Patient Safety and Quality

Perceptions of teamwork in hospital labor and delivery units depend on caregiver role and the unit environment

Teamwork is often critical to patient safety in a hospital unit. Caregiver assessments of teamwork in a hospital labor and delivery (L&D) unit depend on the unit environment and their role in the unit, concludes a new study. The investigators, who developed the Safety Attitudes Questionnaire (SAQ) teamwork climate scale, used the instrument to assess caregiver assessments of teamwork climate in L&D units in 44 hospitals in diverse regions of the United States. The SAQ measured the extent to which caregivers reported they felt supported, could speak up comfortably, could ask questions, felt their input was heeded, that conflicts were resolved, and that physicians and nurses collaborated. The researchers correlated the scale with external teamwork-related items such as workload and procedure briefings.

Good teamwork climate scale scores at the L&D unit level were associated with better information management at point-of-care transitions, like communication during shift changes and briefings before a procedure. A good teamwork climate also appeared to be related to familiarity with other caregivers—for example, knowing their names and being able to predict their actions during emergencies. In L&D units where caregivers reported a good teamwork climate, decisions were made collaboratively and, when necessary, it was possible to disagree with staff physicians. Staff from these units also reported lower levels of caregiver burnout from work. Poor teamwork climate in a unit was associated with communication breakdowns that led to costly and unproductive delays.

Caregiver role influenced perceptions of teamwork. Overall, physicians and nurse managers were much more satisfied than nurses with the collaboration they experienced. For example, anesthesiologists had higher scale scores than certified registered nurse anesthetists for five of the six teamwork climate items. Most (80 percent) L&D staff felt it was easy for personnel in their unit to ask questions. However, only 55 percent found it easy to speak up if they perceived a problem with patient care, and only half felt that conflicts were appropriately resolved. The study was supported in part by the Agency for Healthcare Research and Quality (HS11544).

See "Variation in caregiver perceptions of teamwork climate in labor and delivery units," by John B. Sexton, Ph.D., M.A., Christine G. Holzmueller, B.L.A., Peter J. Pronovost, M.D., Ph.D., and others, in the August 2006 Journal of Perinatology 26, pp. 463-470.

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