Perceptions Of Teamwork Research Articles

Teamwork and Perceptions of Palliative Care Quality

Palliative care practice guidelines recommend experts collaborate on interdisciplinary teams to ensure high-quality care. However, there is limited knowledge of how various palliative care teamwork structures and processes influence care quality. This study describes palliative care team structures (eg, certification, setting) and processes (eg, leadership, communication) and examines their influence on perceptions of palliative care quality. A cross-sectional design addresses the research aims. Providers completed an online survey from May 2013 to May 2014 that included demographic and organizational questions, and the TeamSTEPPS Teamwork Perceptions Questionnaire. Of the 460 participants with outcome data, 81.1% were registered nurses; 89.9% were female. Most participants reported care quality as excellent in their settings (50.4%). Excellent quality was associated with male gender (P = .032), formal team membership (P = .001), hospice/palliative care unit employment (P < .000), non–acute care settings (P = .040), less education (P = .016), and collaborating with more disciplines (P = .003). All TeamSTEPPS scales were associated with excellent quality of care (P < .000). In the logistic model, team structure (odds ratio [OR], 1.132; confidence interval [CI], 1.047-1.225; P = .002), communication (OR, 1.095; CI, 1.014-1.182; P = .021), and collaboration with more disciplines (OR, 1.138; CI, 1.030-1.253; P = .011) were associated with excellent care quality. Interprofessional education and enhanced organizational structures to encourage collaboration may improve palliative care quality.

Development, Implementation and Evaluation of a Longitudinal Interprofessional Education Project

Abstract Background A collaborative, interprofessional approach is required to provide high-quality care for patients with multiple chronic conditions. Health professional education is challenged to provide students opportunities to practice team-based care. Purpose This longitudinal project embedded learning activities for interprofessional teams of students to experience collaborative practice and practice team-based care using simulation. Method Faculty ( N = 18) from nursing, medicine, pharmacy, social work, and dietetics created a series of interprofessional learning activities. Interprofessional teams of students ( N = 81) conducted four simulated primary care visits with a standardized patient having multiple chronic conditions. Pre- and post- surveys measured students' perceptions of interprofessional practice, roles, and teamwork. Discussion Students engaged in shared, patient-centered care during the simulated clinic visits. Students' perceived understanding of interprofessional roles and responsibilities, ability to work in teams, and clinical reasoning significantly increased. Conclusions This project allowed health professions students to practice team-based care in a realistic but protected environment.

Effect of interprofessional clinical education programme length on students’ attitudes towards teamwork

ABSTRACTThis article reports on a study involving a range of health professions students who participated in similar one-semester (short) or two-semester (long) interprofessional clinical education programmes that focused on clinical assessment of senior citizens living independently in the community. Students’ attitudes towards teamwork skills and perceptions of their own teamwork skills both before and after the programmes were assessed using two validated scales. Osteopathic medical student participants reported no significant changes in attitudes towards interprofessional healthcare teamwork skills or their perceptions of their own interprofessional teamwork skills after either the one- or two-semester programmes. For athletic training, speech–language pathology, exercise sciences, public health, and nursing students, though, attitudes towards teamwork skills significantly improved (p < .05) after the one-semester programme; and perceptions of their own team skills significantly improved (p < .05) after both the one- and two-semester programmes. Overall, this study provides some support for interprofessional teamwork attitude change, but with a significant difference between medical as compared to nursing, allied health, and public health students.

Perceptions of Teamwork Following TeamSTEPPS Implementation at Ambulatory Reproductive Healthcare Facilities [3G

INTRODUCTION: TeamSTEPPS is an evidence-based teamwork system for healthcare professionals designed to improve patient safety. While team training has proven benefits in the hospital setting, it has not been well-studied in the ambulatory care environment. The objective of this project is to evaluate the impact of TeamSTEPPS in a network of ambulatory reproductive healthcare centers in the United States. METHODS: The Teamwork Perceptions Questionnaire (TPQ), a validated self-administered survey containing five domains of seven items each, was used to assess staff perceptions of teamwork within ambulatory reproductive healthcare centers. Unique participant codes linked responses at each time point. Comparisons were made between baseline and six-month assessments using paired t tests. RESULTS: Fifty-seven pairs of surveys were obtained from seven centers. Six of the seven items in the Team Structure, Situation Monitoring, and Mutual Support domains showed improvement, though only four were statistically significant (all P≤.03). Six items in the Leadership domain showed worse scores at six months, and four were statistically significant (all P≤.01). In the Communication domain, five items showed improved scores, though none was statistically significant. CONCLUSION: Six months after implementing TeamSTEPPS, improvements were seen in all domains with the exception of Leadership, though only eight items showed statistically significant change. Worsening perceptions of leadership may be due to increased awareness of best practices or indicate improvements in leadership are difficult. This short observation period may be inadequate to measure the extent of change from the TeamSTEPPS program. One-year assessments, as well as assessments of additional centers, are underway.

Knowledge integration, teamwork and performance in health care.

Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition for effective teamwork and team performance. As it is known that different groups of health care professionals often tend to work in isolation, the authors compared the perceptions of knowledge integration. It can be expected that based on this isolation, knowledge integration is assessed differently. The purpose of this paper is to test these differences in the perception of knowledge integration between the professional groups and to identify to what extent knowledge integration predicts perceptions of teamwork and team performance and to determine if teamwork has a mediating effect. The study is a multi-center cross-sectional study with a descriptive-explorative design. Data were collected by means of a staff questionnaire for all health care professionals working in the rehabilitation clinics. The results showed that there are significant differences in knowledge integration within interprofessional health care teams. Furthermore, it could be shown that knowledge integration is significantly related to patient-centered teamwork as well as to team performance. Mediation analysis revealed partial mediation of the effect of knowledge integration on team performance through teamwork. PRACTICAL/IMPLICATIONS: In practice, the results of the study provide a valuable starting point for team development interventions. This is the first study that explored knowledge integration in medical rehabilitation teams and its relation to patient-centered teamwork and team performance.

Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program.

Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center. DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement. There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization. Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.

Promoting Patient Safety: Results of a TeamSTEPPS® Initiative.

Teamwork is an essential component of communication in a safety-oriented culture. The Joint Commission has identified poor communication as one of the leading causes of patient sentinel events. The aim of this quality improvement project was to design, implement, and evaluate a customized TeamSTEPPS® training program. After implementation, staff perception of teamwork and communication improved. The data support that TeamSTEPPS is a practical, effective, and low-cost patient safety endeavor.

A Team-Based Practicum Bringing Together Students Across Educational Institutions and Health Professions

Objective. To assess student perceptions of teamwork during an interprofessional exercise and to evaluate if students could identify domestic violence through a standardized patient interview. Design. Medical, pharmacy, nursing, physical therapy, and social work students were assigned to teams to interview and examine a patient with a "cut on the hand" later revealed a result of domestic violence. They also practiced suturing technique and developed a patient care plan. A postexercise survey was administered. Assessment. From 70% to 94% of students surveyed agreed or strongly agreed, respectively, that their responsibilities were clear. All (100%) recognized the benefits of team-based care. Only 38% of the medical students reported team members providing insight into domestic violence, and 52% did not recognize team members as resources for these cases. Conclusion. Students gained perspective of knowledge and responsibilities of each team member. However, the results suggest further enhancements of curriculum related to domestic violence are needed.

Comunicação e cultura de segurança do paciente no ambiente hospitalar: visão da equipe multiprofissional

Objetivo: analisar a cultura de segurança do paciente em relação à comunicação na visão da equipe multiprofissional hospitalar. Método: pesquisa transversal, descritiva, quantitativa. Participaram 71 profissionais de múltiplas funções/formações de um hospital de ensino público do Paraná que responderam ao questionário “Hospital Survey on Patient Safety Culture”. Fez-se análise estatística descritiva sobre os itens de avaliação das dimensões que melhor retratam cultura de segurança do paciente em relação à comunicação. Resultados: houve boa percepção em relação ao trabalho em equipe e comunicação interna na unidade de trabalho, contudo, com maior expressividade, apontou-se cultura de segurança desfavorável em relação às comunicações e atividades com equipes externas ao setor de trabalho, bem como deficiências na passagem de plantão. Conclusões: há necessidade de incremento na comunicação entre unidades distintas na organização hospitalar, além de medidas que confluam melhorias na passagem de plantão dos setores.

Change in Residents' Experience in Continuity Clinic After Patient-Focused Primary Care Redesign

ObjectiveEvaluation of efforts to redesign primary care has primarily focused on clinical services, with limited assessment of the effect on learners. This study evaluated the change in pediatric residents' perception of training, teamwork, and patient care in 2 different continuity clinic settings that were implementing patient-focused primary care redesign. MethodsContinuity clinic residents at 2 large urban pediatric training programs completed a survey, developed de novo, before and after primary care redesign. Differences in the proportion of positive (≥4 of 5) ratings before and after redesign were compared using chi-squared tests in 2 practice sites, each of which focused on improving specific aspects of their practice. ResultsThe response rate was >70% in both sites and in both years. Residents in the site focused on teamwork and continuity were more likely to report improved teamwork training (64% vs 83%; P < .05) and teamwork among residents (82% vs 98%; P < .05) after redesign. Perception of overall quality of care in clinic also improved (47% vs 68%; P < .05). Residents in the site focused on clinic flow were more likely to report that physicians, nurses, and administrative staff worked together to optimize patient flow after redesign (25% vs 48%; P < .05). No improvements were seen in domains without focused interventions in either site. ConclusionsPractice redesign focused on clinical outcomes can positively affect resident perception of their training and clinical experience in continuity clinic. Future redesign efforts deliberately involving residents might further enhance continuity clinic training.

Health care professionals' attitudes regarding patient safety: cross-sectional survey.

BackgroundPatient safety is being seen as an increasingly important topic in the healthcare fields, and the rise in numbers of patient safety incidents poses a challenge for hospital management. In order to deal with the situation, it is important to know more about health care professionals’ attitudes regarding patient safety. This study looks to describe health care professionals’ attitudes regarding patient safety, and whether differences exist based on the background factors of study participants.MethodsA quantitative study using a questionnaire was conducted in three multi-disciplinary hospitals in Western Lithuania. Data was collected in 2014 from physicians, nurses and nurse assistants.ResultsThe results showed positive safety attitudes, and these were especially related to the respondents’ levels of job satisfaction. A respondent’s older age was associated with how they evaluated their teamwork climate, safety climate, job satisfaction, and perception of management. Profession, working unit, length of work experience, information received about patient safety during education, further education, and working shifts were all associated with several safety attitude areas.ConclusionsThe safety attitudes of respondents were generally found to be positive. Attitudes related to patient safety issues were positive among health care professionals and opens the door for the open discussion of patient safety and adverse events. However, in future we also need to investigate the knowledge and skills professionals have in relation to patient safety, in order to gain a deeper understanding of the present situation.

Improving Interdisciplinary Relationships in Primary Care with the Implementation of TeamSTEPPS

A major challenge in healthcare is lack of interdisciplinary collaboration (O’Daniel &amp; Rosenstein, 2008). The Institute of Medicine report, To Err is Human: Building a Safer Health System (1999), shows that errors often occur due to lapses in partnership and communication. This article describes the implementation of TeamSTEPPS, an evidence-based tool for optimizing staff relationships and partnership, in a clinic in which a change in the care model had affected interprofessional collaboration and teamwork, threatening healthcare outcomes and staff engagement. The implementation of TeamSTEPPS, customized using elements of IDEO’s (2015) Human-Centered Design, shifted the culture of the clinic towards partnership, resulting in improved staff perceptions of teamwork and statistically significant improvements in the quality of patient care.

Implementation and Evaluation of a Team Simulation Training Program.

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

Compliance and Surgical Team Perceptions of WHO Surgical Safety Checklist; Systematic Review

This systematic review aimed to assess surgical safety checklist compliance and evaluate surgical team perceptions and attitudes, post-checklist implementation in the operating room. The World Health Organization (WHO) surgical safety checklist (SSC) has decreased complications and mortality. However, it is unclear whether this reduction is influenced by the vicarious enhancement in teamwork, communication, and staff awareness established by SSC implementation. The preferred reporting items for systematic reviews and meta-analyses model of review guided a search across MEDLINE, PubMed, and Embase databases. English-language studies using any adapted form of the WHO-SSC in operating rooms were reviewed by abstract and full text. Twenty-six studies, 13 assessing SSC compliance and 13 investigating surgical team perceptions of SSC, were evaluated. Compliance studies showed a checklist initiation rate of &amp;gt;90%, but actual observed completion rate varied widely across studies. Sign out was the most poorly performed phase of the checklist (&amp;lt;50%) with time out being the best. Verification of patient identity and procedure demonstrated a high degree (&amp;gt;90%) of compliance across studies, but “verification of team-members” was significantly less compliant. Studies assessing surgical team perceptions found that SSC improved participants' perception of teamwork, communication, patient safety, and staff awareness of adverse events. However, when stakeholders placed differing degrees of importance on SSC completion, results indicated the SSC might actually antagonize team relationships. SSC compliance varies significantly across studies, being highly dependent on staff perceptions, training, and effective leadership. Surgical teams have positive perceptions of SSC; thus with effective implementation strategies, compliance rates across all phases can be substantially improved.

Detecting Total Quality Management Status and Teamwork Orientation in Al-Yarmouk Teaching Hospital

Teamwork in hospitals has been recognized as an important contributor in providing high-quality healthcare for patients. However, it is imperative to understand the factors that affect the relationships among medical patient teams and their perceptions of patient’s healthcare quality. The primary objective of this study is to detect the Total Quality Management (TQM) status and teamwork orientation in one of the main Healthcare organizations in Iraq named Al-Yarmouk Teaching Hospital. A questionnaire survey was specially designed as to achieve study objectives. The questionnaire is divided into (60) various items specifically developed to gather information about the study variables. This study was carried out using a cross-sectional survey in which (64) respondents from (Al-Yarmouk Teaching Hospital) had completed a newly developed survey with a response rate of 100%. Descriptive statistics, Pearson Correlation, and ANOVA were used for data analysis. The main result of this study was that there was a positive correlation between all TQM dimensions and Teamwork. The survey analysis in addition to survey sample investigation throughout researcher’s own observations has revealed that the hospital does not meet TQM requirements. Moreover, the study result on one hand has shown that the impact of teamwork on staff Satisfaction value is 0.854, on the other hand it has proved the absence of impact between teamwork and staff perceptions on Quality of Patient Care.

Utilization of Portable Radios to Improve Ophthalmology Clinic Efficiency in an Academic Setting.

Improvement in clinic efficiency in the ambulatory setting is often looked at as an area for development of lean management strategies to deliver a higher quality of healthcare while reducing errors, costs, and delays. To examine the benefits of improving team communication and its impact on clinic flow and efficiency, we describe a time-motion study performed in an academic outpatient Ophthalmology clinic and its objective and subjective results. Compared to clinic encounters without the use of the portable radios, objective data demonstrated an overall significant decreases in mean workup time (15.18 vs. 13.10), room wait (13.10 vs. 10.47), and decreased the total time needed with an MD per encounter (9.45 vs. 6.63). Subjectively, significant improvements were seen in careprovider scores for patient flow (60.78 vs. 84.29), getting assistance (61.89 vs. 88.57), moving patient charts (54.44 vs. 85.71), teamwork (69.56 vs. 91.0), communications (62.33 vs. 90.43), providing quality patient care (76.22 vs. 89.57), and receiving input on the ability to see walk-in patients (80.11 vs. 90.43). For academic purposes, an improvement in engagement in patient care and learning opportunities was noted by the clinic resident-in-training during the pilot study. Portable radios in our pilot study were preferred over the previous method of communication and demonstrates significant improvements in certain areas of clinical efficiency, subjective perception of teamwork and communications, and academic learning.

Physician and Nurse Nighttime Communication and Parents' Hospital Experience.

Night teams of hospital providers have become more common in the wake of resident physician duty hour changes. We sought to examine relationships between nighttime communication and parents' inpatient experience. We conducted a prospective cohort study of parents (n = 471) of pediatric inpatients (0-17 years) from May 2013 to October 2014. Parents rated their overall experience, understanding of the medical plan, quality of nighttime doctors' and nurses' communication with them, and quality of nighttime communication between doctors and nurses. We tested the reliability of each of these 5 constructs (Cronbach's α for each >.8). Using logistic regression models, we examined rates and predictors of top-rated hospital experience. Parents completed 398 surveys (84.5% response rate). A total of 42.5% of parents reported a top overall experience construct score. On multivariable analysis, top-rated overall experience scores were associated with higher scores for communication and experience with nighttime doctors (odds ratio [OR] 1.86; 95% confidence interval [CI], 1.12-3.08), for communication and experience with nighttime nurses (OR 6.47; 95% CI, 2.88-14.54), and for nighttime doctor-nurse interaction (OR 2.66; 95% CI, 1.26-5.64) (P < .05 for each). Parents provided the highest percentage of top ratings for the individual item pertaining to whether nurses listened to their concerns (70.5% strongly agreed) and the lowest such ratings for regular communication with nighttime doctors (31.4% excellent). Parent communication with nighttime providers and parents' perceptions of communication and teamwork between these providers may be important drivers of parent experience. As hospitals seek to improve the patient-centeredness of care, improving nighttime communication and teamwork will be valuable to explore.

Quality management and perceptions of teamwork and safety climate in European hospitals

This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. Perceived teamwork and safety climate. Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.

An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams.

An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.

Health Care Providers’ Perceptions of Team Identity and Teamwork in the Operating Room

Health Care Providers’ Perceptions of Team Identity and Teamwork in the Operating Room