reality, teams often reflect the dominant population or culture and therefore miss the opportunity to maximize team outcomes and reduce the potential for error.

The makeup of the team may result in different levels of perceived success depending on the stage of team development. One study suggests that homogeneous team members tend to report more favorable outcomes and working processes early in the team’s development. Heterogeneous team members’ perceptions change over time, with members reporting improved work relationships as the group evolves. Heterogeneous teams also report a greater range of perspectives and alternatives generated (Watson et al., 1993). In this study, task performance remained higher for the homogeneous group throughout the study period, although the overall quality of decision making and team performance was comparable by the study’s end. In light of these findings, the investigators note the importance of allowing sufficient time for heterogeneous teams to develop the skills needed to work together effectively. The long-term impact, especially in the case of strategies for error identification and reduction, is worth the wait.

Team development strategies also need to include some attention to individual members’ assessment of personal strengths and weaknesses and how these contribute to team performance. Also important is self-assessment of perceptions about how error occurs, and how stress and team performance contribute to errors and error identification. Evidence from a survey of ICU and operating room physicians and nurses suggests these individuals seriously underestimate the effect of stress on performance and the likelihood of error (Sexton et al., 2000). In this study, 60 percent of health care professionals rated their ability to perform when fatigued as comparable to their performance when not fatigued during critical conditions. This same percentage believed in the ability of professionals to leave their personal problems behind when working. In addition, a majority of respondents (70 percent) rated their ability to make decisions in emergency situations as comparable to that during routine conditions. The investigators expressed their concern about the clear indication that health care workers failed to recognize the impact of stress and fatigue on decision making. They also noted that the percentages seen in this study were significantly higher than those reported for a sample of airline pilots, who demonstrated a considerably greater level of awareness of the impact of stress, personal problems, and critical events on decision-making errors.

In this same study, physicians rated the presence of collaborative relationships significantly higher than did nurses. Surgeons rated the quality of teamwork with others highly, while others did not reciprocate. On the contrary, nurses and anesthesia staff described the level of teamwork with physicians as poor. Respondents also reported difficulty in discussing mistakes, citing damage to their personal reputation, the threat of malpractice suits,



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