With Teamwork Training for the OR, HRA Improves Patient Outcomes in NYC


While patients’ overall postoperative outcomes have improved in recent decades, many preventable adverse events still derive from poor OR teamwork and communication

The hospital leadership at four large academic medical centers in New York City sought to implement a major teamwork training initiative involving thousands of perioperative professionals, with a goal of increasing collaboration and improving communication, ultimately enhancing patient safety.


The Healthcare Risk Advisors (HRA) team harnessed its extensive experience in supporting team training for medical professionals, having honed these skills in emergency departments and obstetric settings, where healthcare professionals must master communication for high-stakes, high-speed situations. As expert facilitators, the HRA team knows that quality improvement efforts succeed when they are seated within and supported by the culture of their institutions.

PHASE ONE: Implementation of Large-Scale Training

HRA introduced the TeamSTEPPS™ program—short for Team Strategies and Tools to Enhance Performance and Patient Safety—designed to improve patient safety by optimizing performance through team structure and by teaching four key skills: communication, leadership, situation monitoring, and mutual support.

To maximize the team training’s positive impact, David L. Feldman, MD, MBA, FACS, Senior Vice President for HRA and Chief Medical Officer for TDC Group, led the HRA team in custom designing a train-the-trainer program for each participating hospital. Thereafter, the TeamSTEPPS training was completed by roughly 1,000 more perioperative professionals per hospital—including surgeons, anesthesiologists, nurses, and surgical technicians.

PHASE TWO: Internalization and Feedback

Providing TeamSTEPPS training on a large scale was only the beginning of this effort, because the perioperative staff needed an opportunity to put what they’d learned into practice and receive feedback.

Driving retention and implementation of the training hinged on integrating the high-reliability habits of aviation into healthcare, based on the principle that “Telling is not training.” Learners needed to not only acquire the information and see how it is directly relevant to their own work—which is why HRA recruits TeamSTEPPS champions from across disciplines to complete the train-the-trainer program—but also to have an opportunity to use what they have learned and to receive feedback.

Observers viewed nearly 1,500 OR encounters and delivered feedback to hundreds of surgical teams.

PHASE THREE: Sustaining Gains

Recognizing that sustaining gains from any quality improvement project is a challenge in healthcare, the HRA team has provided long-term support through refresher training (a.k.a. “redosing”) with the TeamSTEPPS program. Again, hospital leadership supported this enthusiastically, endorsing HRA’s reputation and collaborative spirit.


Teamwork training in the OR has produced impressive results in improved patient safety and reduced liability. One institution experienced a 67 percent overall reduction in unintentionally retained surgical items and wrong site/side/person procedures over a two-year period. Analyzing malpractice data from before and after the TeamSTEPPS intervention, the HRA team saw a 65 percent decrease in the frequency of claims that involved intraoperative communication among OR team members.

By auditing training results and examining medical malpractice data, the HRA team has confirmed that the training provided has improved patient safety and mitigated hospital liability.

Team Training Chart

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.