How to measure teamwork in healthcare simulation

Jan B. Schmutz, Mirko Antino

ABSTRACT Teamwork is vital for patient safety and clinical performance, yet measuring it reliably in healthcare simulation remains challenging. This article offers a practical overview of three common approaches to assess teamwork: survey measures, systematic behavioural observation (SBO) and Behaviourally Anchored Rating Scales (BARS). Surveys capture how team members perceive their teamwork and are best suited for shared psychological states such as trust or cohesion. SBO records what teams actually do in real time, allowing detailed analysis of interaction patterns. BARS combine observation with evaluative judgement, providing structured and feedback-oriented assessments of teamwork quality. The article also highlights key issues in measurement quality, including reliability, validity, rater training and level of analysis. No single method captures teamwork fully; the choice depends on purpose and resources. Combining methods often yields the most complete understanding and supports targeted debriefing, improved training and ultimately, better patient care. Key points:
- Teamwork is essential for clinical performance and patient safety but challenging to measure reliably in simulation.
- Three complementary measurement methods can be used: surveys, systematic behavioural observation (SBO) and Behaviourally Anchored Rating Scales (BARS).
- Surveys assess perceptions and shared psychological states; behavioural observation captures real actions; BARS evaluate the quality of observed behaviours.
- High-quality teamwork measurement requires clear definitions and checks for validity and reliability, including rater training.
- Combining multiple methods provides the most comprehensive picture of teamwork and supports targeted debriefing and improvement.