The active ingredients of effective teamwork in maternity care

The body of work described in this thesis aimed to identify the characteristics of effective teams to inform the development of better team training. Whereas previous studies from the same research group showed that practical team rehearsals (clinical drills) are beneficial, subsequent work suggested that further improvement might be possible. The commentary links the studies that comprise this thesis with the background: a sustained need for better teamwork, a previous preponderance of opinion over evidence as to what constitutes effective teamwork in healthcare, and a widespread use of teamwork training programmes based on aviation despite lack of evidence for impact of aviation-derived training alone on outcome. The commentary summarises the peer-reviewed papers, starting with a critical review of training programmes at the time this body of work was developed and planned. Two studies followed that aimed to clarify the successes and the challenges, from a team perspective, of a unit with published improvements in outcome after the introduction of a clinical training programme. Mixed-methods multicentre research was used in subsequent studies in an iterative process, to identify what makes teams effective in simulation, and what makes them effective in actual emergencies as described by frontline staff. A critical analysis evaluates their contribution to testing the hypothesis and to informing further research. The commentary concludes by summarising the academic, clinical, and educational impact of this thesis and by outlining possible future work to ensure team training programmes remain relevant, evidence-based, effective, and responsive to patient and staff needs.