Teamwork, organizational learning, patient safety and job outcomes

The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors

Purpose

This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes.

Patients and Methods

In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate.

Results

The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety.

Conclusion

This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.

Interprofessional collaboration mediates the relationship between perceived organizational learning and safety climate in hospitals: A cross-sectional study

BACKGROUND

Organizational learning (OL) and interprofessional collaboration (IPC) are said to enhance medical safety in hospitals, but the relationship between these variables has not been quantitatively tested.

OBJECTIVE

This study examines the mediating effects of IPC on the relationship between OL and safety climate (improvement, compliance, and patient/family involvement).

METHODS

An anonymous self-reporting questionnaire was administered to 1,495 healthcare workers from November 2021 to January 2022. The questions regarded the hospital's safety climate, OL, and IPC. A mediation analysis using structural equation modeling was conducted to examine the mediating role of IPC on the relationship between OL and the three safety climates. The indirect effect was estimated using 2,000 bootstrap samples.

RESULTS

Responses from 643 healthcare workers were analyzed. The direct effects of OL were 𝛽 = .74, 75 (p < .001) on improvement and involvement and 𝛽 = 0.1 (p > .05) on compliance. The indirect effects of IPC on improvement and involvement were 𝛽 = .14 (95%CI: .00 ∼ .06) and 𝛽 = .37 (95%CI: .04 ∼ .09), respectively.

CONCLUSION

This study determined the mechanisms that enhance a hospital's safety climate, demonstrating that IPC mediates the relationship between OL and improvement and patient/family involvement. However, OL and IPC are not related to compliance.

Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches

Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.

Assessing managerial patient safety practices that influence adverse events reporting among nurses in the Savannah Region, Ghana

Introduction

Patient safety is a global concern for both health professionals and the public. Studies show that evaluating patient safety culture can help improve patient safety outcomes. Nursing care strategically places nurses at the centre of patient safety promotion and their proximity to patients makes them the drivers of patient safety. Managerial decisions regarding patient safety impact greatly on patient safety outcomes in the healthcare organization. This study aimed to assess the managerial patient safety practices that influence adverse event reporting in three hospitals in the Savannah Region of Ghana.

Methods

A quantitative cross-sectional design was used to collect data from 210 participants in three hospitals. Data were analysed using descriptive, Pearson's correlation and linear regression.

Results

It was found that patient safety practices with good positive rating scores were management support (56.6%), managers' expectations (62.8%) and feedback about errors (56.2%). Areas with weak patient safety practices were staffing levels (42.4%), open communication (40.2%) and non-punitive response to errors (36.7%). Again, nurses' attitude towards adverse events reporting was generally low (37.3%). Managerial patient safety practices that had significant associations with adverse events reporting were management support ( r = .18, p < .001), open communication ( r = .19, p < .001), non-punitive to errors ( r = .21, p < .001) and feedback about errors ( r = .37, p < .001). Again, the significant predictors of adverse events reporting were feedback about errors ( β  =  .36, p < .001) and non-punitive response to errors ( β  =  .21, p  < .01).

Conclusion

Nurses perceived patient safety culture in their units to be good. Although nurses' attitude towards adverse events reporting was low, the significant predictors of adverse events reporting were feedback about errors and non-punitive response to errors. Therefore, healthcare managers should continually strengthen patient safety to ensure optimal care outcomes.

Implications for nursing practice

Feedback on errors and non-punitive response to errors had a great influence on adverse events reporting, managerial failure to provide feedback and a non-punitive work environment could result in under-reporting of adverse events. This can be a major threat to patient safety; hence clinical practice should be aware of this and put in strategies to appropriately address them.

Health care managers' competence in knowledge management: A scoping review

AIM

To identify current evidence on health care managers' competence in knowledge management.

BACKGROUND

Although successful knowledge management improves the quality of care and performance of health care organisations, there is limited evidence on health care managers' competence in knowledge management EVALUATION: A scoping review was conducted by including original published and unpublished studies (qualitative, quantitative, and experimental) and review designs in English, Finnish, or Swedish. The studies were retrieved from six databases (CINAHL, ProQuest, PubMed, Scopus, Mednar, and Finnish database Medic) in November 2020 and then complemented in January 2022. Narrative synthesis was used to synthesize data.

KEY ISSUES

A total of 21 articles was included in the review. The main themes of managers' competence in knowledge management presented in these were system management, professional development, and leadership behaviour and attitude. No valid and reliable instruments were described in the included studies.

CONCLUSION

At present, there is a limited understanding of health care managers' competence in knowledge management. A comprehensive understanding of this topic can provide a direction for future research.

IMPLICATIONS FOR NURSING MANAGEMENT

The results can be utilized in the assessment and development of managers' competence in knowledge management, as well as the formulation of education and in-service training for health care managers.

Shaping the Nursing Profession Postpandemic Through Reconstructed Leadership Practices

Responding to and navigating the COVID-19 pandemic were demanding and all-consuming for executive nurse leaders. Long-term pandemic challenges will continue and therefore it is important for nurse leaders to develop their reflective practice to increase role competency, gain wisdom, and advance the profession. The complex postpandemic world requires nurse leaders to show up differently, stop ineffective practices, continue best practices, and implement new ideas to improve performance and outcomes. This article offers a framework for leadership reflection, through role negotiation technique, to identify lessons from the lived nurse executive experience of the COVID-19 pandemic. Specific focus is placed on communication, teamwork, professional governance, posttraumatic growth, gratitude, diversity/equity/inclusion, and social determinants of health. These concepts, along with specific tactics, will help leaders set priorities, aid nursing leadership practice, identify meaningful goals and desired outcomes, and effectively lead to advance the nursing profession postpandemic.

The Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces

ABSTRACT

How to develop a better patient safety culture has been an important goal for healthcare organizations, but the effects of safety culture on psychosocial factors, such as emotional exhaustion and stress, have not been fully addressed. This study aimed to reconfigure important dimensions affecting safety culture and examine the associations between safety culture and psychosocial factors (emotional exhaustion and work-life balance). The partial least squaring technique was used to analyze the data, showing that job satisfaction (β = 0.320, P < 0.001), working conditions (β = 0.307, P < 0.001), and perception of management (β = 0.282, P < 0.001) positively affected the safety climate. The safety climate and work-life balance could reduce the occurrence of emotional exhaustion, whereas a high-stress environment would cause a higher level of emotional exhaustion. Given these findings, hospitals should endeavor to help employees feel safe and not threatened, reduce stress, and advise them to maintain a good work-life balance.

Above and beyond: helping behaviors among nurses in positive and negative reciprocity relationships

Purpose

The purpose of this paper is to explore antecedents of helping behaviors among nurses using a social exchange framework. The paper reports an investigation into the effects of reciprocity, perceived coworker efficacy and stress on active and passive helping behaviors.

Design/methodology/approach

To test hypotheses, the authors performed random coefficient modeling on Mplus with data from 155 full-time nurses.

Findings

Nurses were willing to help coworkers regardless of perceived reciprocity levels in the relationship. Rather, their perceptions of the coworker's efficacy and previous behavior predicted helping.

Originality/value

This manuscript contributes to the literature in a number of ways. First, it provides empirical evidence that individuals will suppress or ignore reciprocity norms during an interdependent task. This lends credence to the idea that social exchanges may need to be examined in light of other variables or at other levels of analysis. Second, it demonstrates that investment behaviors (i.e. helping) can and do occur in exchange relationships despite low reciprocity. Overall, the data suggest that individuals are willing to maintain relationships despite a lack of returns.

Decision-Making Model to Assess the Organizational Climate in Healthcare Organizations

Organizational climate impacts on the employee’s well-being, commitment and positive behavior. Most studies to assess climate in healthcare organizations use qualitative and/or statistical methods. Here, we propose a general framework, based on a multiple criteria decision making/aid (MCDM / A) method, which considers different objectives in a single problem. Such framework includes internal and external factors to assess organizational climate and presented adequate results when tested in a particular case. To assess the organizational climate, we use the ELECTRE TRI method, an outranking method that combine the decision-maker (DM) preferences and his value judgments. We conclude that MCDM methods can improve agility, provide a systemic vision on organizational climate assessment and contribute to the decision-making process

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

BACKGROUND

Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR.

METHODS

This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding.

RESULTS

Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified.

CONCLUSIONS

The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.

Psychometric Properties of the Greek Version of the Medical Office on Patient Safety Culture in Primary Care Settings

Background: Safety culture is considered one of the most crucial premises for further development of patient care in healthcare. During the eight-year economic crisis (2010–2018), Greece made significant reforms in the way the primary health care system operates, aiming at the more efficient operation of the system without degrading issues of safety and quality of the provided health services. In this context, this study aims to validate a specialized tool—the Medical Office Survey on Patient Safety Culture (MOSPSC)—developed by the Agency for Healthcare Research and Quality (AHRQ) to evaluate primary care settings in terms of safety culture and quality. Methods: Factor analysis determined the correlation of the factor structure in Greek data with the original questionnaire. The relation of the factor analysis with the Cronbach’s coefficient alpha was also determined, including the construct validity. Results: Eight composites with 34 items were extracted by exploratory factor analysis, with acceptable Cronbach’s alpha coefficients and good construct validity. Consequently, the composites jointly explained 62% of the variance in the responses. Five items were removed from the original version of the questionnaire. As a result, three out of the eight composites were a mixture of items from different compounds of the original tool. The composition of the five factors was similar to that in the original questionnaire. Conclusions: The MOSPSC tool in Greek primary healthcare settings can be used to assess patient safety culture in facilities across the country. From the study, the patient safety culture in Greece was positive, although few composites showed a negative correlation and needed improvement.

Changing me to we: Developing teambuilding in radiation therapy

BACKGROUND

There has been a causal link identified within the literature between poor team function and errors, patient outcomes, staff satisfaction and performance. Lacking is supporting evidence on teambuilding and its impact on overall team performance and team dynamics. Within radiation therapy, there is difficulty in understanding the inner workings of team dynamics due to the unique complex nature of teams and with very little evidence on the impact of team building specific to radiation therapy. The focus of this research is to form a better understanding of the effects of teambuilding before and after a teambuilding education session.The knowledge gained can help in future trainings to promote and facilitate teambuilding to develop team dynamics and lead a change in culture.

METHODS

Team building sessions were booked and scheduled for 148 radiation therapists. Pre and post session evaluations were distributed to all participants and collected at the end of each team building session. Descriptive statistics were used to analyze Likert scale responses. Open-ended question responses were coded and analyzed for emerging themes using thematic analysis.

RESULTS

110 of 148 radiation therapists attended one of the scheduled team building sessions. Pre-session evaluations indicated radiation therapists have a good understanding of factors that affect teamwork (88% agree); are aware of the multi-generational impact (78% agree); have the skill set to build a respectful team (86% agree); and are comfortable dealing with conflict (67% agree). Post-session evaluations indicated that participants had gained increased knowledge on teamwork (66.3% agree; 30.7% strongly agree); are more aware of the generational impact within teams (59% agree); new strategiesdeveloped to help improve team dynamics and the ability to use the lessons learnt immediately (67% and 71% respectively agree). Open ended comments indicated an interest in additional teambuilding sessions and further education on conflict resolution.

CONCLUSION

Results showed an increased awareness of the factors that impact team dynamics amongst radiation therapists and an interest in receiving further education in teambuilding. Findings will be utilized to better inform debate in future development of teambuilding educational sessions to improve overall team dynamics in radiation therapy.

Building learning organizational culture during COVID-19 outbreak: a national study

Background

Hospitals and healthcare institutions should be observant of the ever-changing environment and be adaptive to learning practices. By adopting the steps and other components of organizational learning, healthcare institutions can convert themselves into learning organizations and ultimately strengthen the overall healthcare system of the country. The present study aimed to examine the influence of several organizational learning dimensions on organization culture in healthcare settings during the COVID-19 outbreak.

Methods

During COVID-19 crisis in 2020, an online cross-sectional study was performed. Data were collected via official emails sent to 1500 healthcare professionals working in front line at four sets of hospitals in Saudi Arabia. Basic descriptive analysis was constructed to identify the variation between the four healthcare organizations. A multiple regression was employed to explore how hospitals can adopt learning process during pandemics, incorporating several Dimensions of Learning Organizations Questionnaire (DLOQ) developed by Marsick and Watkins (2003) and Leufvén and others (2015).

Results

Organizational learning including system connections (M = 3.745), embedded systems (M = 3.732), and team work and collaborations (M = 3.724) tended to have major significant relationships with building effective learning organization culture. Staff empowerment, dialogues and inquiry, internal learning culture, and continuous learning had the lowest effect on building health organization culture (M = 3.680, M = 3.3.679, M = 3.673, M = 3.663, respectively). A multiple linear regression was run to predict learning organization based on the several variables. These variables statistically significantly predicted learning organization, F (6, 1124) = 168.730, p < .0005, R² = 0.471, (p < .05).

Discussion

The findings concluded that although intrinsic factors like staff empowerment, dialogues and inquiry, and internal learning culture, revealed central roles, still the most crucial factors toward the development of learning organization culture were extrinsic ones including connections, embed system and collaborations.

Conclusions

Until knowledge-sharing is embedded in health organizational systems; organizations may not maintain a high level of learning during crisis.

Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework

Background

Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective.

Methods

This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers.

Results

A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts.

Conclusions

We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.

Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia

PURPOSE

The key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia.

DESIGN/METHODOLOGY/APPROACH

This narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study.

FINDINGS

Culture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised.

RESEARCH LIMITATIONS/IMPLICATIONS

This review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification.

SOCIAL IMPLICATIONS

This analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels.

ORIGINALITY/VALUE

This article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.

Contribution of PCA/K-means methods to the mixed assessment of patient safety culture

Purpose

The assessment of patient safety culture (PSC) is a major priority for healthcare providers. It is often realized using quantitative approaches (questionnaires) separately from qualitative ones (patient safety culture maturity model (PSCMM)). These approaches suffer from certain major limits. Therefore, the aim of the present study is to overcome these limits and to propose a novel approach to PSC assessment.

Design/methodology/approach

The proposed approach consists of evaluating PSC in a set of healthcare establishments (HEs) using the HSOPSC questionnaire. After that, principal component analysis (PCA) and K-means algorithm were applied on PSC dimensional scores in order to aggregate them into macro dimensions. The latter were used to overcome the limits of PSC dimensional assessment and to propose a quantitative PSCMM.

Findings

PSC dimensions are grouped into three macro dimensions. Their capitalization permits their association with safety actors related to PSC promotion. Consequently, a quantitative PSC maturity matrix was proposed. Problematic PSC dimensions for the studied HEs are “Non-punitive response to error”, “Staffing”, “Communication openness”. Their PSC maturity level was found underdeveloped due to a managerial style that favors a “blame culture”.

Originality/value

A combined quali-quantitative assessment framework for PSC was proposed in the present study as recommended by a number of researchers but, to the best of our knowledge, few or no studies were devoted to it. The results can be projected for improvement and accreditation purposes, where different PSC stakeholders can be implicated as suggested by international standards.

Impact of physician's sex/gender on processes of care, and clinical outcomes in cardiac operative care: a systematic review

OBJECTIVES

This systematic review aimed to assess the role of physician's sex and gender in relation to processes of care and/or clinical outcomes within the context of cardiac operative care.

DESIGN

A systematic review.

DATA SOURCES

Searches were conducted in PsycINFO, Embase and Medline from inception to 6 September 2018. The reference lists of relevant systematic reviews and included studies were also searched.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Quantitative studies of any design were included if they were published in English or French, involved patients of any age undergoing a cardiac surgical procedure and specifically assessed differences in processes of care or clinical patient outcomes by physician's sex or gender. Studies were screened in duplicate by two pairs of independent reviewers.

OUTCOME MEASURES

Processes of care, patient morbidity and patient mortality.

RESULTS

The search yielded 2095 publications after duplicate removal, of which two were ultimately included. These studies involved various types of surgery, including cardiac. One study found that patients treated by female surgeons compared with male surgeons had a lower 30-day mortality. The other study, however, found no differences in patient outcomes by surgeon's sex. There were no studies that investigated anaesthesiologist's sex/gender. There were also no studies investing physician's sex or gender exclusively in the cardiac operating room.

CONCLUSIONS

The limited data surrounding the impact of physician's sex/gender on the outcomes of cardiac surgery inhibits drawing a robust conclusion at this time. Results highlight the need for primary research to determine how these factors may influence cardiac operative practice, in order to optimise provider's performance and improve outcomes in this high-risk patient group.

Understanding team dynamics to promote team building in a radiotherapy department

Background:

Teamwork is a central framework in healthcare delivery. Team dynamics can impact the team as a whole and has been identified within the literature as a contributory factor to quality and safety, patient satisfaction, staff satisfaction and overall performance. Within radiation therapy (RT), teamwork is essential in the delivery of high-quality care, yet team building and team development is under-reported.

Aim:

The focus of this research is to form a better understanding of what plays an impact on teams in a large urban RT cancer centre and how to better engage staff to work together, improve team dynamics and promote team building.

Materials and Methods:

An electronic search of the literature was conducted to better inform debate and aid in the development of team-building sessions in a busy radiotherapy department. Abstracts were screened and relevant articles selected if they met the search criteria that included relevancy related to team building, contributory factors on team dynamics, team-based learning, team performance and implication of civility.

Results:

A total of 45 articles were included in the final analysis. The majority were from the disciplines of medicine (45%), business (22%) and nursing (18%). Only 3 of the 45 articles (7%) focused on the profession of RT. Most articles discussed more than 1 theme with team dynamics and team building being the most common themes discussed in 16 articles each (36%). Other common themes included teamwork (31%), respect and civility (20%), leadership and hierarchy (11%), medical errors (11%) and team training (11%). Only 3 of the 45 articles (7%) focused on RT.

Conclusion:

There is a lack of longitudinal evidence to support the impact of team building sessions to improve team dynamics and promote a positive, cohesive team environment. Specifically within RT, the impact team building has on team dynamics has been under investigation.

Highlights:

High-quality patient care can be linked to team collaboration and cohesiveness. Changing the culture within a team and engaging in civility and respect in everyday practice has the potential to improve team dynamics, patient safety, staff and patient satisfaction.

Organizational learning culture and business intelligence systems of health-care organizations in an emerging economy

Purpose

This paper aims to investigate the role of business intelligence systems (BIS) in the relationship between organizational learning culture and organizational performance in the health-care context.

Design/methodology/approach

A quantitative approach was applied to identify the hypothesized relationships. Data were obtained from a survey of 217 mid- and top-level managers of health-care organizations in Bangladesh. Structural equation modeling was used to analyze the data.

Findings

The findings attest to the effectiveness of the mediating role of BIS in the relationship between organizational learning culture and organizational performance within health-care organizations. The theoretical and practical implications of the findings are also discussed.

Research limitations/implications

The study data were collected from a single country, which made generalization difficult. Further research should be carried out to replicate the present study with different organizational cultural variables and organizational outcomes, such as patient satisfaction.

Practical implications

This study provides a clear direction for hospital managers to invest more resources in an effective learning culture, to be positively mediated by BIS and to eventually enhance their hospitals’ performance. In addition, this study also suggests that hospital managers should focus on building a knowledge-based learning culture, to effectively use the information provided by BIS.

Originality/value

Despite the prior study on the applications of BIS and their value to an organization, little is known about the impact of organizational learning culture on BIS in health-care organizations. The findings give support to the argument that organizational learning culture plays an important role in BIS that, in turn, affects business performance.

Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses

BACKGROUND

Literature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagia.

OBJECTIVES

This study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriers.

METHOD

This cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses' perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to compliance.

RESULTS

Three main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrier.

CONCLUSION

For dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids.

Key strategies for improving transitions of care collaboration: lessons from the ECHO-care transitions program

Transitioning the care of a patient from a hospital to a skilled nursing facility (SNF) is critical and often risky. Poor care transitions can result in delays, medication mistakes, incomplete follow-up care, and adverse health outcomes. Ensuring a smooth and effective care transition is the goal for providers at both the hospital and SNF. At its foundation, successful care transitions rely on teamwork, relationship building, and communication among diverse groups of providers. Beth Israel Deaconess Medical Center (BIDMC) developed the ECHO-CT (Extension for Community Healthcare Outcomes-Care Transitions) program to improve transitions of care through structured, bi-directional communication between hospital-based and SNF-based providers. This paper describes key strategies for success in this model including: facilitating teamwork, eliminating hierarchy, and encouraging a bi-directional learning environment. We propose these as strategies that could be implemented in other organizations seeking to improve value during transitions of care.

The influence of Senge’s book The Fifth Discipline on an academic career: a research journey into the learning organization and some personal reflections

Purpose

In this paper, the author explores his research journey into the learning organization and its impact on his academic career. This paper describes how Peter Senge’s book The Fifth Discipline: The Art and Practice of The Learning Organization (1990) was the spark that led to the author’s focus on empirical research in the field.

Design/methodology/approach

This paper provides author’s personal reflections on how this decision put him on a path to a variety of serendipitous experiences, exciting research areas and also enabled him to engage in productive collaborative research with many of his colleagues.

Findings

The findings conclude with a discussion on what the author see as new challenges and perspectives for advancing research into the learning organization.

Originality/value

This paper provides a unique perspective on how The Fifth Discipline by Peter Senge has influenced an academic career. It presents a personal reflection of a research journey into the learning organization that spans over 30 years.

The complete clinician model

Historically, medical education has focused on acquiring knowledge of basic science and clinical medicine. Relationship management skills are an essential aspect of excellent clinicians that may have been overlooked in the educational curriculum and undervalued in practice. The complete clinician model is a theoretical model for clinician development that describes why knowledge acquisition and relationship management are both imperative skills to refine when progressing to be an excellent clinician. Four quadrants are described, with ideal progress going from the trainee quadrant to the golden quadrant, ultimately aiming for competence in both knowledge acquisition and relationship management. The pediatric resident milestones from the Accreditation Council for Graduate Medical Education were placed in the model to underscore the importance placed on both knowledge acquisition and relationship management skills. Relationship management training should be integrated into the medical curriculum. This model may be applicable to professional education in other health care disciplines.

Adapting a Lean leadership-training program within a health care organization through cocreation

Purpose

The purpose of this paper is to describe and evaluate a Lean leadership-training program within the health-care sector. A training program developed through a cocreative process with the intent of enhancing the possibilities for a context-specific adaption of Lean.

Design/methodology/approach

A cocreated leadership-training program, executed over a period of one year, is described both as a model development process and as the final training program. The program was evaluated through reflective discussions and feedback as well as a written final evaluation of the program from participants in the program.

Findings

The evaluation shows that the objectives of the training program were met, at least among the participants who attended the whole program. Using a cocreative process when developing and realizing a leadership-training program enhances the possibilities for an organization to adapt Lean to its own context. One condition for this approach to be successful is that the expectations of both the organization and the university need to be in focus through the whole process. In addition, the executive team needs to be continuously engaged and create conditions for the organization to realize the potential benefits of the training program.

Originality/value

This paper highlights the challenge when applying Lean in a health-care organization but also describes a way to address Lean training and learning in this context.

Organizational learning and patient safety: hospital pharmacy settings

Purpose

The purpose of this paper is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings as determined by the learning organization survey short-form (LOS-27) and pharmacy survey on patient safety culture instruments, and to further explore how dimensions of organizational learning relate to dimensions of pharmacy patient safety culture.

Design/methodology/approach

This study is a cross-sectional study. Data were obtained from three public hospital pharmacies and three private hospital pharmacies in Kuwait. Partial least square structural equation modeling was used to analyze the data.

Findings

A total of 272 surveys (59.1 percent response rate) were completed and returned. The results indicated a significant positive relationship between organizational learning and patient safety culture in hospital pharmacy settings (path coefficient of 0.826, p-value <0.05 and R2 of 0.683). Several dimensions of the organizational learning showed significant links to the various dimensions of the pharmacy patient safety culture. Specifically, training (TRN), management that reinforces learning (MRL) and supportive learning environment (SLE) had the strongest effects on the pharmacy patient safety culture dimensions. Moreover, these effects indicated that MRL, SLE and TRN were associated with improvements in most dimensions of pharmacy patient safety culture.

Originality/value

To the best of the authors’ knowledge, this is the first attempt to assess the relationship between organizational learning, patient safety culture and their dimensions in hospital pharmacy settings.

A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana

INTRODUCTION

Adverse events pose a serious threat to quality patient care. Promoting a culture of safety is essential for reducing adverse events. This study aims to assess healthcare providers' perceptions of patient safety culture in three selected hospitals in the Upper East region of Ghana.

METHODS

The English version of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 406 clinical staff. Statistical Package for Social Science (SPSS) software, version 23, was used to analyze the data. The results were presented using descriptive statistics, Pearson Correlation Analysis and One-way Analysis of Variance (ANOVA).

RESULTS

It was found that two out of twelve patient safety culture dimensions recorded high positive response rates (≥ 70%). These include teamwork within units (81.5%) and organizational learning (73.1%). Three patient safety culture dimensions (i.e. staffing, non-punitive response to error and frequency of events reported) recorded low positive response rates (≤ 50%). The overall perception of patient safety correlated significantly with all patient safety culture dimensions, except staffing. There was no statistically significant difference in the overall perception of patient safety among the three hospitals.

CONCLUSION

Generally, healthcare providers in this study perceived patient safety culture in their units as quite good. Some of the respondents perceived punitive response to errors. Going forward, healthcare policy-makers and managers should make patient safety culture a top priority. The managers should consider creating a 'blame-free' environment to promote adverse event reporting in the hospitals.

Organizational Culture at a Tertiary Care Center in Saudi Arabia: A Mixed Approach Study

Objective

To explore the prevailing culture among leaders at the King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia, as well as to evaluate the impact of organizational culture from the perspective of employees.

Subjects and methods

Utilizing a convenient sampling method, data were collected at the KFMC, Saudi Arabia, using two research approaches (focus group and cross-sectional). A total of 446 employees participated in this questionnaire-based study, and all questionnaires were analyzed to obtain the final data.

Results

About 51% of the participants were males and 49% were non-Saudi nationals. On a scale of 5 points, the overall score of the KFMC culture assessment was 3.6 (72%). The strongest recognized factor was the enjoyment (3.9/5; 78%). On the other hand, the factor with the lowest score was innovation (3.3/5; 66%).

Conclusion

The culture within an organization is very important. Communicating organizational strategic plans of change to employees and assuring their acknowledgment of the vision can inspire the behavior and attitude of employees at the workplace. This study strikes a note of challenge in some dimensions and items. Top management leaders are recommended to adjust their leadership behavior to focus on these challenges.

Exploring healthcare professionals' perceptions of medication errors in an adult oncology department in Saudi Arabia: A qualitative study

Objective

Adverse events which result from medication errors are considered to be one of the most frequently encountered patient safety issues in clinical settings. We undertook a qualitative investigation to identify and explore factors relating to medication error in an adult oncology department in Saudi Arabia from the perspective of healthcare professionals.

Methods

This was a qualitative study conducted in an adult oncology department in Saudi Arabia. After obtaining required ethical approvals and written consents from the participants, semi-structured interviews and focus group discussions were carried out for data collection. A stratified purposive sampling strategy was used to recruit medical doctors, pharmacists, and nurses. NVivo Pro version 11 was used for data analyses. Inductive thematic analysis was adopted in the primary coding of data while secondary coding of data was carried out deductively applying the Hospital Survey of Patient Safety Culture (HSOPSC) framework.

Result

The total number of participants were 38. Majority of the participants were nurses (n = 24), females (n = 30), and not of Saudi nationality (n = 31) with an average age of 36 years old. Causes of medication errors were categorized into 6 themes. These causes were related teamwork across units, staffing, handover of medication related information, accepted behavioural norms, frequency of events reported, and non-punitive response to error.

Conclusion

There were numerous causes for medication errors in the adult oncology department. This means substantive improvement in medication safety is likely to require multiple, inter-relating, complex interventions. More research should be conducted to examine context-specific interventions that may have the potential to improve medication safety in this and similar departments.

The Influence of Organizational Factors on Road Transport Safety

Road transport safety is a major concern across Europe due to the human and socio-economic costs associated with work-related traffic accidents. Traditional approaches have adopted regulatory and technical measures to prevent road accidents leaving aside the organizational factors that might contribute to road transport safety. However, contemporary sociotechnical systems theory acknowledges the need to take into account organizational factors. This study adopts a sociotechnical approach and it examines the relationship between a number of organizational factors (organizational learning and training) and road traffic accidents in the organizations under study. Our sample was composed of 107 road transportation organizations from Spain. Binary logistic regression analyses were carried out to test our hypotheses. Organizational size and type of transport (goods or passengers) were included in the model as control variables. Results showed that in those organizations where organizational learning was supported, the occurrence of traffic accidents was less likely. Unexpectedly, the relationship between training and the occurrence of traffic accidents was not significant. Thus, findings partially supported the formulated hypothesis. Future research should shed light on the relationship between training and traffic accidents taking into account potential intervening variables.

Influence from organisational factors on patient safety and safety behaviour among nurses and hospital staff

Purpose

Hospital systems are expected to influence patient safety outcomes. The purpose of this study is to explore organisational factors influencing patient safety and safety behaviour among nurses and other hospital staff.

Design/methodology/approach

Based on a theoretical model, six dimensions were selected from the hospital survey on patient safety culture. Moreover, one standardized dimension measuring safety behaviour was included. The data were collected from 1,703 hospital workers completing a cross-sectional survey.

Findings

Confirmatory factor analysis and supplementary statistics supported the use of measurement concepts applied in the study. A two-step statistical approach using structural equation modelling resulted in a satisfactory final model illustrating direct and indirect influence of the explanatory factors used.

Research limitations/implications

The limitation of this study is the use of a cross-sectional survey design.

Practical implications

The study illustrates how organisational factors are interconnected. The theoretical model developed and tested can be applied to improve safety behaviour and patient safety in hospital settings.

Social implications

The social implications of this study include the social relationships within the hospital setting, illustrating how organisational factors influence both safety behaviour and perception of patient safety levels.

Originality/value

A new theoretical model is developed and tested among hospital staff. The paper adds a new perspective on how organisational factors influence perceived safety outcomes in hospital settings.

A study of deficiencies in teamwork skills among Jordan caregivers

Purpose

The purpose of this paper is to present the deficiencies in teamwork skills at Jordan hospitals as seen by team members. The study aims to identify training needs to improve teamwork-related soft skills of caregivers to enhance staff satisfaction and improve quality of care. Moreover, the paper provides a methodology to identify the training needs in any healthcare workplace by repeating the same questionnaire.

Design/methodology/approach

A self-administrated questionnaire was designed to study deficiencies in teamwork and team leadership at Jordan hospitals as seen by team members. Surveyed care providers included physicians, nursing and anesthesiologists operating in emergency departments, surgical operating rooms and intensive care units from various hospitals.

Findings

With a response rate of 78.8 percent, statistical analysis of collected data of opposing staff members revealed low levels of satisfaction (40.7-48 percent opposing), lack of awareness on the impact of teamwork on quality of care (15.6-22.1 percent opposing), low levels of involvement of top management (27.1-57.3 percent opposing), lack of training (52.5-69.8 percent opposing), lack of leadership skills (29.8-60 percent opposing), lack of communication (22.3-62.1 percent opposing), lack of employee involvement (37.6-50.8 percent opposing) and lack of collaboration among team members (28.6-50 percent opposing). Among the many, results illustrate the need for improving leadership skills of team leaders, improving communication and involving team members in decision making.

Originality/value

Several studies investigated relationships between teamwork skills and quality of care in many countries. To the authors’ knowledge, no local study investigated the deficiencies of teamwork skills among Jordan caregivers and its impact on quality of care. The study provides the ground for management at Jordan hospitals and to healthcare academic departments to tailor training courses to improve teamwork skills of caregivers. Data of this study are collected from the society who is working in the field of healthcare. As the results of this are produced from a real data, it is expected that applying the recommendations will impact the society positively by enhancing the patients’ satisfaction.

Dynamic workplace interactions for improving patient safety climate

Purpose

Employee engagement (EE), supervisor support (SS) and interprofessional collaboration (IPC) are important contributors to patient safety climate (PSC). The purpose of this paper is to propose and empirically test a model that suggests the presence of a three-way interaction effect between EE, IPC and SS in creating a stronger PSC.

Design/methodology/approach

Using validated tools to measure EE, SS, IPC and PSC data were collected from a questionnaire of 250 clinical and support staff in an Australian health service. Using a statistical package (SPSS) an exploratory factor analysis was conducted. Bivariate correlations between the derived variables were calculated and a hierarchical ordinary least squares analysis was used to examine the interaction between the variables.

Findings

This research finds that PSC emerges from synergies between EE, IPC and SS. Modelling demonstrates that the effect of IPC with PSC is the strongest when staff are highly engaged. While the authors expected SS to be an important predictor of PSC; EE has a stronger relationship to PSC.

Practical implications

These findings have important implications for the development of patient safety programmes that focus on developing excellent supervisors and enabling IPC.

Originality/value

The authors provide quantitative evidence relating to three of the often mentioned constructs in the typology of patient safety and how they work together to improve PSC. The authors believe this to be the first empirically based study that confirms the importance of IPC as a lead marker for improved patient safety.

Assessing the relationship between patient safety culture and EHR strategy

Purpose

– The purpose of this paper is to explore the relationship between hospitals’ electronic health record (EHR) adoption characteristics and their patient safety cultures. The “Meaningful Use” (MU) program is designed to increase hospitals’ adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated.

Design/methodology/approach

– Providers’ perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality’s surveys on patient safety culture (level 1) and the American Hospital Association’s survey and healthcare information technology supplement (level 2).

Findings

– The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers’ perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research.

Originality/value

– Relating EHR MU and providers’ care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

Elaboration of a risk map in a paediatric Emergency Department of a teaching hospital

OBJECTIVE

To develop a risk map in a paediatric ED of a tertiary teaching hospital, combining proactive and reactive strategies.

METHODS

Between June and December 2013, a multidisciplinary committee in a paediatric Emergency Department (ED) in Bilbao (Basque Country of Spain) mapped the patient's journey and identified potential risks to patients (proactive strategy). The researchers also analysed incidents reported by professionals and caregivers (mainly parents) in the paediatric ED from November 2004-December 2013 (reactive strategies). Combining the results of both strategies, we applied the 'Failure mode and effects analysis' tool to identify and prioritise high or very high-risk situations and apply them to the risk map.

RESULTS

Using proactive strategies, 49 opportunities for failures, 60 effects and 252 causes were identified. The most common failures were related to the discharge of the patient; the most common effects were complaints by parents, long stay in the ED, delay in diagnosis/treatment and unnecessary treatment. Main causes were not including the family in the process, shift change, incorrect identification of the patient and computer errors. Using reactive strategies, 1795 reported incidents were analysed. The most common incidents were related to medical equipment (38%), resources/organisation of staff (17%), clinical process (15%), facilities (12%) and medication errors (5%). Proactive strategies identified risks in tests, treatment and discharge. The reactive strategy added risks concerning prehospital transfer, triage, medical care, tests, treatment and discharge.

CONCLUSIONS

Proactive and reactive strategies, involving professionals and caregivers, can complement each other in identifying potential patient safety risks in a paediatric ED.

Healthcare quality maturity assessment model based on quality drivers

Purpose - Healthcare providers differ in their readiness and maturity levels regarding quality and quality management systems applications. The purpose of this paper is to serve as a useful quantitative quality maturity-level assessment tool for healthcare organizations. Design/methodology/approach - The model proposes five quality maturity levels (chaotic, primitive, structured, mature and proficient) based on six quality drivers: top management, people, operations, culture, quality focus and accreditation. Findings - Healthcare managers can apply the model to identify the status quo, quality shortcomings and evaluating ongoing progress. Practical implications - The model has been incorporated in an interactive Excel worksheet that visually displays the quality maturity-level risk meter. The tool has been applied successfully to local hospitals. Originality/value - The proposed six quality driver scales appear to measure healthcare provider maturity levels on a single quality meter.

Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy

Although speaking up to protect patients is a key ethical and moral mandate for nurses, silence still prevails in many situations. On the basis of concepts of safety culture, generational theory, personal cultural literature, advocacy theory, oppressed group theory, and moral distress theory, the author conducted a literature review and offers a new theoretical framework. The proposed theory identifies primary factors of speaking up: generational, personal culture, and organizational.

Interprofessional team management in pediatric critical care: some challenges and possible solutions

BACKGROUND

Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.

METHODS

We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.

FINDINGS

The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one's own unit, engagement of health care professionals occurs and projects become accepted.

CONCLUSION

Bottom-up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety.

How hospitalists work to pull healthcare teams together

Purpose

– The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork.

Design/methodology/approach

– Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types.

Findings

– Hospitals rely on effective, interprofessional teamwork but typically do not support it. Hospitalist physicians must bridge the internal boundaries within their hospitals to coordinate their patients’ care, but they face challenges – scattered patients, fragmented information, uncoordinated teams, and unreliable processes – that can impact the timeliness and safety of care. Hospitalists largely rely on personal presence and memory to deal with these challenges. Some invent low-tech supports for teamwork, but these are typically neither tested nor shared with others. Formal support for teamwork, primarily case management rounds, is applied unevenly and may not be respected by all team members.

Research limitations/implications

– The findings are drawn from observation over a limited period of time with a small, purposefully chosen sample of physicians and hospitals.

Practical implications

– Hospitals must recognize the issues hospitalists and other providers face, evaluate and disseminate supports for teamwork, and make interprofessional teamwork a core feature of hospital design and evaluation.

Originality/value

– The authors show the nuances of how hospitalists struggle to practice teamwork in a challenging context, and how the approaches they take (relying on memory and personal presence) do not address, and may actually contribute to, the system-level problems they face.

Creating an environment for patient safety and teamwork training in the operating theatre: A quasi-experimental study

INTRODUCTION

Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre.

METHOD

A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n=22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n=11) attending the conventional curriculum.

RESULTS

The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum.

CONCLUSION

The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.