Background <p>Healthcare professionals working in complex dynamic work systems are often forced to adjust their behaviour to changing conditions, possibly causing practice variation. Teams can analyse the (un)desirability of those variations by conducting team process improvement. This refers to a learning process in which teams reflect on past performances and formulate improvement strategies. The objective of this study was to identify barriers and facilitators for team process improvement when applying the Functional Resonance Analysis Method (FRAM).</p> Methods <p>This study entails a multicentre prospective study. Nine cardiology and orthopaedic wards from eight Dutch hospitals participated in this study. For each ward, team process improvement consisted of four phases: 1) Constructing FRAM, 2) Discussing differences between protocols and daily practice, 3) Reflecting on intended improvements, 4) Evaluating team reflection process.</p> Results <p>On all wards, we identified several discrepancies between protocol and daily practice. After sharing and discussing these results, most wards proposed improvements aimed at making the process safer and more efficient. Facilitators for team process improvement included: team composition (dedicated task forces and multidisciplinary teams) and being familiar with the analysed process. Identified barriers included a lacking motivation and limited involvement from the ward’s contact person in the study.</p> Conclusions <p>This study showed that FRAM can provide valuable input to initiate team process improvement. The reflection process helped healthcare professionals to decide whether adjustments are needed to keep patients safe or if they introduced risks that were meant to be reduced by implementing protocols. To undertake successful team reflection, we suggest assembling dedicated task forces that regularly evaluate the process. The task force should consist of healthcare professionals from different disciplines.</p>