American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Statement on High-Performance Teams

This statement was developed by the interdisciplinary ad hoc Committee on Development of High Performance Teamwork in Surgery through Education, and approved by the Board of Regents at its October 2009 meeting.

The American College of Surgeons recognizes that safe patient care requires contributions from many providers and disciplines practicing together. Team science has shown that teamwork leads to better performance outcomes. Teamwork before, during, and after operations is essential to achieving the best patient outcomes. Therefore, the surgeon must be able to function effectively both as a leader and member of high-performing teams.

Critical attributes of high-performing teams include the following:

  • A commitment by all team members to teamwork for the best interest of the patient
  • Respectful behaviors, where contributions of all disciplines and providers are valued
  • Recognition and constructive resolution of conflict
  • Coordination among all team members that includes accountability for mutual performance awareness and backup behaviors
  • Leadership characterized by the following:
    • Clearly defined leadership roles, particularly in critical situations
    • Leadership style appropriate to the clinical situation
    • Clear direction to the team from the leader(s)
    • Leaders who continuously solicit input from team members and engage in team-based decision making
  • Timely, accurate, and structured communication with verification of understanding
  • Effective care coordination, including structured hand-offs through all phases of care
  • Ability to remain flexible and adaptable to changing situations

All health care organizations and venues have an obligation to promulgate teamwork. There are four critical components for success:

  • Ensuring that all staff learn and use team-based knowledge, skills, and attitudes. The institution must provide appropriate education and training.
  • Providing opportunities to practice team-based skills in a supportive environment that includes feedback and fosters experiential learning.
  • Building teamwork techniques, prompts, and structure into the institutional workflow, such that teamwork becomes the routine and team behaviors are the norm.
  • Institutional leadership and governance must support sustained team-based practice through the following:
    • Recurrent refresher training
    • Monitoring performance
    • Rewards for teamwork and team behaviors
    • Willingness to sanction noncompliant individuals regardless of status or role


Reprinted from Bulletin of the American College of Surgeons
Vol. 95, No. 2, February 2010