The Evidence
Effective teamwork is fundamental to achieving positive outcomes in health and care settings. Research, including numerous studies by Professor Michael West, has demonstrated strong links between effective teamworking and critical organisational and system-level outcomes:
Organisational performance
Effective teamwork is crucial for driving organisational success and improving service delivery across various sectors, including health and social care.
Carter et al. (2008) found that NHS Trusts which had a higher proportion of staff working in well structured ‘real’ teams (and thus a lower proportion of staff in poorly structured teams) reported significantly better Trust-level outcomes. Price and Toye (2017) found that high-performing teams have an economic impact 23% higher than underperforming teams. Guzzo and Salas (1995) attribute an increase in team-based working to intended improvements in organisational productivity, customer service and an eventual beneficial impact on the bottom line.
A meta-analysis of 49 research studies by Tannenbaum and Cerasoli (2013) suggests teams that improve the quality of their work through regular reviews are 35 to 40% more productive. Dawson and West (2018) suggest that increasing engagement might result in substantial financial savings for trusts.
Borrill, C., West, M. A., Shapiro, D., & Rees, A. (2013). Team working and organizational performance. Journal of Occupational and Organizational Psychology, 76(3), 223-250.
Carter, M. R., West, M., Dawson, J., Richardson, J., & Dunckley, M. (2008). Developing team-based working in NHS trusts. Aston University.
Dawson, J.F., West, M.A. (2018) Employee engagement, sickness absence and agency spend in NHS trusts. NHS England.
Guzzo, R., & Salas E. (eds) (1995). Team effectiveness and decision making in organizations. San Francisco, CA: Jossey-Bass.
Price, C. & Toye, S. (2017) Accelerating Performance: How Organizations Can Mobilize, Execute, and Transform with Agility. Hoboken: John Wiley & Sons
Salas, E., Cooke, N. J., & Rosen, M. A. (2005). On teams, teamwork, and team performance: Discoveries and developments. Human Factors, 47(3), 604-610.
Tannenbaum S.I., Cerasoli C.P. (2013) Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors. 2013 Feb;55(1):231-45.
West, M. A., & Lyubovnikova, J. (2012). Illusions of team working in health care. Journal of Health Organization and Management, 26(2), 240-256.
Innovation
Effective teamwork is a critical driver of creativity and innovation in healthcare settings.
West and Anderson (1996) studied NHS teams in the UK and found that team processes best predicted the overall level of innovation. A study of health care teams by Moser et al (2018) found that a prosocial climate – evidenced in high helping behaviour and information sharing – is associated with higher levels of team innovation.
Additionally, Edmondson (2018) highlighted that when teams have reasonably high psychological safety, potentially game-changing ideas for innovation are shared. West and Sacramento (2012) found that effective team working leads to higher levels of innovation in the delivery of patient care in primary care and community mental health teams. Schippers et al (2015) found team reflexivity was positively related to team innovation.
Borrill, C., West, M. A., Shapiro, D., & Rees, A. (2013). Team working and innovation in health care. Journal of Health Organization and Management, 27(3), 229-249.
Edmondson, A. C. (2018) The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Hoboken, NJ: John Wiley & Sons.
Hülsheger, U. R., Anderson, N., & Salgado, J. F. (2009). Team-level predictors of innovation at work: A comprehensive meta-analysis. Journal of Applied Psychology, 94(5), 1128-1145.
McKinsey (2024) Go, teams: When teams get healthier, the whole organization benefits. www.mckinsey.com
Moser, K. S., Dawson, J. F., & West, M. A. (2019). Antecedents of team innovation in health care teams. Creativity and Innovation Management, 28(1), 72–81.
Schippers, M.C., West, M.A. and Dawson, J.F. (2015) Team Reflexivity and Innovation: The Moderating Role of Team Context. Journal of Management, 41 (3). pp. 769-788.
Tannenbaum S.I., Cerasoli C.P. (2013) Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors. 2013 Feb;55(1):231-45.
West, M. A., & Anderson, N. R. (1996) Innovation in top management teams. Journal of Applied Psychology, 81(6), 680-693.
West, M. & Sacramento, C. A. (2012) Creativity and innovation: the role of team and organizational climate, Handbook of organizational creativity. Mumford, M. (ed.). London: Academic Press, p. 359-386 28 p
Staff stress, absenteeism and turnover
Cohesive teamwork plays a crucial role in enhancing staff well-being and retention, particularly in health and social care settings.
According to Lyubovnikova et al. (2014) hospitals in which staff report higher levels of teamwork have lower rates of workplace injuries, illness, harassment and violence, as well as lower levels of staff intent to leave the organisation. A UK study by West and Dawson (2012) on NHS staff found that working in well-structured teams is a predictor of staff absenteeism and turnover. In a similar study of NHS staff, Buttigieg et al. (2011) discovered that those in well-structured teams have the highest levels of job satisfaction and the least intention to leave their job.
In a study of 400 healthcare teams by Borrill et al. (2000) researchers found that quality of team functioning was associated with lower stress levels in team members. In a study of manufacturing teams, Chen et al. (2018) demonstrated that team reflexivity has beneficial implications on levels of burnout, namely exhaustion, cynicism and inefficiency.
Borrill, C., Carletta, J., Carter, A., et al. (2000). The effectiveness of health care teams in the NHS. Aston University Press.
Borrill, C., West, M. A., Shapiro, D., & Rees, A. (2013). Team working and effectiveness in health care. British Journal of Healthcare Management 6(8), 364-371
Buttigieg, S. C., West, M.A. & Dawson, J.F. (2011) Well-structured teams and the buffering of hospital employees from stress. Health Services Management Research 24(4):203-12
Chen, J., Bamberger, P. A., Song, Y., & Vashdi, D. (2017). The Effects of Team Reflexivity on Psychological Well-Being in Manufacturing Teams. Journal of Applied Psychology. 103. 443-462.
Dixon-Woods M., Baker R., Charles K., Dawson J., Jerzembek G., Martin G., McCarthy I., McKee L., Minion J., Ozieranski P., Willars J., Wilkie P., West M. (2014) Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014 Feb;
Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2014). 24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations. European Journal of Work and Organizational Psychology, 24(6), 929–950.
Powell M, Dawson J, Topakas A, Durose J, Fewtrell C. (2014) Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. Southampton (UK): NIHR Journals Library; 2014 Dec. PMID: 25642572.
Salas, E., Cooke, N. J., & Rosen, M. A. (2005). On teams, teamwork, and team performance. Human Factors, 47(3), 604-610.
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
Customer satisfaction
Effective teamwork enhances service delivery, communication and overall client experiences and is closely linked to higher client or patient satisfaction, especially in health and social care settings.
West et al. (2022) studied NHS datasets in the UK, finding that leader support influences patient satisfaction through shaping staff experience, particularly staff influence over decisions and work pressure. In his analysis of NHS staff and patient surveys, Dawson (2018) found the higher the effectiveness of team working reported by staff, the more satisfied patients were. According to West et al. (2011) patient satisfaction is highest when care is provided by teams that have clear objectives. Similarly, O’Leary et al. (2012) found that hospitals with high teamwork ratings experience higher patient satisfaction.
Finally, Ambrosini et al. (2007) reported that effective inter-team coordination was a critical factor in delivering increased customer satisfaction.
Ambrosini, V., Bowman, C., & Burton-Taylor, S. (2007) Inter-team coordination activities as a source of customer satisfaction. Human Relations, 60(1), 59-98.
Dawson, J.F. (2018) Links between NHS staff experience and patient satisfaction: analysis of surveys from 2014 and 2015, University of Sheffield, 21 February 2018
O’Leary, K. J., Sehgal, N. L., Terrell, G., & Williams, M. V. (2012). Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement. J Hosp Med. 2012 Jan;7(1):48-54.
West, M., Dawson, J., Admasachew, L., & Topakas, A. (2011). NHS Staff Management and Health Service Quality. Lancaster: Lancaster University Management School and the Work Foundation Aston Business School.
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
West, M., Borrill, C. S., Carletta, J., Dawson, J., Garrod, S., Rees, A., Richards, A. & Shapiro, D. (2001) The effectiveness of health care teams in the National Health Service, Birmingham: University of Aston.
West, T.H.R., Daher, P., Dawson, J.F., Lyubovnikova, J., Buttigieg, S.C., West, M.A. (2022) The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England. BMJ Open.
Patient care and safety
Effective teamwork has a profound impact on patient care and safety in health and social care settings.
A UK-based study by Lyuobvnikova et al. (2015) found that increasing the percentage of staff working in ‘real teams’ in acute hospitals in England by just 5% is associated with a reduction of 3% in patient mortality. According to O’Leary et al. (2012), teamwork is critically important to providing safe and effective care.
A US meta-analysis study by Hughes et al. (2016) found that team training can reduce patient deaths by 15% and medical errors by 19%. Similarly, a study by Manser (2009) found that many of the contributing factors to incidents and adverse events originate from communication issues and flawed teamwork rather than from a lack of clinical skills. Research by Mazzocco et al. (2009) found that surgical teams exhibiting fewer teamwork behaviours contributed to a higher risk of complications and death for patients.
Borrill, C., Carletta, J., Carter, A., et al. (2000). The effectiveness of health care teams in the NHS. Aston University Press.
Borrill, C., West, M. A., Shapiro, D., & Rees, A. (2013). Team working and effectiveness in health care. British Journal of Healthcare Management 6(8), 364-371
Buttigieg, S. C., West, M.A. & Dawson, J.F. (2011) Well-structured teams and the buffering of hospital employees from stress. Health Services Management Research 24(4):203-12
Chen, J., Bamberger, P. A., Song, Y., & Vashdi, D. (2017). The Effects of Team Reflexivity on Psychological Well-Being in Manufacturing Teams. Journal of Applied Psychology. 103. 443-462.
Dixon-Woods M., Baker R., Charles K., Dawson J., Jerzembek G., Martin G., McCarthy I., McKee L., Minion J., Ozieranski P., Willars J., Wilkie P., West M. (2014) Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014 Feb;
Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2014). 24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations. European Journal of Work and Organizational Psychology, 24(6), 929–950.
Powell M, Dawson J, Topakas A, Durose J, Fewtrell C. (2014) Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. Southampton (UK): NIHR Journals Library; 2014 Dec. PMID: 25642572.
Salas, E., Cooke, N. J., & Rosen, M. A. (2005). On teams, teamwork, and team performance. Human Factors, 47(3), 604-610.
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
Staff engagement
Effective team working is associated with higher levels of staff satisfaction, engagement and well-being.
West and Dawson (2012) found that NHS Trusts with better teamwork experienced an increase in staff engagement, leading to greater job satisfaction and commitment. Additionally, a study by Borrill et al. (2000) showed that in those teams characterised by clear leadership, high levels of integration, good communication and effective team processes, team members have good mental health and low stress levels. Study findings from Bragadóttir et al. (2023) show that there is a significant relationship between nursing teamwork and job satisfaction.
Daugherty et al. (2015) found the teamwork climate of a work unit is highly related to the level of engagement that staff feel in their work, such that units with high teamwork climate also have staff with a strong commitment to ownership over their job responsibilities.
Borrill, C., Carletta, J., Carter, A., et al. (2000). The effectiveness of health care teams in the NHS. Aston University Press.
Borrill C., West M., Carter M., Dawson J. (2003) The Relationship Between Staff Satisfaction and Patient Satisfaction: Results from Wolverhampton Hospitals NHS Trust. Birmingham: Aston University.
Bragadóttir H, Kalisch BJ, Flygenring BG, Tryggvadóttir GB. (2023) The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals. SAGE Open Nurs. 2023 May 15;9:23779608231175027.
Buttigieg, S. C., West, M. & Dawson, J. F. (2011) Well-structured teams and the buffering of hospital employees from stress In : Health Services Management Research. 24, 4, p. 203-212 9 p.
Daugherty Biddison E.L., Paine L., Murakami P., Herzke C., & Weaver S.J. (2015). Associations between safety culture and employee engagement over time: A retrospective analysis. British Medical Journal Quality & Safety, 25, 31–37.
Dixon-Wood, M., Baker, R., Charles, K., Dawson, J., Jerzembek, G., Martin, G., McCarthy, I., McKee, L., Minion, J., Ozieranski, P., Willars, J., Wilkie, P., West, M. (2013) Culture and Behaviour in the English National Health Service: overview of lessons from a large multimethod study. British Medical Journal
Salas, E., Cooke, N. J., & Rosen, M. A. (2005). On teams, teamwork, and team performance. Human Factors, 47(3), 604-610.
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
Richardson, J., & West, M. (2012). Teamwork and Engagement. In S. L. Albrecht (Ed.), Handbook of Employee Engagement. Edwin Elgar. Vancouver.
Team performance
Research provides substantial evidence supporting the link between effective structure and processes in teams and team performance.
Michael West (2012) reveals that reflexive teams are more productive, effective and innovative than those that don’t reflect on a regular basis. In fact, taking time out as a team leads to an average 25% uplift in performance. Hu and Liden (2011) found clarity of and commitment to team objectives increased team potency, one of the most important factors in team effectiveness and team motivation. The findings of a meta-analysis by Marlow et al. (2018) revealed that communication quality has a significantly stronger relationship with team performance than communication frequency.
According to a cross-sector meta-analysis of 7,563 teams by Courtright et al. (2015), when team members depend upon one another and create workflows that require coordinated action, and when tasks are rewarded and communicated at the team level to emphasise collective outputs, team performance is enhanced significantly. Research by Peralta et al. (2015) in call centre and roller hockey teams found goal and process clarity enhanced team performance and a study by Schmutz et al. (2019) concluded that effective teamwork is positively associated with improved clinical performance.
Buljac-Samardzic, M., Doekhie, K.D., van Wijngaarden, J.D.H. (2020)Interventions to improve team effectiveness within health care: a systematic review of the past decade. Human Resources for Health;18(1):2.
Courtright S. H., Thurgood G. R., Stewart G. L., Pierotti A. J. (2015)Structural interdependence in teams: An integrative framework and meta-analysis. Journal of Applied Psychology, 100: 1825–1846.
Hu, J., & Liden, R. C. (2011) Antecedents of team potency and team effectiveness: An examination of goal and process clarity and servant leadership. Journal of Applied Psychology, 96(4), 851–862.
Marlow, S. L., Lacerenza, C. N., Paoletti, J., Burke, C. S., & Salas, E. (2018) Does team communication represent a one-size-fits-all approach?: A meta-analysis of team communication and performance. Organizational Behavior and Human Decision Processes, 144, 145–170.
Peralta, C. F., Lopes, P. N., Gilson, L. L., Lourenço, P. R., & Pais, L. (2015) Innovation processes and team effectiveness: The role of goal clarity and commitment, and team affective tone. Journal of Occupational and Organizational Psychology, 88(1), 80–107.
Schmutz, J.B., Meier, L.L., Manser, T. (2019) How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open. Sep 12;9(9):e028280.
West, M. A. (2012) Effective Teamwork: Practical Lessons from Organizational Research. Chichester: John Wiley & Sons.