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Table 5 Relationships between teamwork, well-being and patient safety

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 scoreb
Davenport et al., 2007 [118] Relationships between team and safety climate, working conditions, emotional exhaustion and patient morbidity/mortality yes 6083 surgical team members, 52 hospitals, USA Cross-sectional self-report questionnaire, record review Teamwork: SAQ subscale team climatea, levels of communication and collaboration Well-being: Emotional Exhaustiona Patient safety: risk adjusted 30-day morbidity/mortality Spearman’s rank correlation 1) Negative association between patient morbidity and a) clinician’s communication with attending doctors b) but not with clinician’s communication with residents c) nurses d) other health care providers 2) No associations between team climate and a) mortality b) morbidity 3) No associations between emotional exhaustion and a) mortality b) morbidity 1a) ρ = −0.38, p < 0.01 1b) NS 1c) NS 1d) NS 2a) NS 2b) NS 3a) NS 3b) NS 11.5 (16)
Laschinger & Leiter, 2006 [119] Mediation of relationship between nursing work environment and patient safety outcomes by burnout yes 8597 nurses, acute care hospitals, Canada Cross-sectional self- report questionnaire Teamwork: Nurse-Physician-Relations Scalea Well-being: MBIa Patient safety: adverse events scale Path analysis 1) Good overall model fit 2) Nurse-physician-relations and a) emotional exhaustion b) depersonalization c) adverse events are negatively correlated d) personal accomplishment are positively correlated 3) Adverse events and a) emotional exhaustion b) depersonalization are positively correlated c) personal accomplishment are negatively correlated (only results from correlation matrix are reported) 1) χ2 = 16 438.19, df = 1.344, CFI = 0.908, IFI = 0.908, RMSEA = 0.037 2a) r = −0.22, p = <0.01 2b) r = −0.16, p = <0.01 2c) r = −0.14, p = <0.01 2d) r = 0.13, p = <0.01 3a) r = 0.30, p = <0.01 3b) r = 0.34, p = <0.01 3c) r = −0.22, p = <0.01 10.5 (16)
Rathert et al., 2009 [120] Mediation of relationships between work environment and work engagement, commitment and patient safety by psychological safety no 306 nurses and other clinical care providers, acute care hospital, USA Cross-sectional self-report questionnaire Teamwork: Psychological Safety Scalea Well-being: Work engagement scale Patient safety: scale adapted from AHRQ Patient Safety Culture Survey Path analysis 1) Good overall model fit 2) Psychological safety does not mediate relationship between work environment and a) patient safety b) work engagement 3) Positive correlation between patient safety and a) work engagement b) psychological safety 4) No correlation between psychological safety and work engagement 1) RMSEA = 0.06, NNFI = 0.92, CFI = 0.93 2a) NS 2b) NS 3a) r = 0.14, p > 0.013 3b) r = 0.39, p < 0.01 4) NS 10.5 (16)
Van Bogaert et al., 2014 [122] Relationships between nurse practice environment, work characteristics, burnout and job and patient outcomes no 1108 nurses, 96 units, 7 hospitals, Belgium Cross-sectional self-report questionnaire Teamwork: nurse-physician relationsa Well-being: MBIa Patient safety: patient falls, hospital-acquired infections, medication errors Multilevel regression 1) Good nurse-physician relations on the unit level are associated with fewer a) patient falls b) hospital-acquired infections and c) medication errors 2) Emotional exhaustion on the unit level is associated with more a) patient falls b) hospital-acquired infections and c) medication errors 3) Depersonalization on the unit level is associated with more a) patient falls b) hospital-acquired infections and c) medication errors 4) High personal accomplishment on the unit level is associated with fewer a) patient falls b) hospital-acquired infections and c) medication errors 1a) Adj. OR = 0.70, 95 % CI 0.48 – 1.03 1b)) Adj. OR = 0.56, 95 % CI 0.41 – 0.78 1c) Adj. OR = 0.58, 95 % CI 0.41 – 0.82 2a) Adj. OR = 1.25, 95 % CI 1.06 – 1.48 2b) Adj. OR = 1.33, 95 % CI 1.15 – 1.53 2c) Adj. OR = 1.39, 95 % CI 1.20 – 1.61 3a) Adj. OR = 1.40, 95 % CI 1.15 - 1.70 3b) Adj. OR = 1.57, 95 % CI 1.31 - 1.87 3c) Adj. OR = 1.67, 95 % CI 1.40 - 2.00 4a) Adj. OR = 0.81, 95 % CI 0.64 - 1.02 4b) Adj. OR = 0.78, 95 % CI 0.64- 0.95 4c) Adj. OR = 0.88, 95 % CI 0.71 - 1.08 12.5 (16)
Wilkins et al., 2008 [121] Relationships between nurses’ work environment, health status and medication errors no 4379 nurses, Canada Cross-sectional self-report, phone interviews Teamwork: Nurse-Physician-Relations Scalea Well-being: mental health (1 item) Patient safety: medication error (1 item) Logistic regression 1) Lower levels of nurse-physician relations are associated with more medication errors 2) Mental health status is not associated with medication errors 1) OR = 1.6, 95 % CI 1.1 – 2.3, p < 0.05 2) NS 11 (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. a validated instrument
  3. b in brackets: maximal possible score