Background: Teamwork is essential to providing safe, effective, patient-centered care. Prior research documented discrepancies in perceptions of teamwork and collaboration among nurses and physicians. However, prior studies have been limited to single sites and academic medical centers.
Methods: We conducted surveys of healthcare professionals in 4 hospitals participating in the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, an AHRQ funded study providing mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. The 4 hospitals, selected from 14 applicants based on their commitment to change and lack of existing similar interventions, include two hospitals in the Southeast, one in the Midwest, and one in the West. All hospitals are nonprofit and have between 200 and 350 beds. Two are non-teaching hospitals and two are teaching hospitals, though neither is a major affiliate of a medical school. We assessed teamwork climate using the Safety Attitudes Questionnaire (range 0-100) and asked respondents to rate the quality of collaboration experienced with their own and other professional categories (i.e., hospitalists, residents, nurses, nurse assistants) as has been done in prior studies. Herein, we report baseline survey results. We compared teamwork climate scores using the Kruskal-Wallis test and ratings of collaboration using chi square tests. We restricted our analyses to professional categories with 10 or more participants.
Results: Overall, 436 of 518 (84.2%) eligible healthcare professionals completed the survey. Response rates exceeded 75% for each hospital. After excluding professional categories with less than 10 participants, 381 surveys remained. The median teamwork climate score was 80.4 (IQR=17.9) for all participants. Although the median scores differed across professional categories, the results were not statistically significant (See Table 1; p=0.42). Ratings of collaboration varied significantly based on professional category. As shown in table 2, 63.3% of hospitalists rated the quality of collaboration with nurses as high or very high while only 48.7% of nurses rated the quality of collaboration with hospitalists as high or very high. Nurses’ ratings of collaboration with hospitalists were relatively consistent across all 4 sites with 42.2% to 57.8% of nurses rating the quality of collaboration with hospitalists as high or very high (p=0.24). Hospitalists’ ratings of collaboration with nurses were somewhat higher and not significantly different across the 4 sites with 56.5% to 75.0% of hospitalists rating the quality of collaboration with nurses as high or very high (p=0.72).
Conclusions: Though teamwork climate did not differ across professional categories, ratings of collaboration varied significantly. Consistent with research in academic medical centers, hospitalists in community settings perceived collaboration with nurses as more favorable than nurses perceived collaboration with hospitalists. Nurses’ relatively low ratings of collaboration with hospitalists were consistent across the 4 sites. Analyses were limited due to low number of respondents in some professional categories. Subsequent evaluation will determine whether teamwork, collaboration, and patient outcomes improve as a result of interventions included in the RESET project.
