cation affect crew coordination (Aarons, 2002). Health-related training sessions in CRM have included sessions related to team culture, problem solving, team communication, team-building skills, and workload management strategies (Kosnik, 2002).

Formal investigations of these processes are limited at this point. Work to this end is under way, however, particularly at the University of Texas, where the CRM approach is being tested for its usefulness in a number of industries, including health care. The concepts associated with CRM make intuitive sense and support health researchers’ and authors’ suggestions concerning the structure, training, and goal-focused approach needed for successful team outcomes in high-risk settings.


Barriers to Effective Team Development and Performance

One of the most difficult barriers to effective team performance in health care is the differences in world view that exist across participating health professionals (Baggs and Schmitt, 1997; Prescott and Bowen, 1985). As Shine (2002) notes, physicians of the twentieth century have prided themselves on their individual autonomy and their perceived decision-making infallibility. Eliminating or reframing this perception will be difficult for many physician members of interdisciplinary teams. As a result, the formation of teams will best be served by the careful selection of individuals who already demonstrate an awareness of the need to change and are amenable to different ways of planning for and providing care.

A number of factors have been identified that contribute to poor interdisciplinary working relationships. Larson (1999) suggests these barriers lead to unethical care delivery practices because of the likelihood of deficient care delivery outcomes and the potential for patient harm when disciplines fail to work together. Principal in Larson’s summary of the literature is a divergence in perspective on the ability and authority of nurse members of interdisciplinary teams. In previous research concerning interprofessional relationships, physicians have routinely rated actual and ideal nurse authority significantly lower than have nurses (Larson, 1999). Physicians also have tended to focus on the need for nurses to provide more data when presenting information, whereas nurses have focused on the need to improve interpersonal relationships.

The creation of teams may increase the demands associated with the job and result in increased intraorganizational strain. In some cases, the benefits derived from using decision-making teams have not surpassed the costs associated with increased workforce stress (Landsbergis et al., 1999).

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