Measuring Teamwork in Health Care Settings: A Review of Survey Instruments

by Melissa A. Valentine, Ingrid M. Nembhard & Amy C. Edmondson

Overview — It is critical to accurately assess teamwork in health-care organizations. About 60 percent of primary-care practices in the United States use team-based models to coordinate work across the broad spectrum of health professionals needed to deliver quality care; in many other countries the percentage is almost 100 percent. While the benefits of effective teamwork are substantial, effective teamwork is often lacking in these settings, with negative consequences for patients. To date, little has been known about the survey instruments available to measure teamwork. In this paper Valentine, Nembhard, and Edmondson report the results of their systematic review of survey instruments that have been used to measure teamwork in various contexts. Their research helps to identify existing teamwork scales that may be most useful in testing theoretical models. Key concepts include:

Researchers often develop a new scale for their project rather than adapt existing scales. It would be better to utilize existing, psychometrically valid scales when possible so that cumulative knowledge of teamwork can be built.
Many scales have been developed to assess teamwork. However, only eight scales satisfy the standard psychometric criteria the authors identified, and only three of those have been significantly associated with non-self-reported outcomes.
Future research needs to clarify the concept of teamwork. Currently, the variation in ways of conceptualizing teamwork even within the scales that do show relationships to outcomes of interest makes it difficult to know what dimensions are core versus peripheral to the concept.
The criteria set forth in this article should be considered standard research practice, and as such the scales that the authors identified are worthy of attention.

Author Abstract

Objective. To identify, review, and evaluate survey instruments used to assess teamwork, a process critical to delivering quality care, so as to facilitate high quality research on this topic.

Data sources. The ISI Web of Knowledge database, which includes articles from MEDLINE, Social Science Citation Index, and Science Citation Index.

Study design. We conducted a systematic review of articles published before January 2010 to identify survey instruments used to measure teamwork and determine their psychometric validity.

Data extraction. We identified relevant articles using the search terms team, teamwork, work groups, or collaboration, in combination with survey or questionnaire.

Principal findings. We found 36 scales that measured teamwork; only 8 scales met all of the criteria for psychometric validity. Twelve of the 36 scales have shown significant relationship to non-self-report outcomes of interest. Each of these 12 scales assessed some dimension of the quality of social interactions between members. All but one also assessed some dimension of the quality of task-related interactions.

Conclusions. Numerous survey instruments exist to measure teamwork. Few have demonstrated all of the psychometric properties recommended for use, and there is inconsistency in conceptualizations of teamwork. More research is needed to develop and refine measures of teamwork for reliable use by researchers and practitioners/managers.