New data on team training: It lowers MDs’ legal risks — Evidence is ‘very encouraging’

TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) wasn’t designed specifically to decrease legal risks, but reduced liability appears to be an important side benefit to improved teamwork, reports James B. Battles, PhD, AHRQ’s social science analyst for patient safety.

TeamSTEPPS is an evidence-based communication and teamwork curriculum jointly developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense to help healthcare teams operate more efficiently and to make care safer. (See resource at end of this article for more information.)

“Research from analyzing adverse events and reviewing closed liability claims shows that two of the biggest contributing factors to adverse events that lead to patient harm are poor communication and lack of teamwork,” says Battles.

There are TeamSTEPPS materials for hospitals, nursing homes, and primary care practices, and modules for teams that treat patients with limited English proficiency, he adds.

“We know that improving team work and communication contributes to lowering liability risk,” says Battles. “There have been large-scale efforts at implementing teamwork, and we are seeing that they may be associated with reductions in liability.” A 2010 study done by the Veterans Administration reported a significant reduction in surgical mortality based on teamwork training.1 A 2006 review of malpractice claims indicated that communication problems were major contributing factors in 24% of cases that result in such claims.2 Other studies using root cause analysis to examine contributing factors have found teamwork and communication issues cited as root causes in 52% to 70% of adverse events.3,4

“The use of teamwork training and simulation and shown to improve performance and have had a positive impact on medical liability in labor and delivery,” says Battles.5,6

Early data from AHRQ’s medical liability demonstration projects are showing that teamwork and effective communication reduce risks, he reports. For example, an obstetric project has resulted in fewer birth injuries and medical liability claims.

“The data is just beginning to come in, but it’s very encouraging,” says Battles.


1. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304(15):1,693-1,700.

2. Rogers SO Jr, Gawande AA, Kwaan M, et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery 2006; 140(1):25-33.

3. Rabol LI, Andersen ML, Ostergaard D, et al. Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals. BMJ Qual Saf 2011; 20(3):268-274.

4. Singh H, Thomas EJ, Petersen LA, et al. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med 2007; 167(19):2,030-2,036.

5. Merien AE, van de Ven J, Mol BW, et al. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstet Gynecol 2010; 115(5):1,021-1,031.

6. Riley W, Davis S, Miller K, et al. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf 2011; 37(8):357-364.


TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) training is available at no charge. Prospective trainees are asked to complete a readiness assessment. For more information on TeamSTEPPS, contact the Agency for Healthcare Research and Quality, Rockville, MD. Phone: (312) 422-2609. Email: Web: