Helping fluid teams work: A research agenda for effective team adaptation in healthcare


Although membership changes within teams are a common practice, research into this phenomenon is relatively nascent (Summers et al.; Acad Manag J 55:314–338, 2012). The small literature base, however, does provide insight into skills required for effective adaptation. The purpose of this effort is to provide a brief research synopsis, leading to research hypotheses about medical team training. By generalizing previous scientific findings regarding skills required for effective membership adaptation in different kinds of teams, we posit mechanisms whereby teamwork training might also support adaptation among medical teams (Burke et al.; Qual & Saf Health Care 13:i96–i104, 2004 and Salas et al.; Theor Issues Ergon Sci 8:381–394, 2007). We provide an overview of the membership change literature. Drawing upon literature from both within and outside of the medical domain, we suggest a framework and research propositions to aid in research efforts designed to determine the best content for helping to create adaptable medical teams through team training efforts. For effective adaptation, we suggest ad hoc teams should be trained on generalizable teamwork skills, to share just “enough” and the “right” information, to engage in shared leadership, and to shift from explicit to implicit coordination. Our overarching goal was to present what is known from the general research literature on successful team adaptation to membership changes, and to propose a research agenda to evaluate whether findings generalize to member changes in medical teams.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Tannenbaum S, Mathieu JE, Salas E, Cohen D. Teams are changing: are research and practice evolving fast enough? Ind Organ Psychol. 2012;5:2-24.

    Google Scholar 

  2. 2.

    Summers JK, Humphrey SE, Ferris GR. Team member change, flux in coordination, and performance: effects of strategic core roles, information transfer, and cognitive ability. Acad Manag J. 2012;55:314-38.

    Article  Google Scholar 

  3. 3.

    Kozlowski SWJ, Gully SM, Nason ER, Smith EM. Developing adaptive teams: a theory of compilation and performance across levels and time. In: Ilgen DR, Pulakos ED, eds. The Changing Nature of Work Performance: Implications for Staffing, Personnel Actions, and Development. San Francisco: Jossey-Bass; 1999:240-92.

    Google Scholar 

  4. 4.

    Alonso A, Baker DP, Holtzman A, Day R, King H, Toomey L, et al. Reducing medical error in the military health system: how can team training help? Hum Resour Manag Rev. 2006;16:396-415.

    Article  Google Scholar 

  5. 5.

    Salas E, Sims DE, Burke CS. Is there a 'Big Five' in teamwork? Small Group Res. 2005;36:555-99.

    Article  Google Scholar 

  6. 6.

    Klein G, Pierce L. Adaptive teams. 6th International Command and Control Research and Technology Symposium 2001. p. 28.

  7. 7.

    Burke CS, Stagl KC, Salas E, Pierce L, Kendall D. Understanding team adaptation: a conceptual analysis and model. J Appl Psychol. 2006;91:1189-207.

    PubMed  Article  Google Scholar 

  8. 8.

    Ziller RC. Toward a theory of open and closed groups. Psychol Bull. 1965;64:164-82.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: team learning and new technology implementation in hospitals. Adm Sci Q. 2001;46:685-716.

    Article  Google Scholar 

  10. 10.

    Hirst G. Effects of membership change on open discussion and team performance: the moderating role of team tenure. Eur J Work Organ Psychol. 2009;18:231-49.

    Article  Google Scholar 

  11. 11.

    Edmondson AC. Speaking up in the operating room: how team leaders promote learning in interdisciplinary action teams. J Manag Stud. 2003;40:1419-52.

    Article  Google Scholar 

  12. 12.

    Bushe GR, Chu A. Fluid teams: solutions to the problems of unstable team membership. Organ Dyn. 2011;40:181-8.

    Article  Google Scholar 

  13. 13.

    LePine JA. Team adaptation and postchange performance: effects of team composition in terms of members' cognitive ability and personality. J Appl Psychol. 2003;88:27-39.

    PubMed  Article  Google Scholar 

  14. 14.

    LePine JA. Adaptation of teams in response to unforeseen change: effects of goal difficulty and team composition in terms of cognitive ability and goal orientation. J Appl Psychol. 2005;90:1153-67.

    PubMed  Article  Google Scholar 

  15. 15.

    DeRue DS, Hollenbeck JR, Johnson MD, Ilgen DR, Jundt DK. How different team downsizing approaches influence team-level adaptation and performance. Acad Manag J. 2008;51:182-96.

    Article  Google Scholar 

  16. 16.

    Lewis K, Belliveau M, Herndon B, Keller J. Group cognition, membership change, and performance: investigating the benefits and detriments of collective knowledge. Organ Behav Hum Decis Process. 2007;103:159-78.

    Article  Google Scholar 

  17. 17.

    Summers JK. Attributions for team member change and the resulting flux on team coordination processes and effectiveness [Dissertation]: The Florida State University; 2009.

  18. 18.

    Kane AA, Argote L, Levine JM. Knowledge transfer between groups via personnel rotation: effects of social identity and knowledge quality. Organ Behav Hum Decis Process. 2005;96:56-71.

    Article  Google Scholar 

  19. 19.

    Feldman DC. Who's socializing whom? The impact of socializing newcomers on insiders, work groups, and organizations. Hum Resour Manag Rev. 1994;4:213-33.

    Article  Google Scholar 

  20. 20.

    Sutton RI, Louis MR. How selecting and socializing newcomers influences insiders. Hum Resour Manag. 1987;26:347-61.

    Article  Google Scholar 

  21. 21.

    Ancona D. Outward bound: strategies for team survival in an organization. Acad Manag J. 1990;33:334-65.

    Article  Google Scholar 

  22. 22.

    Gersick CJG, Hackman JR. Habitual routines in task-performing groups. Organ Behav Hum Decis Process. 1990;47:65-97.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Waller MJ. The timing of adaptive group responses to nonroutine events. Acad Manag J. 1999;42:127-37.

    Article  Google Scholar 

  24. 24.

    Choi H, Thompson L. Old wine in a new bottle: impact of membership change on group creativity. Organ Behav Hum Decis Process. 2005;98:121-32.

    Article  Google Scholar 

  25. 25.

    Baer M, Leenders R, Oldham G, Vadera A. Win or lose the battle for creativity: the power and perils of intergroup competition. Acad Manag J. 2010;53:827-45.

    Article  Google Scholar 

  26. 26.

    De La Hera C, Rodriguez F. The effects of member change and continuity on the productive efficiency of work teams. Psychol Spain. 1999;3:88-97.

    Google Scholar 

  27. 27.

    Nemeth C, Ormiston M. Creative idea generation: harmony versus stimulation. Eur J Soc Psychol. 2007;37:524-35.

    Article  Google Scholar 

  28. 28.

    Cascio WF. Costing human resources. 4th ed. Dallas: Southwestern College Publishing; 1999.

    Google Scholar 

  29. 29.

    Argote L. Organizational learning: creating, retaining, and transferring knowledge. Norwell: Kluwer; 1999.

    Google Scholar 

  30. 30.

    Gruenfeld DH, Mannix EA, Williams KY, Neale MA. Group composition and decision making: how member familiarity and information distribution affect process and performance. Organ Behav Hum Decis Process. 1996;67:1-15.

    Article  Google Scholar 

  31. 31.

    Kim PH. When what you know can hurt you: a study of experiential effects on group discussion and performance. Organ Behav Hum Decis Process. 1997;69:165-77.

    Article  Google Scholar 

  32. 32.

    Levine JM, Moreland RL. Culture and socialization in work groups. In: Resnick LB, Levine JM, Teasdale SD, eds. Perspectives on Socially Shared Cognition. Washington, DC: American Psychological Association; 1991:257-79.

    Google Scholar 

  33. 33.

    Moreland RL, Argote L, Krishnan R. Training people to work in groups. In: Tindale RS, ed. Theory and Research on Small Groups. New York: Plenum Press; 1998:37-60.

    Google Scholar 

  34. 34.

    Smith-Jentsch KA, Kraiger K, Cannon-Bowers JA, Salas E. Do familiar teammates request and accept more backup? Transactive memory in air traffic control. Hum Factors: J Hum Factors Ergon Soc. 2009;51:181-92.

    Article  Google Scholar 

  35. 35.

    Woolley AW. Means vs. ends: implications of process and outcome focus for team adaptation and performance. Organ Sci. 2009;20:500-15.

    Article  Google Scholar 

  36. 36.

    Salas E, Rosen MA, Burke CS, Goodwin GF. The wisdom of collectives in organizations: an update of the teamwork competencies. In: Salas E, Goodwin GF, Burke CS, eds. Team Effectiveness in Complex Organizations: Cross-disciplinary Perspectives and Approaches. New York: Routledge/Taylor & Francis Group; 2009:39-79.

    Google Scholar 

  37. 37.

    Cannon-Bowers JA, Tannenbaum SI, Salas E, Volpe CE. Defining competencies and establishing team training requirements. In: Guzzo RA, Salas E, eds. Team Effectiveness and Decision Making in Organizations. San Francisco: Jossey-Bass; 1995:333-80.

    Google Scholar 

  38. 38.

    Cannon-Bowers JA, Salas E, Converse S. Shared mental models in expert team decision making. In: Castellan NJ Jr, ed. Individual and Group Decision Making: Current Issues. Hillsdale: Lawrence Erlbaum Associates, Inc; 1993:221-46.

    Google Scholar 

  39. 39.

    Burke CS, Salas E, Wilson-Donnelly K, Priest H. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. Qual Saf Health Care. 2004;13:i96-i104.

    PubMed  Article  Google Scholar 

  40. 40.

    Baker DP, Gustafson S, Beaubien JM, Salas E, Barach P. Medical team training programs in health care. In: Henriksen K, Battles JB, Marks ES, Lewin DI, eds. Advanced in Patient Safety: From Research to Implementation. Vol 4. AHRQ: Rockville, MD Feb 2005. Programs, tools and concepts. AHRQ Publication No. 05-0021-02

  41. 41.

    Diedrich FJ, Entin EE, Hutchins SG, Hocevar SP, Rubineau B, MacMillan J. When do organizations need to change (Part I)? Coping with incongruence. 8th Annual International Command and Control Research and Technology Symposium; Washington, DC: 2003.

  42. 42.

    Entin EE, Weil S, See K, Serfaty D. Understanding team adaptation via team communication. In: Proceedings of the 2005 Human Systems Integration Conference; Washington, DC: 2005:1–7.

  43. 43.

    Smith-Jentsch KA, Cannon-Bowers JA, Tannenbaum SI, Salas E. Guided team self-correction. Small Group Res. 2008;39:303-27.

    Article  Google Scholar 

  44. 44.

    Gaba DM, Howard SK, Fish KJ, Smith BE, Sowb YA. Simulation-based training in Anesthesia Crisis Resource Management (ACRM): a decade of experience. Simul Gaming. 2001;32:175-93.

    Article  Google Scholar 

  45. 45.

    Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992;63:763-70.

    PubMed  CAS  Google Scholar 

  46. 46.

    Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79:186-94.

    PubMed  Article  Google Scholar 

  47. 47.

    Mesmer-Magnus JR, DeChurch LA. Information sharing and team performance: a meta-analysis. J Appl Psychol. 2009;94:535-46.

    PubMed  Article  Google Scholar 

  48. 48.

    Carson JB, Tesluk PE, Marrone JA. Shared leadership in teams: an investigation of anttecedent conditions and performance. Acad Manag J. 2007;50:1217-34.

    Article  Google Scholar 

  49. 49.

    Marks MA, Mathieu JE, Zaccaro SJ. A temporally based framework and taxonomy of team processes. Acad Manag Rev. 2001;26:356-76.

    Google Scholar 

  50. 50.

    Brannick MT, Roach RM, Salas E. Understanding team performance: a multimethod study. Hum Perform. 1993;6:287.

    Article  Google Scholar 

  51. 51.

    Burtscher MJ, Manser T, Kolbe M, Grote G, Grande B, Spahn DR, et al. Adaptation in anaesthesia team coordination in response to a simulated critical event and its relationship to clinical performance. Br J Anaesth. 2011;106:801-6.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Entin EE, Serfaty D. Adaptive team coordination. Hum Factors: J Hum Factors Ergon Soc. 1999;41:312-25.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Wendy L Bedwell PhD.

Additional information


Practice: Medical teams may benefit from teamwork training that focuses on generalizable skills, information sharing, shared leadership, and implicit coordination to successfully adapt to non-routine events.

Research: Research is needed to evaluate whether teamwork training improves the adaptation of medical teams.

Policy: Hospital administrators should dedicate resources to evaluate whether teamwork training improves the adaptability of their medical teams.

About this article

Cite this article

Bedwell, W.L., Ramsay, P.S. & Salas, E. Helping fluid teams work: A research agenda for effective team adaptation in healthcare. Behav. Med. Pract. Policy Res. 2, 504–509 (2012).

Download citation


  • Team training
  • Team adaptation
  • Membership fluidity
  • Membership change
  • Membership loss
  • Adaptive team performance