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Table 2 Relationships between teamwork and well-being

From: Integrating teamwork, clinician occupational well-being and patient safety – development of a conceptual framework based on a systematic review

Study Topic Primary topic Sample & setting Design & data collection methods Assessment of variables Analyses Findings Outcomes & effect sizes Quality scored
Bobbio et al., 2012 [38] Mediation of relationship between empowering leadership/organizational support and burnout by trust in leader/organization no 273 nurses, general hospital, Italy Cross-sectional self-report questionnaire Team leadership: Empowering leadership scalea Well-being: Maslach Burnout Inventory (MBI)a Path analysis 1) Satisfactory model fit 2) Trust in leader mediates relationship leading by example and emotional exhaustion 3) Trust in leader mediates relationship between showing concern/ interacting with the team and a) emotional exhaustion b) cynicism 4) Trust in organization mediates relationship between informing and a) emotional exhaustion and b) cynicism 5) No mediation effects for reduced professional efficacy 1) χ2 (18) = 21.27, p = 0.27, χ2/df = 1.18, RMSEA = 0.03, CFI = 1.00, SRMR = 0.02 Indirect effects: 2) β = −0.04, p < 0.05 3a) β = −0.23, p < 0.001 3b) β = −0.15, p < 0.001 4a) β = −0.03, p < 0.05 4b) β = −0.04, p < 0.02 5) NS 11.5 (16)
Bratt et al., 2000 [39] Relationships between nurse/unit characteristics, work environment and job satisfaction no 1973 nurses, 70 pediatric intensive care units, 65 pediatric hospitals, USA/Canada Cross-sectional self-report questionnaire Teamwork: a) Group cohesion: Group Judgment Scale b) Nurse-physician collaboration: Collaboration and Satisfaction about Care Decisionsa Well-being: Job Stress Scalea Pearson’s correlation Job stress is negatively correlated with 1) group cohesion 2) nurse-physician collaboration 1) r = −0.43, p < 0.001 2) r = −0.37, p < 0.001 9.5 (16)
Brunetto et al., 2011 [40] Relationships between supervisor-subordinate relationship, teamwork, role ambiguity and well-being yes 1138 nurses, 3 public and 7 private urban and regional hospitals, Australia Cross-sectional self-report questionnaire Teamwork: Nurses’ Satisfaction with Teamwork Scale Well-being: Perception of Well-being Scale (self-developed) Pearson’s correlation Positive correlation between nurses’ satisfaction with teamwork and well-being Public sector: r = 0.35, p < 0.001 Private sector: r = 0.39, p < 0.001 9.5 (16)
Brunetto et al., 2013 [48] Workplace relationships, engagement, well-being, commitment, and turnover no 1228 nurses, Australia / USA Cross-sectional self-report questionnaire Teamwork: Satisfaction with teamworka Well-being: employee engagementa, well-being scale developed by first author Structural equation modeling (SEM) Teamwork is positively associated with 1) engagement and 2) well-being in the a) Australian and b) US sample 1a) B = .19, p < .001 1b) B = .24, p < .001 2a) β = .30, p < .001 2b) β = .37, p < .001 12 (16)
Bruyneel et al., 2009 [41] Relationship between nurse working environment and nurse-perceived outcomes no 179 nurses, 12 units, 5 acute care hospitals, Belgium Cross-sectional self-report questionnaire Teamwork: Nursing Work Index-Revised (NWI-R)a subscale Nurse-Physician-Relations Well-being: MBIa Multivariate logistic regression Nurse-physician relations are not associated with emotional exhaustion NS 11.5 (16)
Budge et al., 2003 [20] Relationships between nurses’ work characteristics, work relationships and health no 225 nurses, general hospitals, New Zealand Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: Short-Form Health Survey (SF-36)a subscales mental health and vitality Pearson’s correlation Positive correlation between nurse-physician relations and 1) mental health 2) vitality 1) r = 0.29, p < 0.001 2) r = 0.36, p < 0.001 12.5 (16)
Cheng et al., 2013 [49] Relationships between team climate, emotional labor, burnout, quality of care, and turnover no 201 nurses, 1 hospital, Australia Cross-sectional self-report questionnaire Teamwork: Team Climate Inventory (TCI)a Well-being: Oldenburg Burnout Inventory (OLBI)a Structural equation modeling 1) Good overall model fit 2) Team climate is negatively associated with burnout 1) χ2 = 241.31; χ2/df = 11.49; TLI = .95; CFI = .98; RMSEA = .051 2) β = −.37, p < .01 13 (16)
Gabriel et al., 2011 [18] Collegial nurse-physician relations and psychological resilience moderate relationships between task accomplishment satisfaction and pre-/postshift affect no 57 nurses, 1 hospital, USA Cross-sectional pen-and-paper diary-report Teamwork: Nurse-Physician-Relations Scalea Well-being: Affect scale, psychological resilience based upon Connor–Davidson Resilience Scale (CD-RISC)a Pearson’s correlation, multilevel modeling 1) Nurse-physician relations are a) negatively correlated with preshift negative affect b) positively correlated with preshift positive affect 2) No correlations between nurse-physician-relations and psychological resilience 3) Nurse-physician relations a) negatively predict postshift negative affect b) positively predict postshift positive affect 1a) r = 0.30, p < 0.05 1b) r = 0.33, p < 0.05 2) NS 3a) γ = −0.13, p < 0.01 3b) γ = 0.2, p < 0.01 12 (16)
Gevers et al., 2010 [54] Relationship between acute/chronic job demands and acute job strain and relationship between the latter and individual teamwork behavior yes 48 nurses, nursing students and physicians, emergency department, The Netherlands Cross-sectional self-report questionnaire Teamwork and well-being: self-developed items adapted from existing measures (Hierarchical) linear regression 1) Acute a) cognitive strains b) emotional strains separately negatively predict individual teamwork behavior c) whereas physical strains do not 2) When all three predictors are analyzed simultaneously, only acute emotional strains remain significant 1a) β = −0.35, p < 0.01, R2 = 0.18, [f 2 = 0.22]b,c 1b) β = −0.44, p < 0.001, R2 = 0.25, [f2 = 0.33]b,c 1c) NS 2) β = −0.36, p < 0.05, R2 = 0.26, [f2 = 0.35]b,c, emotional & physical strains: NS 13 (16)
Gunnarsdottir et al., 2009 [42] Relationships between nurses’ work environment and work outcomes no 695 nurses, various specialties, university hospital, Iceland Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: Emotional Exhaustiona (Hierarchical) linear regression 1) Nurse-physician relations are negatively associated with emotional exhaustion 2) Upon inclusion of four additional predictors, this association becomes non-significant 1) β = −2.38, p < 0.001, []b 2) NS 12.5 (16)
Kanai-Pak et al., 2008 [43] Relationships between nurses’ work environment and work outcomes yes 5956 nurses, various specialties, 19 hospitals, Japan Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: Emotional Exhaustiona Multivariate logistic regression Lower nurse-physician relations are associated with higher risk for emotional exhaustion Adj. OR = 1.35, p < 0.05 10.5 (16)
Klopper et al., 2012 [44] Relationships between nurses’ work environment, job satisfaction and burnout no 935 nurses, ICU, 62 hospitals, South Africa Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: MBIa Spearman’s rank correlation 1) Negative correlation between nurse–physician relations and a) emotional exhaustion b) depersonalization 2) Positive correlation between nurse–physician relations and personal accomplishment 1a) ρ = −0.255, p < 0.01 1b) ρ = −0.193, p < 0.01 2) ρ = 0.199, p < 0.01 8.5 (16)
Lehmann-Willenbrock et al., 2012 [45] Mediation of relationships between appreciation of age diversity and nurse Well-being/team commitment by co-worker trust yes 138 nurses, 1 hospital, Germany Cross-sectional self-report questionnaire Teamwork: Team commitment scale Well-being: Workplace Irritation Scalea Pearson’s correlation Negative correlation between team commitment and irritation r = −0.33, p < 0.01 12.5 (16)
Li et al., 2013 [50] Relationships between nurse work environment and burnout no 23 446 nurses, 2087 units, 352 hospitals, 11 European countries Cross-sectional self-report questionnaire Teamwork: Nurse-physician relationsa Well-being: MBIa Multilevel regression 1) As expected, nurse-physician relations on the a) unit, but not on the b) hospital or c) country level are negatively related to emotional exhaustion on the individual level 2) As expected, nurse-physician relations on the a) unit, but not on the b) hospital or c) country level are negatively related to depersonalization on the individual level 3) As expected, nurse-physician relations on the a) unit, but not on the b) hospital or c) country level are positively related to personal accomplishment on the individual level 1a) B = −0.11; 95 % equal tail credibility interval (ETCI) -0.21 to −0.002 1b) NS 1c) NS 2a) B = −0.17; 95 % ETCI −0.27 to -.07 2b) NS 2c) NS 3a) B = 0.20; 95 % ETCI −0.29 to -.12 3b) NS 3c) NS 13.5 (16)
Pisarski & Barbout, 2014 [37] Relationships between team climate, roster control, work-life conflict and fatigue yes 166 nurses, 1 hospital, Australia Longitudinal self-report questionnaire Teamwork: 10 items adapted from teamwork climate measure developed by authors Well-being: 2 items from Standard Shiftwork Index (SSI) Multiple hierarchical regression 1) Overall, team climate at time 1 does not predict fatigue at time 2 2) Team climate of day shift nurses is negatively related to fatigue 1) NS 2) β = −.16, p < .05 13 (16)
Profit et al., 2013 [57] Relationships between burnout and patient safety culture yes 2073 nurses and other healthcare professionals in 44 neonatal intensive care unit Cross-sectional self-report questionnaire Teamwork: Safety Attitudes Questionnaire (SAQ)a subscale teamwork climate Well-being: 4-item version of MBIa Pearson correlation Negative correlation between burnout and teamwork climate r = −.38, p < .05 11 (16)
Rafferty et al., 2001 [46] Relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care yes 5006 nurses, 32 hospitals, UK Cross sectional self-report questionnaire Teamwork: Items referring to teamwork on unit derived from NWI-Ra Well-being: MBIa Pearson’s correlation Negative correlation between teamwork and burnout r = −0.219, p < 0.001 6.5 (16)
Raftopoulos et al., 2011 [53] Relationships between safety and teamwork climate and stress no 106 midwives, public maternity units, Cyprus Cross-sectional self-report questionnaire Teamwork: Safety Attitudes Questionnaire (SAQ)a subscale teamwork climate Well-being: job exhaustion, occupational stress (1 item each) Backward stepwise linear regression 1) Job exhaustion negatively predicts teamwork climate (14 predictors altogether) 2) No association between teamwork and occupational stress 1) β = −12.85, p = 0.046, R2 = 0.117, [f2 = 0.13]b,c 2) NS 10 (16)
Rathert et al., 2012 [55] Mediation of relationship between nurses’ work environment and workarounds by emotional exhaustion no 272 nurses & other medical care providers, acute care hospital, North America Cross-sectional self-report questionnaire Teamwork: 4 items from Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Surveya Well-being: Emotional Exhaustiona Path analysis 1) Negative association between teamwork and emotional exhaustion within larger path model 2) Good final model fit 1) β = −0.19, p < 0.01 2) GFI = 0.99, AGFI = 0.92, NNFI = 0.97, RMSEA = 0.06, χ2 = 11.81 (df = 6) 11.5 (16)
So et al., 2011 [56] Cultural differences in relationships between team structure, job design, and Well-being yes 470 nurses & other medical care providers, acute hospitals, China & UK Cross-sectional self-report questionnaire Teamwork: items about team structure (roles, objectives, cooperation, performance reflection) Well-being: items about perceived work stress Path analysis Negative association between team structure and work stress within larger path model 1) in the UK sample 2) but not in the Chinese sample 3) Good overall model fit 1) β = −0.18, p < 0.05, R2all stress predictors = 0.302 2) NS 3) χ2 = 787.94 (df = 246, p = 0.05), CFI = 0.91, NNFI = 0.91, RMSEA = 0.071, 90 % CI 0.065 – 0.076 12.5 (16)
Sutinen et al., 2005 [21] Relationships between health, work and social characteristics and retirement attitudes no 447 physicians, several hospitals, Finland Cross-sectional self-report questionnaire Teamwork: TCIa Well-being: General Health Questionnaire (GHQ-12)a Pearson’s correlation Negative correlation between teamwork and minor psychiatric morbidity r = −0.12, p < 0.05 10.5 (16)
Van Bogaert et al., 2009 [47] Mediation of relationships between nurse work environment and nurse job outcomes and quality of care by burnout no 401 nurses, medical, 31 units, general and university hospital, Belgium Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: MBIa Pearson’s correlation Path analysis 1) Negative correlation between nurse-physician relationship and a) depersonalization b) personal accomplishment 2) Within path model: negative association between nurse-physician relationship and emotional exhaustion 3) Adequate overall model fit 1a) r = 0.155, p < 0.05 1b) r = −0.115, p < 0.01 2) β = −0.19 3) χ2 = 548.1, df = 313, p < 0.001, CFI = 0.906, IFI = 0.903, RMSEA = 0.43 11.5 (16)
Van Bogaert et al., 2010 [19] Relationships between nurse work environment, nurse job outcomes, quality of care, and burnout no 546 nurses, 42 units, general and university hospitals, Belgium Cross-sectional self-report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: MBIa Linear mixed effects multilevel model 1) Positive association between nurse-physician relationship and personal accomplishment 2) Negative association between nurse-physician relationship and a) emotional exhaustion b) depersonalization 1) β = 1.98, p < 0.0001 2a) β = −3.79, p < 0.0001 2b) β = −1.09, p < 0.05 11.5 (16)
Van Bogaert et al., 2013 [52] Relationships between nurse work environment, nurse characteristics, burnout, nurse job outcomes, and quality of care no 1201 nurses, 116 units, 8 hospitals, Belgium Cross-sectional self-report questionnaire Teamwork: nurse-physician relations subscale of NWIa Well-being: MBIa Structural equation modelling (SEM) 1) Satisfactory overall model fit 2) No relationship between nurse-physician relations and emotional exhaustion 3) Negative correlation between nurse-physician relations and depersonalization but no relationship in final SEM 4) Positive correlation between nurse-physician relations and personal accomplishment but no relationship in final SEM 1) CFI = .90, IFI = .90, RMSEA = .43 2) NS 3) r = −.08, p < .01 4) r = .11, p < .01 13 (16)
Van Bogaert et al., 2014 [51] Relationships between role-, job- and organizational characteristics, and occupational stress and well-being no 365 nurse unit managers, Belgium Cross-sectional self-report questionnaire Teamwork: nurse-physician relations subscale of Leiden Quality of Work Questionnaire for Nurses (LQWQ-N)a Well-being: emotional exhaustion subscale from MBIa; Utrecht Work Engagement Scale (UWES)a Hierarchical multiple regression 1) Nurse-physician relations negatively predict emotional exhaustion 2) Nurse-physician relations do not predict work engagement 1) β = −.22, p < .01 2) NS 14 (16)
  1. We report not only significant but also non-significant relationships between predictor and outcome variables of interest in this review as hypothesized in the reviewed studies; even if not explicitly stated in the original publication
  2. avalidated instrument
  3. beffect sizes calculated by authors, calculation not possible if brackets empty
  4. cCohen’sƒ2 based on R2 instead of ΔR2
  5. din brackets: maximal possible score