The importance of understanding and maximizing team performance has been discussed by several authors, who note that 70 to 80 percent of health care errors are caused by human factors associated with interpersonal interactions (Schaefer et al., 1994). Others stress the increasing numbers of professionals directly involved in care delivery processes and the relationship between the resulting importance of cooperative working relationships and the complexity of patient needs (Headrick et al., 1998). Addressing this demand is hindered by a number of factors, including the wide variation in team makeup, which ranges from those composed of senior clinicians overseeing residents and fellows (Posner and Freund, 1999) to those involving representatives of multiple professions from multiple organizations (Green and Plesk, 2002; Kosseff and Niemeier, 2001; Stone et al., 2002). Clear differences exist in those situations in which team makeup is driven by hierarchical learning or reporting mechanisms and those in which the team members have equal influence on team performance and outcome. In addition, health professionals interact in a variety of ways, ranging from loosely coordinated collaborative relationships at one end of the continuum to more tightly organized work teams at the other, often within the same day (Headrick et al., 1998). Difficulties also arise when determining whether the failure of a team’s performance is the cause or the result of poor team member behavior. In a study of deteriorating team performance, a back-and-forth pattern developed between member performance and overall team performance as top management teams began to fail (Hambrick and D’Aveni, 1992).
A number of theories exist concerning the ways in which teams work and how they produce favorable outcomes. Some of the more prominent theories relevant to the discussion of decision making for patient safety and for the creation of desirable care delivery outcomes are reviewed below.
Early theoretical efforts to conceptualize the group processes operating in teams drew heavily upon sociological studies of hierarchical differentiation. In these investigations, the social structure of the group was examined for its impact on team communication and problem solving (Feiger and Schmitt, 1979). In summarizing the basic research in this field, Feiger and Schmitt note that status-driven hierarchical processes undermine analysis and problem-solving activities in teams. These same processes may facili-