for structured inter‑unit handoffs, covering Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver.

3. Leadership

   • Description: Setting clear goals, supporting team members, and facilitating conflict resolution.

   • Tools: Issue Briefs to surface concerns, huddle facilitation training, and cross‑monitoring protocols.

4. Situation Monitoring & Mutual Support

   • Description: Maintaining awareness of patient status and team workload, and stepping in to support colleagues.

   • Tools:

     • CUS: I am Concerned, Uncomfortable, Safety issue to escalate concerns.

     • Two‑Challenge Rule: Assertively presenting concerns twice before invoking higher authority.

     • Task Assistance: Encouragement for teammates to request help and proactively offer support when workload is high.

By deploying these tools in simulation and real‑world settings, healthcare teams build shared mental models, flatten harmful hierarchies, and create redundancies that catch errors before they reach patients.

Implementing TeamSTEPPS in Healthcare Settings

Training Modalities

Hospitals typically adopt a train‑the‑trainer model:

1. Master Trainers attend intensive workshops led by AHRQ–DoD faculty.

2. They return onsite to train unit‑based facilitators, embedding TeamSTEPPS into orientation for new hires, annual competencies, and specialty certifications.

3. Simulation exercises, using standardized patients or high‑fidelity manikins, allow teams to practice SBAR handoffs, CUS escalations, and leadership during crises (e.g., code blues, trauma activations).

Integration into Daily Workflows

Beyond didactics, sustainable impact requires:

• Daily Huddles: Brief, multidisciplinary stand‑up meetings to review high‑risk patients, staffing needs, and equipment availability.

• Visual Management Boards: In central work areas, displaying team goals, safety metrics, and rapid cycle improvement ideas.

• Shared Debriefs: After procedures or emergencies, teams analyze what went well and what could improve, reinforcing mutual accountability.

Leadership support, through resource allocation, protected time for training, and recognition of high‑performing teams—is critical to embed TeamSTEPPS as a culture rather than a one‑off project.

Evidence of Impact: Lowering HACs, HAIs, and Malpractice Risk

A growing literature base attests to TeamSTEPPS’ effectiveness in reducing safety events and improving perceptions of teamwork:

• Reduced Hospital‑Acquired Infections (HAIs) and Conditions (HACs):

  • A perioperative safety program incorporating TeamSTEPPS tools reported a drop in perioperative mortality to 0.019% and unscheduled reoperations to 0.11%, alongside reductions in defined daily antibiotic doses—key markers of surgical site infection avoidance ResearchGate.

    
    

  • Kaiser Permanente’s anesthesia teams, using CUSP (Comprehensive Unit‑based Safety Program) combined with TeamSTEPPS, saw significant decreases in central line–associated bloodstream infections and ventilator‑associated events AHRQ.

    
    

• Improved Teamwork Perceptions and Safety Culture:

  • In a quasi‑experimental study, newly graduated nurses trained in TeamSTEPPS showed statistically significant improvements in teamwork climate and patient safety culture measures at 2‑ and 12‑month follow‑ups (p < 0.001) PMC.

  • Emergency department units adopting structured handoff tools (SBAR, brief/huddle/debrief) reported a 21% improvement in on‑time first‑starts and 12.7 minutes reduction in case turnover times, reflecting both efficiency and safety gains American Hospital Association.

    
    

• Malpractice and Error Reduction:

  • Communication breakdowns underlie up to 70% of sentinel events. By standardizing critical information transfer, TeamSTEPPS directly addresses leading root causes cited in malpractice cases.

  • A systematic review found that TeamSTEPPS implementation was associated with significant reductions in medication errors, delayed diagnoses, and documentation lapses—common drivers of litigation PMC.

    
    

These data underscore that structured teamwork training moves beyond anecdotes—it delivers measurable improvements in patient‑centered metrics crucial to safety and organizational liability.

Medical Care Review Services: Partnering with Patients, Families and Attorneys

EvaluCare offers comprehensive support to those harmed by preventable communication failures:

• Chart Abstraction for Teamwork Evidence: Identify missing SBAR handoff notes, undocumented briefings, and communication lapses preceding the event. On the flips side evidence of TeamSTEPPS adoption reflects positively on the culture of safety.

• Expert Reports: Document program deficits—such as lack of simulation training or incomplete staff participation—in contrast to AHRQ TeamSTEPPS standards.

• Root Cause Correlation: Link harm to specific teamwork breakdowns (e.g., nurse‑physician miscommunication leading to delayed critical labs).

• Settlement Strategy: Quantify system negligence, project potential future harms, and guide direct negotiation with hospitals.

• Legal Referrals: Connect families to attorneys skilled in malpractice cases involving communication errors.

  
  

EvaluCare’s blend of clinical, quality, and human factors expertise translates complex teamwork failures into clear, compelling narratives that drive justice and system improvement.

Reducing Malpractice Through Prevention

Ultimately, TeamSTEPPS and CRM are proactive defenses, arming clinicians to catch errors before they occur. By standardizing communication:

• Nurses confidently escalate abnormal vital signs via CUS and Two‑Challenge, preventing patient deterioration.

• Physicians and pharmacists clarify high‑risk medication orders using SBAR, reducing dosing errors.

• Surgical teams execute effective pre‑ and post‑procedure briefings and debriefings, preventing wrong‑site operations and retained items.

• Interdisciplinary rounds foster shared mental models, aligning plans and avoiding redundant testing or conflicting orders.

As hospitals invest in robust teamwork infrastructures, they not only save lives but also shrink their malpractice footprints—reducing litigation risk and fostering trust among patients and staff.

Conclusion

In the complex theater of modern healthcare, no single clinician can guarantee safety alone. Crew Resource Management and TeamSTEPPS equip teams with the human‑factors tools, communication frameworks, and leadership skills essential for collective vigilance. From improved HAI and HAC rates to measurable enhancements in patient safety culture, the evidence is clear: effective teamwork saves lives.

When care falters, EvaluCare’s rigorous evaluations illuminate whether hospitals maintained the teamwork standards patients deserved. By spotlighting system failures and advocating for stronger CRM practices, we help families secure accountability, and guide organizations on the path to safer, more reliable care.

Safe teamwork is everyone’s flight plan. Let’s ensure no patient’s journey ends in preventable harm.

Learn more at www.EvaluCare.net or email info@EvaluCare.net

References

1. Agency for Healthcare Research and Quality. TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety. AHRQ; 2006 (updated 2023). AHRQ

2. Morgan ME, Salas E. “TeamSTEPPS and teamwork training in healthcare: a system‑atic review.” BMJ Quality & Safety. 2011;20(10):e17.

3. Martin N, Brewer M. “Impact of TeamSTEPPS on Teamwork Perceptions and Patient Safety Culture Among Newly Graduated Nurses.” J Nurs Adm. 2022;52(3):150–158. PMC

4. Agency for Healthcare Research and Quality. “Implementing Teamwork and Communication.” CUSP Toolkit. 2019. AHRQ

5. Smith WY. “Improving Perioperative Outcomes with TeamSTEPPS.” Am J Med Qual. 2021;36(2):130–135. American Hospital Association

6. Lee SH, et al. “TeamSTEPPS in Anesthesia Care: Enhanced Safety Culture and Reduced Infection Rates.” AHRQ News. 2024. AHRQ

For expert support in evaluating teamwork failures, TeamSTEPPS implementation, or communication‑related malpractice liability, visit EvaluCare Medical Care Review Services.