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The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.

An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.

The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.

This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.

Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

Stagl, Salas, Rosen, Priest, Burke, Goodwin, and Johnston (this volume) conducted a review of distributed team performance and discussed some of the implications of distributed, multicultural operations for individual, team, and organizational decision making. Expanding upon Stagl and colleagues’ discussion, Alutto (this volume), and Coovert and Burke (this volume) provided thought-provoking commentary on these issues. The current note briefly responds to some of the questions posed and comments made by Alutto, Coovert, and Burke and concludes by calling for a continued dialogue by all stakeholders concerned with fostering effective distributed teams.

Early writings about teamwork in healthcare emphasized that healthcare providers needed to evolve from a team of experts into an expert team. This is no longer enough. As patients, accreditation bodies, and regulators increasingly demand that care is coordinated, safe, of high quality, and efficient, it is clear that healthcare organizations increasingly must function and learn not only as expert teams but also as expert multiteam systems (MTSs).

In this chapter, we offer a portrait of the robust, and albeit complex, multiteam structures that many healthcare systems are developing in order to adapt to rapid changes in regulatory and financial pressures while simultaneously improving patient safety, quality, and performance.

The notion of continuous improvement rooted in continuous learning has been embraced as a battle cry from the boardroom to the bedside, and the MTS concept offers a meaningful lens through which we can begin to understand, study, and improve these complex organizational systems dedicated to tackling some of the most important goals of our time.

The practical need for understanding and improving team resilience has increased, and more research is needed to provide an evidence-base for guiding organizational practices and policies. In this chapter, the authors highlight what we see as critical challenges and opportunities for advancing the science of team resilience. We focus on conceptual and methodological challenges involved in conducting field-based research on team resilience, as the authors believe field-based research is a particularly critical approach for advancing the science of team resilience. The authors first provide a brief review of recent theoretical work in defining team resilience. Then the authors describe key challenges that must be managed in field studies seeking to refine and capitalize on this critical area of research to provide solutions capable of supporting individual, team, and organizational outcomes. These challenges include defining trajectories of resilient team performance, understanding the consequences of repeated episodes of team resilience, formal specifications of events precipitating resilient team performance, measuring the event appraisal and communication process, and adopting measurement methods with high temporal resolution. Finally, the authors provide directions for future research to address these gaps.

Distributed performance arrangements are increasingly used by organizations to structure dyadic and team interactions. Unfortunately, distributed teams are no panacea. This chapter reviews some of the advantages and disadvantages associated with the geographical and temporal distribution of team members. An extended discussion of the implications of distributed team performance for individual, team, and organizational decision making is provided, with particular attention paid to selected cultural factors. Best practices and key points are advanced for those stakeholders charged with offsetting the performance decrements in decision making that can result from distribution and culture.

Joseph A. Alutto is dean, Max M. Fisher College of Business, as well as executive dean of the Professional Colleges, The Ohio State University. He holds the John W. Berry, Sr., Chair in Business. From 1976 to 1990, he was dean of the School of Management, State University of New York at Buffalo. He has published more than 70 articles in leading academic journals and serves on a number of corporate and public sector boards, including Nationwide Financial Services, United Retail Group, Inc., and M/I Homes.