Perceptions Of Teamwork Research Articles

The RIPPER Experience: A 3 Year Evaluation of an Australian Interprofessional Rural Health Education Pilot

AbstractBackground: The Rural Interprofessional Program Educational Retreat (RIPPER) uses interprofessional learning and educational strategies to prepare final year Tasmanian nursing, medical, and pharmacy students for effective healthcare delivery. RIPPER provided students (n = 90) with the opportunity to learn about working in an interdisciplinary team using authentic and relevant situational learning. RIPPER allowed students to work and learn interprofessionally in small teams and to apply their different professional skills and knowledge to a variety of rural healthcare situations.Methods and Findings: This article reports on three years of results from the program’s evaluation which used a pre-post test mixed method design. The findings show a significant and positive shift in students’ attitudes and understanding of interprofessional learning and practice following their participation in RIPPER. The evaluation findings suggest the need for sustainable interprofessional rural health education that is embedded in undergraduate curricula.Conclusion: The evaluation of RIPPER suggests that exposure of healthcare students to interprofessional education can positively affect their perceptions of collaboration, patient care, and teamwork. The evaluation also points to the rural context as an ideal place to showcase elements of effective interprofessional practice.

Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research.

The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety (P = .05) and teamwork (P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [F(3, 365) = 4.20, P < .05]; safety grade for work area [F(3, 360) = 2.61, P < .05]; number of events reported within the last month [F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.

Validity and Reliability of the Brief TeamSTEPPS Teamwork Perceptions Questionnaire

Teamwork is an essential component of hospital nursing quality and safety. The purpose of this study is to test the validity and reliability of the Brief TeamSTEPPS Teamwork Perception Questionnaire (Brief T-TPQ). The 20-item questionnaire was completed electronically by a sample (N = 456) of hospital bedside nurses and tested for reliability and validity. The survey demonstrated internal consistency reliability of .83-.94 with a total survey reliability of .93. A hierarchical relationship three factor subscale structure was confirmed, explaining 64% of the variance and acceptable factor loadings. A secondary five-factor structure revealed statistically and conceptually coherent skills and behaviors sub-subscales. Discriminant validity was demonstrated with self-esteem and control over practice. The 20-item Brief T-TPQ is a valid and reliable survey to measure hierarchical teamwork relationships as well as teamwork skills and behaviors.

Abstract 268: From Advanced Cardiac Life Support (ACLS) to Airway-Circulation-Leadership-Support (A-C-L-S): A Novel Team Training Model for Resuscitation Teams

INTRODUCTION The 2010 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care emphasize providers should coordinate and perform chest compressions and ventilations in a team-based approach. We developed a team training model called Airway-Circulation-Leadership-Support (A-C-L-S) to improve resuscitation performance, and presented our preliminary experience of A-C-L-S model in resuscitation team training for emergency department (ED) staff. METHODS CPR technical and non-technical tasks were prioritized and bundled into a mnemonic - ‘A-C-L-S’ which comprises 4 domains: Airway (A), Circulation (C), Leadership (L), and Support (S). A-team is assigned to manage airway, avoid hyperventilation, and monitor EtCO2. C-team focuses on rapid defibrillation and high-quality chest compression with feedback from an accelerometer. L-team assumes coordination and situation monitoring. S-team is responsible for intravenous access, drugs administration, time keeping, and recording. Each team training course consists of: (1) a video-assisted lecture on A-C-L-S model; (2) two high-fidelity simulation-based cardiac arrest scenarios before and after the lecture, each followed by (3) video-facilitated debriefing emphasizing the A-C-L-S model. A 10-item questionnaire using 5-point Likert scale was administered to evaluate perception of CPR teamwork before (i.e. prior clinical experiences) and after the course. RESULTS Seven A-C-L-S team training courses were delivered to 52 ED staff (17 residents and 35 nurses, all qualified ACLS providers) at a university teaching hospital from April to May 2011. Perception of CPR teamwork improved significantly in leadership (48.9% to 78.7%, p = 0.017), task assignment (34.1% to 74.5%, p = 0.002), role commitment (42.6% to 85.1%, p = 0.000), workload distribution (34.1% to 67.4%, p = 0.024), and shared goal (44.7% to 76.1%, p = 0.002) after the A-C-L-S team training. CONCLUSIONS Our novel A-C-L-S team training model can facilitate and reinforce the perception of CPR teamwork among ED staff. Application of this model in different scenarios and disciplines, and its impact on actual resuscitation performance and patient outcomes deserve further study.

Abstract 73: Improving Teamwork Perceptions and Cardiopulmonary Resuscitation Performance by High-Fidelity Simulation-Based Teamwork Training

Introduction: The quality of cardiopulmonary resuscitation (CPR) performance influences patient's outcome. Besides individual technical knowledge and skills, teamwork perceptions have an impact on team performance, and consequently on resuscitation quality. This study aimed to investigate the impacts of high-fidelity simulation (HFS)-based teamwork training on team perceptions and CPR performance. Methods: This was a prospective, case-controlled study. A four-scenario, HFS-based teamwork training program was developed and implemented from November 2007 to February 2008. In addition to resuscitation skills, the program focused on teaching teamwork competencies, including leadership, communication, situation monitoring, and mutual support. Case scenarios were simulated using a high-fidelity mannequin simulator in a simulated emergency department (ED) setting. Audio-visual assisted feedback was given by facilitators after each scenario. A standardized questionnaire for assessment of teamwork performance was developed, using 5-point Likert scales. All participants completed the questionnaires immediately after each scenario, according to their performance during that simulation session. Both the first and last case scenarios were patients of out-of-hospital cardiac arrest. CPR performance including compression rate, no-flow ratio, and initiation time of defibrillation was measured by reviewing the videos. Results: A total of 83 ED staffs, including 24 residents and 59 nurses, were enrolled. Teamwork perceptions improved significantly after the simulation training course ( p &lt;0.001). For CPR performance, there was a trend toward decreased hyperventilation rate (19.1±5.6 vs. 14.8±8.2 min -1 , p =0.10), increased chest compression rate (102.4±17.1 vs. 110.4±15.2 min -1 , p =0.12), and faster initiation of defibrillation (93.4±26.9 vs. 69.1±39.0 secs, p =0.09) after the training course. No-flow fraction (0.23±0.07 vs. 0.17±0.08, p =0.01), initiation of intubation (99.1±40.6 vs. 77.0±37.0 secs, p =0.02) and intravenous access (86.9±37.7 vs. 63.4±33.8 secs, p =0.02) were significantly improved. Conclusion: HFS-based teamwork training is effective in improving teamwork perceptions and some aspects of CPR performance.

Improving Perceptions of Teamwork Climate With the Veterans Health Administration Medical Team Training Program

There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except "Nurse input is well received." Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse-physician differences persisted at completion of the Veterans Health Administration MTT Program.

Evaluating Efforts to Optimize TeamSTEPPS Implementation in Surgical and Pediatric Intensive Care Units

An evidence-based teamwork system, Team-STEPPS, was implemented in an academic medical center's pediatric and surgical ICUs. A multidisciplinary change team of unit- and department-based leaders was formed to champion the initiative; develop a customized action plan for implementation; train frontline staff; and identify process, team outcome, and clinical outcome objectives for the intervention. The evaluation consisted of interviews with key staff, teamwork observations, staff surveys, and clinical outcome data. All PICU, SICU, and respiratory therapy staff received TeamSTEPPS training. Staff reported improved experience of teamwork posttraining and evaluated the implementation as effective. Observed team performance significantly improved for all core areas of competency at 1 month postimplementation and remained significantly improved for most of the core areas of competency at 6 and 12 months postimplementation. Survey data indicated improvements in staff perceptions of teamwork and communication openness in both units. From pre- to posttraining, the average time for placing patients on extracorporeal membrane oxygenation (ECMO) decreased significantly. The average duration of adult surgery rapid response team events was 33% longer at postimplementation versus pre-implementation. The rate of nosocomial infections at postimplementation was below the upper control limit for seven out of eight months in both the PICU and the SICU. The implementation of a customized 2.5-hour version of the TeamSTEPPS training program in two areas--the PICU and SICU--that had demonstrated successful ability to innovate suggests that the training was successful.

Supervisor-nurse relationships, teamwork, role ambiguity and well-being: Public versus private sector nurses

This paper uses a leader—member exchange theoretical framework to compare the relationship of the supervisor—subordinate relationship upon nurses’ satisfaction with teamwork and their perceived levels of role ambiguity, and in turn, their perceptions of well-being. Data were collected using a survey-based, self-report strategy from 1138 nurses, of whom 901 worked in private sector hospitals and 237 were from the public sector.Using path analysis, the findings from this study identify that supervisor—nurse relationships affect nurses’ perceptions of teamwork, role ambiguity and well-being, although the association is different for public sector compared with private sector nurses. However, of the two groups, private sector nurses were the most satisfied with their supervisor—nurse relationship and teamwork, and had higher perceived levels of both role clarity (instead of role ambiguity) and consequent well-being.

Student Team Project: Gender Differences in Team Project Experience and Attitudes Toward Team-Based Work

The development of favorable behaviors and attitudes in team-based work is crucial in hospitality and tourism education. In this article, the authors examine the gender difference in team project experience and attitudes toward team-based work among students majoring in hospitality management. Female students have attitudes toward team-based work that are more negative than male students. Also, gender is a significant moderator in that female students' perception of a group's teamwork, in comparison with that of male students, is more significant in predicting student attitudes. Implications of these findings for hospitality and tourism educators are discussed.

Discrepant perceptions of communication, teamwork and situation awareness among surgical team members.

ObjectiveTo assess surgical team members’ differences in perception of non-technical skills.DesignQuestionnaire design.SettingOperating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands.ParticipantsSixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists.MethodsAll surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT.ResultsRatings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ≤ 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ≤ 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate.ConclusionsThis study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare system.

Gerência em saúde: a percepção de coordenadores da estratégia saúde da família, em Uberaba-MG

The objective of this study was to analyze the health management performed in the Family Health Strategy (FHS) program from Uberaba-MG and to describe the perception its coordinators. This is a descriptive and qualitative research, using the thematic analysis described by Minayo 8 . The target population was composed by 15 coordinators of FHSs. The inclusion criterion was to be coordinator of FHS in the urban zone. Data was collected through a semi-structured interview and the percentile frequency was calculated and interpreted. There were 348 registration units distributed in 6 thematic areas: conduct and attitude of the coordinators; Work performance of coordinators; Perception of teamwork; Management model; The public health service; and Efficiency and Difficulties faced by the coordinators. The centralization of actions, the almost inexistence of a planning, the authoritarianism and excessive control of professionals are facts that permeate the work of the FHS coordinators. Coordinators do not have any management model to follow, they identify different policies on the job, and they highlight that political issues hinder the work. They perform actions ranging from setting appointments to human resource management.

Patients’ and health professionals’ perceptions of teamwork in primary care

Effective teamwork in primary care settings is integral to the ongoing health of those with chronic conditions. This study compares patient and health professional perceptions about teams, team membership, and team members' roles. This study aimed to test both the feasibility of undertaking a collaborative method of enquiry as a means of investigating patient perceptions about teamwork in the context of their current health care, and also to compare and contrast these views with those of their usual health professionals in New Zealand suburban general practice settings. Using a qualitative methodology, 10 in-depth interviews with eight informants at two practices were conducted and data analysed using inductive thematic analysis. The methodology successfully elicited confidential interviews with both patients and the health professionals providing their care. Perceptions of the perceived value of team care and qualities facilitating good teamwork were largely concordant. Patient and health professionals differed in their knowledge and understanding about team roles and current chronic care programmes, and had differing perceptions about health care team leadership. This study supports the consensus that team-based care is essential for those with chronic conditions, but suggests important differences between patient and health professional views as to who should be in a health care team and what their respective roles might be in primary care settings. These differences are worthy of further exploration, as a lack of common understanding has the potential to consistently undermine otherwise well-intentioned efforts to achieve best possible health for patients with chronic conditions.

Self-Confidence and Teamwork: An Experimental Test

We use a laboratory experiment to study how perceptions of skill influence teamwork. Our design is based on Gervais and Goldstein (2007) theory of teams. Team output is increasing in skill and in effort, skill and effort are complements, and workers’ effort choices are complements. An overconfident agent thinks that his skill is higher than it actually is. We find that the presence of overconfident workers in teams is beneficial for firms since it raises effort provision and team output. We also find that overconfidence leads to a Pareto improvement in workers’ payoffs. In contrast, underconfidence is detrimental to firms as well as workers.

Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention

ObjectivesTo assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention.DesignPre- and post intervention survey.SettingEight hospitals participating in a trial of...

A measure of teamwork perceptions for team-based learning

Introduction Teamwork is a developed skill that is essential within pharmacy practice and health care. Exposure to team-based learning (TBL) pedagogy may foster development of this skill. The purpose of this study was to evaluate a measure for perception of teamwork among PharmD students, and then examine a module using TBL pedagogy. Methods Faculty instructors for a 90-contact hour cardiovascular pharmacotherapy module used TBL pedagogy in teaching 18 hours of the therapeutics topics in that module. To determine a change in their perceptions of teamwork, second-year PharmD students took pre- and post-module surveys. The survey instrument used was previously published with use among medical students. Results Fifty-eight of 61 PharmD students participated. The Rasch Measurement Model was used to construct measures of student perceptions along a linear and unidimensional “perception of teamwork” continuum. To make the survey unidimensional, seven of the 20 items were removed. The resulting instrument had a reliability of 0.93 and separation of 3.56. Pre-module survey results were 1.1 ± 2.5 logits, whereas afterwards were 1.3 ± 2.4 logits. Change in students' perceptions were varied at 0.2 ± 2.6 logits (paired t-test p = 0.6293). Older students had a negative correlation ( r = –0.27, p = 0.04), whereas pharmacy work experience had a positive correlation with change in teamwork perception ( r = 0.31, p = 0.02). Conclusion This instrument appears psychometrically valid and reliable to measure changes in PharmD students' perceptions of teamwork with TBL. Study results led to reflection on attributing factors for module improvements by involved faculty.

STORC safety initiative: a multicentre survey on preparedness & confidence in obstetric emergencies

BackgroundPatient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated...

Differences in Nurse and Surgeon Perceptions of Teamwork: Implications for Use of a Briefing Checklist in the OR

The quality of teamwork among health care professionals is known to affect patient outcomes. In the OR, surgeons report more favorable perceptions of communication during procedures and of teamwork effectiveness than do nurses. We undertook a quality improvement project in the Veterans Health Administration to confirm reported teamwork differences between perioperative nurses and surgeons and to examine the implications of these differences for improving practice patterns in the OR. The Safety Attitudes Questionnaire, which measures safety culture, including the quality of communication and collaboration among health care providers who routinely work together, was administered in 34 hospitals. Perioperative nurses who participated in the survey rated teamwork higher with other nurses than with surgeons, but surgeons rated teamwork high with each other and with nurses. On five of six communication and collaboration items, surgeons had a significantly more favorable perception than did perioperative nurses. To increase the likelihood of success when implementing the use of checklist-based crew resource management tools, such as the World Health Organization's Surgical Safety Checklist, project leaders should anticipate differences in perception between members of the different professions that must be overcome if teamwork is to be improved.

Does Teamwork Improve Performance in the Operating Room? A Multilevel Evaluation

Medical care is a team effort, especially as patient cases are more complex. Communication, cooperation, and coordination are vital to effective care, especially in complex service lines such as the operating room (OR). Team training, specifically the TeamSTEPPS training program, has been touted as one methodology for optimizing teamwork among providers and increasing patient safety. Although such team-training programs have transformed the culture and outcomes of other dynamic, high-risk industries such as aviation and nuclear power, evidence of team training effectiveness in health care is still evolving. Although providers tend to react positively to many training programs, evidence that training contributes to important behavioral and patient safety outcomes is lacking. A multilevel evaluation of the TeamSTEPPS training program was conducted within the OR service line with a control location. The evaluation was a mixed-model design with one between-groups factor (TeamSTEPPS training versus no training) and two within-groups factors (time period, team). The groups were located at separate campuses to minimize treatment diffusion. Trainee reactions, learning, behaviors in the OR, and proxy outcome measures such as the Hospital Survey on Patient Safety Culture (HSOPS) and Operating Room Management Attitudes Questionnaire (ORMAQ) were collected. All levels of evaluation demonstrated positive results. The trained group demonstrated significant increases in the quantity and quality of presurgical procedure briefings and the use of quality teamwork behaviors during cases. Increases were also found in perceptions of patient safety culture and teamwork attitudes. The hospital system has integrated elements of TeamSTEPPS into orientation training provided to all incoming hospital employees, including nonclinical staff.

Perceptions of Teamwork in the OR: Roles and Expectations

Researchers investigated perceptions of communication between members of the OR team. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Implementing Standardized Operating Room Briefings and Debriefings at a Large Regional Medical Center

Effective communication and teamwork are critical in many health care settings, particularly the operating room (OR). Several studies have implicated failures of communication and teamwork as the root cause in a high proportion of sentinel events in the OR. In a prospective cohort study at a high-volume teaching, research, and tertiary care referral hospital, a standardized one-page briefing and debriefing tool was developed and implemented in October 2006 to improve interdisciplinary communication and teamwork in the OR. The briefing portion of the tool was completed by the surgical team after the patient's final positioning and before incision; the debriefing portion was initiated and completed by the circulating nurse after the first counts were conducted. Compliance was calculated as the number of cases where the briefing and debriefing tool was completed divided by the total number of eligible cases. Surveys (n=40) were conducted to elicit caregiver perceptions of interdisciplinary communication and teamwork in the OR and the burden and average time taken to complete the briefing and debriefing tool. Between October 2006 and March 2008, 37,133 briefings and debriefings were conducted. Average compliance varied over time since implementation, with overall compliance ranging from 76% to 95%. The majority of caregivers perceived that the briefing and debriefing tool improved interdisciplinary communication and teamwork. On average, it took 2.9 minutes (range, 1-5 minutes) to complete the briefing portion of the tool and 2.5 minutes (range, 1-5 minutes) to complete the debriefing portion. Implementation of a standardized briefing and debriefing tool in a large regional medical center was a, practical and feasible strategy to improve perceptions of interdisciplinary communication and teamwork in the OR.