Team mental models and their potential to improve teamwork and safety: A review and implications for future research in healthcare

The importance of team mental models (TMMs) - team members' shared and organized understanding of relevant knowledge - for teamwork and team-performance, particularly in high-risk industries, has been recognized for almost two decades. In healthcare, however, systematic investigations on the influence of TMM on teamwork and team-performance had yet to be conducted at the time of this review, despite many authors considering the concept to be useful for medical teams. The lack of measurement procedures appropriate for settings as complex and dynamic as, for example, the operating room, represents a major obstacle for empirical research in healthcare. We systematically reviewed empirical studies on TMMs aiming to identify methods that could be applied in healthcare. In particular, we analyzed the methods used, and situations in which TMMs have been investigated. The reviewed studies were sorted according to task and team characteristics. We discuss the results of this review with regard to characteristics of healthcare teams including anaesthesia teams and teams of ward nurses. Each of these examples represents a distinct teamwork setting (e.g. long- vs. short-lived teams) and hence requires a different approach to TMM measurement (e.g. focus on task-model vs. focus on team-model). Implications for study design, feasible measurement approaches, and questions for future research on TMMs in healthcare are discussed. In sum, our findings highlight the possible significance of TMM research in healthcare and its potential benefits for team-performance and, ultimately, patient safety. (C) 2012 Elsevier Ltd. All rights reserved.