TeamSTEPPS Training Failed to Shift Ambulance Crews’ Views on Teamwork and Safety

Ambulance professionals in south-eastern Norway did not report meaningful changes in how they view teamwork or patient safety culture after completing a structured TeamSTEPPS team training programme, according to a repeated cross-sectional questionnaire study published in BMC Emergency Medicine. Across measurements taken at baseline, four months, and twelve months, no statistically significant changes were observed in any dimension of teamwork or patient safety culture, despite a training programme that included a full-day introduction, four months of structured team training, and a three-month sustainment phase.

The study addressed a gap in prehospital safety research. Patient safety depends fundamentally on effective teamwork, particularly in the high-risk, time-critical environment of ambulance services, yet research on how ambulance professionals perceive teamwork and patient safety culture has remained limited. The researchers set out to explore these perceptions during the TeamSTEPPS intervention and to examine whether perceptions differed by demographic characteristics or workplace.

The TeamSTEPPS programme focused on four core teamwork skills: Communication, Leadership, Situation Monitoring, and Mutual Support. Participants came from seven ambulance stations in south-eastern Norway. The researchers measured perceptions using two validated instruments: the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and the Prehospital Survey on Patient Safety Culture (PreHSOPSC). Data were analysed using independent-samples t-tests, ANOVA, and multivariate analysis of covariance.

Participation declined over the course of the study. The response rates for the three time points were 86.5 percent (90 of 104) at baseline, 62.7 percent (64 of 102) at four months, and 52.7 percent (48 of 91) at twelve months.

At baseline, T-TPQ scores were neutral to positive. Leadership was rated lowest, with a mean of 3.26 (SD 0.69), while Situation Monitoring was rated highest, with a mean of 4.06 (SD 0.45). These figures suggest that ambulance crews already viewed several aspects of teamwork favourably before the intervention began, with leadership standing out as the teamwork skill with the greatest potential for improvement.

The patient safety culture scores at baseline were more variable. Frequency of Error Reporting was rated lowest, with a mean of 2.56 (SD 0.71), while Stop Working in Dangerous Situations was rated highest, with a mean of 4.11 (SD 0.51). The authors concluded that ambulance professionals perceived teamwork more favourably than patient safety culture, with the latter showing wider variation between dimensions. Frequency of Error Reporting, alongside Leadership on the teamwork side, was identified as the dimension with the greatest potential for improvement in its respective category.

The central finding, however, was one of stability rather than change. No significant differences were observed across the three time points spanning the TeamSTEPPS intervention, for any dimension of either questionnaire. In other words, a year of structured team training did not measurably shift how these ambulance professionals rated their teamwork skills or their safety culture, whether positively or negatively.

The study was registered as a clinical trial (ClinicalTrials.gov ID: NCT05244928), reflecting its planned, structured intervention design. As a repeated cross-sectional questionnaire study rather than a controlled trial with a comparison group, it captured perceptions at three moments in time among ambulance staff, and each time point sampled the workforce rather than tracking the same individuals individually. The declining response rates also mean the twelve-month results are based on fewer than half of the eligible staff at that stage.

The authors’ conclusion points beyond training alone. Improving perceptions of teamwork and patient safety culture in ambulance services, they write, may require a multifaceted approach that targets system-level interventions and organisational strategies. The finding that Leadership and Frequency of Error Reporting scored lowest at baseline, and remained unchanged through the intervention, suggests these may be the areas where such broader organisational efforts could be directed.

For ambulance services considering TeamSTEPPS-style training, the study offers a measured caution: a structured, year-long programme built around the four TeamSTEPPS skills did not, in this setting, produce statistically significant changes in staff perceptions.

Subject of Research: Ambulance professionals' perceptions of teamwork and patient safety culture during a TeamSTEPPS team training intervention in Norway

Article Title: Ambulance professionals’ perceptions of teamwork and patient safety culture: a TeamSTEPPS intervention study

Article References: Myhr, K., Ballangrud, R., Sollid, S. J. M., & Vifladt, A. (2026). Ambulance professionals’ perceptions of teamwork and patient safety culture: a TeamSTEPPS intervention study. BMC Emergency Medicine. https://doi.org/10.1186/s12873-026-01814-2

Image Credits: AI Generated

DOI: 10.1186/s12873-026-01814-2

Keywords: ambulance services, TeamSTEPPS, teamwork, patient safety culture, prehospital care, team training, error reporting, questionnaire study, Norway, emergency medicine, Ambulance, professionals