Multiteam Systems (MTS) in Healthcare

“Effective team functioning is one of the institute of Medicine’s five principles for implementing health care safety systems that seek high reliability” (Jones et al., 2019, p. 995). One way of achieving this level of effectiveness on a large scale is through the use of multiteam systems (MTS).

The five principles highlighted in Jones et al.’s (2019) study are listed below. The principles were synthesized from health care, high-risk industries, and other literature for health care safety improvement at a national level:

  1. Principle 1. Provide Leadership
  2. Principle 2. Respect Human Limits in Process Design
  3. Principle 3. Promote Effective Team Functioning
  4. Principle 4. Anticipate the Unexpected
  5. Principle 5. Create a Learning environment
    (Kohn, Corrigan, & Donaldson, 2000, pp. 166-179).

Within the principle of promoting effective team functioning, there are two sub-categories. The first, train in teams those who are expected to work in teams, and the second, include the patient in safety design and the process of care (Kohn et al., 2000). Team training is best when all team members are trained together, as a cohesive unit, as opposed to training individually, separate from other team members (Ling, Moreland, & Argote, 1995). Team members who are trained together, as a cohesive unit, are better able to “understand the roles of other team members [and] can more clearly identify examples of weak performance or potential error in their own work and the work of others” (Alonso et al., 2006, p. 400). The second sub-category calls for involving the patient or customer in the process. The customer then becomes a team members. This makes the process transparent, not only between team members but also for the customer.

One common error that has been found in industry and across health care is that some leaders or managers put people together to resolve a single purpose or problem and call them a team. This is erroneous because there is more to a team than having a few people work together on a problem or project. This is stated in the literature in the following: “Simply installing a team structure does not automatically ensure it will operate effectively” (Alonso et al., 2006, p. 400). Teams are not formed by the make-up of individual team member’s skills alone. Teams must be trained on teamwork skills so that they are able to interact, communicate, coordinate, and plan activities while monitoring the team’s progress and support one another throughout. Teamwork is an outcome of the collective, not the outcome of one individual. Teamwork can only be achieved when team members are able to develop a “shared set of team knowledge, skills, and attitudes rather than permanent assignments that carry over from day-to-day” (Alonso et al., 2006, p. 400; see also Morey et al., 2003). This places a high importance on teamwork skill training to achieve desired levels of high effectiveness.

Multiteam Systems

When adding teams to a project or to a large problem solving effort, coordination of activities, goals, and tasks across the volume of teams (teams of teams), within teams, and aligning these efforts with the larger organizational objectives can become complicated or nearly impossible. This is where multiteam system are needed to provide the structure and roles necessary for operating a large number of teams focused on the same project. Multiteam systems are defined as:

Two or more teams that interface directly and interdependently in response to environmental contingencies toward the accomplishment of collective goals. MTS boundaries are defined by virtue of the fact that all teams within the system, while pursuing different proximal goals, share at least one common distal goal; and in doing so exhibit input, process and outcome interdependence with at least one or other teams in the system. (Mathieu et al., 2001, p. 290)

An example of using a multiteam system to structure larger projects come from the field of health care. In their research study, Jones at al. (2019) investigated reducing impatient falls in rural hospitals. They identified that health care provides utilize the benefits of structuring teams of team by using multiteam systems: “A typical health care MTS consists of three inter professional component teams: coordinating, core, and contingency teams” (p. 995). The multiteam structure utilized in this health care setting was to align processes through three component teams (coordinating, core, contingency) within the same multiteam system. The coordinating team lead the multiteam system’s activities and performed functions such as managing resources, coordinating team processes, conducting training, and role clarity (Jones et al., 2019). The core team were involved with care of the patient. The contingency team performs risk management activities such a briefings and debriefings. This multiteam structure is outlined in Figure 1.

Figure 1


Results highlighted that effective coordination and planning among teams aided in fall-risk-reductions and that team training supported reducing the risk of injuries. Multiteam system performance was identified as being directly related to inter-team coordination. Meaning that teams that were capable of communicating and coordinating activities with other team increased the multiteam system’s overall performance. The authors identified multiteam systems as a structure that could be utilized as a system intervention for high-reliability organizations, such as health care. In their conclusion, Jones et al. (2019) stated:

Multiteam system that effectively coordinate processes across divers professionals and teams may improve the capacity of hospitals to manage the complexity of the patient, environment, and system factors….Many patient safety problems are too complex for individuals or individual teams to solve, thus justifying the effort required to implement MTSs. (p. 1003)

Health care providers and other high-reliability organizations should formalize their teamwork skills training and begin developing multiteam system structures focus around complex problems or issues.



Alonso, A., Baker, D. P., Holtzman, A., Day, R., King, H., Toomey, L., & Salas, E. (2006). Reducing medical error in the military health system: How can team training help? Human Resource Management Review, 16(3), 396-415. doi:10.1016/j.hrmr.2006.05.006

Jones, K. J., Skinner, A., Venema, D., Crowe, J., High, R., Kennel, V., . . . Reiter-Palmon, R. (2019). Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals. Health Services Research, 54, 994-1006. doi:10.1111/1475-6773.13186

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safety health system. Washington, D.C.: National Academy Press.

Liang, D. W., Moreland, R., & Argote, L. (1995). Group versus individual training and group performance: The mediating role of transactive memory. Personality and Social Psychology Bulletin, 21, 384-393. doi:10.1177/0146167295214009

Mathieu, J. E., Marks, M. A., & Zaccarro, S. J. (2001). Multiteam Systems. In: N. Anderson, D. S. Ones, H. K. Shangil, et al. (Eds), Handbook of industrial, work and organizational psychology: A brief introduction, pp. 289-313. New York, NY: Sage.

Morey, J. C., Simon, R., Jay, G. D., & Rice, M. M. (2003). A transition from aviation crew resource management to hospital emergency departments: The MedTeams story. In R. S. Jensen (Ed.), Proceedings of the 12th International Symposium on Aviation Psychology (pp. 1-7). Dayton, OH: Wright State University Press.

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