Healthcare Delivery Organizations


With hospital reimbursement now being tied to value-based care, administrators must focus on the following elements to survive.

The good news is—effective teamwork has been shown to impact all of the above.

Regarding quality of care,

  • Caregiver interaction among ICU staff was significantly associated with higher evaluated technical quality of care and greater evaluated ability to meet family member needs1
  • The relationship among UAP, RNs, and LPNs was found to have implications for quality of care and patient safety2
  • The level of nursing teamwork was found to impact the nature and extent of missed nursing care3, 4

Regarding patient satisfaction,

  • A significant positive relation was found between teamwork culture and patient satisfaction for inpatient hospital care5
  • Satisfaction with nursing care had the greatest impact on overall patient satisfaction6

Regarding cost,

  • In a study of ICUs, caregiver interaction comprising the culture, leadership, coordination, communication, and conflict management abilities of the unit was significantly related to lower risk-adjusted length of stay and lower nurse turnover1

To realize the full benefits of effective teamwork, hospitals must promote cultures that foster interprofessional collaborative practice.

Research has shown that care delivered by well functioning teams is better than care provided by health professionals practicing without coordination.1, 7-10 Maintaining market share will be difficult for providers with non-employed physicians if their inability to work together impedes progress in improving value.11

Effective teamwork can be learned and its benefits can be realized.

  • Formal teamwork training for emergency department staff reduced clinical errors, improved team behaviors, and improved staff attitudes12
  • Teamwork training for staff nurses on med-surg units was found to increase teamwork knowledge, increase teamwork, decrease missed nursing care, and increase satisfaction with teamwork13
  • A virtual simulation intervention which focused on common nursing teamwork problems improved overall teamwork scores, trust, team orientation, and backup behavior14
  • An intervention to enhance teamwork and staff engagement on a medical unit in an acute care hospital resulted in significantly lower staff turnover and vacancy rates15

The most important element of well-functioning teams in hospital settings is a mutual trust among team members.16 While studies have identified characteristics associated with trust, no known researchers have looked at a large, comprehensive set of characteristics—until Trust Capital Institute®, that is.

At Trust Capital Institute®, we know how to create trust-based cultures that deliver value-based care. Our Culture of Trust® offerings are based on our proprietary Trust Infusion™ methodology that combines research with years of experience with what works. You won’t find our combination of services in any other firm.

To find out more about how we can help your hospital not only make the transition to value-based reimbursement—but set the standard—contact us.

1 Shortell, S. M., J. E. Zimmerman, D. M. Rousseau, R. R. Gillies, D. P. Wagner, E. A. Draper, W. A. Knaus, and J. Duffy. 1994. The performance of intensive care units: Does good management make a difference? Medical Care 32(5): 508–525.

2 Kalisch, B. J. (2011). The impact of RN-UAP relationships on quality and safety, Nursing Management, September, 16-22.

3 Kalisch, B. J., & Lee, K. H. (2010). The impact of teamwork on missed nursing care, Nursing Outlook, September/October, 233-241.

4 Kalisch, B. J., Gosselin, K., & Choi, S. H. (2012). A comparison of patient care units with high versus low levels of missed nursing care, Health Care Management Review, October-December, 320-328.

5 Materko, M., Mohr, D. C., & Young, G. J. (2004). Teamwork culture and patient satisfaction in hospitals, Medical Care, 42(5), May, 492-498.

6 Wolosin, R., Ayala, L., & Fulton, B. R. (2012). Nursing care, inpatient satisfaction, and value-based purchasing, The Journal of Nursing Administration, 42(6), 321-325.

7 Goni, S. 1999. An analysis of the effectiveness of Spanish primary health care teams. Health Policy 48:107–117.

8 Campbell, S. M., M. Hann, J. Hacker, C. Burns, D. Oliver, A. Thapar, N. Mead, D. G. Safran, and M. O. Roland. 2001. Identifying predictors of high quality care in English general practice: Observational study. British Medical Journal 323(7316): 784–787.
9 Stevenson, K., R. Baker, A. Farooqi, R. Sorrie, and K. Khunti. 2001. Features of primary health care teams associated with successful quality improvement of diabetes care: A qualitative study. Family Practice 18(1): 21–26.
10 Mukamel, D. B., H. Temkin-Greener, R. Delavan, D. R. Peterson, D. Gross, S. Kunitz, and T. F. Williams. 2006. Team performance and risk-adjusted health outcomes in the program of all-inclusive care for the elderly (PACE). Gerontologist 46(2): 227–237.
11 Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care: Providers must lead the way in making value the overarching goal, Harvard Business Review, October, 1-19.

12 Morey, J. C., Simon, R., Jay, G. D., Wears, R. L., Salisbury, M., Dukes, K. A., & Berns, S. D. (2002). Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project, Health Services Research, 37:6, 1553-1581.

13 Kalisch, B. J., Xie, B. & Ronis, D. L. (2013). Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units, Nursing Research, November/December, 62(6), 405-413.

14 Kalisch, B. J., Aebersold, M., McLaughlin, M., Tschannen, D., & Lane, S. (2015). An intervention to improve nursing teamwork using virtual simulation, Western Journal of Nursing Research, 37(2), 164-179.

15 Kalisch, B. J., Curley, M., & Stefanov, S. (2007). An intervention to enhance nursing staff teamwork and engagement, The Journal of Nursing Administration, 37(2), 77-84.

16 Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., Rohrbach, V., & Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine, Washington, DC.

17 Schmutz, J. & Manser, T. (2013). Do team processes really have an effect on clinical performance? A systematic literature review, British Journal of Anaesthesia, March, 1-16.

18 Wheelan, S. A., Burchill, C. N., & Tilin, F. (2003). The link between teamwork and patients’ outcomes in intensive care units, American Journal of Critical Care, November, 12(6), 527-534.

19 Rondeau, K. V., & Wager, T. H. (1998). Hospital chief executive officer perceptions of organizational culture and performance, Hospital Topics, 76(2), 14-21.

20 Shortell, S. M., Zimmerman, J. E., Rousseau, D. M. Gillies, R. R. Wagner, D. P., Draper, E. A., Knaus, W. A., & Duffy, J. (1994). The performance of intensive care units: does good management make a difference? Medical Care, 32(5): 508-25.

21 Morey, J. C., Simon, R., Jay, G. D., Wears, R. L., Salisbury, M., Dukes, K. A., & Berns, S. D. (2002). Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project, Health Services Research, 37(6): 1553-81.

22 Silen-Lipponen, M., Tossavainen, K., Turunen, H. & Smith, A. (1994). Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American Nurses. International Journal of Nursing Practice, 11(1): 21-32.

23 Meterko, M., Mohr, D. C., & Young, G. J.. (2004). Teamwork culture and patient satisfaction in hospitals. Medical Care, 42(5): 492-8.

24 Kalisch, B. J. & Lee, H. (2009). Nursing teamwork, staff characteristics, work schedules, and staffing. Health Care Management Review, 34(4): 323-33.


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