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Validation of a teamwork perceptions measure to increase patient safety
Abstract and Figures
TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is a team-training intervention which shows promise in aiding the mitigation of medical errors. This article examines the construct validity of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), a self-report survey that examines multiple dimensions of perceptions of teamwork within healthcare settings.
Using survey-based methods, 1700 multidisciplinary healthcare professionals and support staff were measured on their perceptions of teamwork. Confirmatory factor analysis was conducted to examine the relationship between the five TeamSTEPPS dimensions: Leadership, Mutual Support, Situation Monitoring, Communication, and Team Structure.
The analysis indicated that the T-TPQ measure is more reliable than previously thought (Cronbach's α=0.978). Further, our final tested model showed a good fit with the data (x(2) (df) 3601.27 (546), p<0.0001, Tucker-Lewis Index (TLI)=0.942, Comparative fit index (CFI)=0.947, root mean square error of approximation (RMSEA)=0.057), indicating that the measure appears to have construct validity. Further, all dimensions correlated with one another, but were shown to be independent constructs.
The T-TPQ is a construct-valid instrument for measuring perceptions of teamwork. This has beneficial implications for patient safety and future research that studies medical teamwork.
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... Nursing Forum culture, teamwork, and attitudes toward teamwork between NAs in medical care and NAs in intensive care; (6) analyze associations between RNs' and NAs' perceptions of teamwork dimensions and their perceptions of patient safety culture outcome dimensions; (7) analyze associations between RNs' and NAs' attitudes toward teamwork dimensions and their perceptions of patient safety culture outcome dimensions. [39,40], the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) [41,42], and the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) [43,44]. Te T-TPQ and T-TAQ are based on the "Big Five" and are included in the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) package. ...
Background: Strong patient safety culture and effective teamwork are necessary for patient safety. Registered nurses (RNs) and nursing assistants (NAs) work closely with patients, and effective teamwork and communication skills are essential.
Aim: To describe and compare the perceptions of patient safety culture, teamwork, and attitudes toward teamwork among RNs and NAs in hospital wards (medical and intensive care), and to explore the potential associations between teamwork and patient safety culture.
Methods: A cross-sectional study was conducted in two hospitals in a single region of Sweden. In one hospital, RNs (n = 103) and NAs (n = 59) in medical care, and RNs (n = 41) and NAs (n = 28) in intensive care were invited to participate. In the other hospital, RNs (n = 67) and NAs (n = 66) involved in medical care were invited. The survey included the Swedish version of Hospital Survey on Patient Safety Culture (S-HSOPS), the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), and the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ).
Results: In total, 155 nurses responded to the survey (response rate = 43%). Overall and in medical care, NAs had a significantly higher score than RNs in “handoffs and transitions” and in intensive care in “information and support to patients and family who have suffered an adverse event” (S-HSOPS). RNs and NAs in intensive care reported higher scores in “communication” (T-TPQ) than RNs and NAs in medical care. Overall and in medical care, RNs had more positive attitudes than NAs in total T-TAQ, “mutual support,” and “communication.” T-TPQ were associated with “overall perceptions of patient safety” and T-TAQ were associated with “frequency of error reported.”
Conclusion: This study shows differences between RNs and NAs working in medical and intensive care in their perceptions of patient safety culture, teamwork, and attitudes toward teamwork. Teamwork perceptions are important for overall patient safety.
... The T-TPQ was developed to address the four factors that make up TeamSTEPPS team training model and has been validated as a measure of the perceptions of teamwork within healthcare. 18 However, on review of the T-TPQ items we considered it did not adequately address the unique operating theatre environment, or align with our theoretical framework. 19,20 We were unable to identify a tool based on staff perceptions that adequately addressed the components of our theoretical model of teamwork and leadership in the context of the operating theatre. ...
Background: Teamwork is recognised as a vital factor in patient safety, and as such we need valid measurement tools to drive change. The aim of this study was to evaluate the validity of the Teamwork Perceptions Survey as a measure of staff perceptions of the functional and relational components of teamwork and leadership in the operating theatre.
Methods: The authors developed a 24-item questionnaire, aligned with the goals of a national team training intervention. The Teamwork Perceptions Survey was administered to New Zealand public hospital operating theatre staff before and after a hospital commencing the intervention. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis.
Results: 2409 (1233 pre- and 176 post-intervention respondents) completed the Teamwork Perceptions Survey. Exploratory factor analysis revealed 3 factors (6 items, communication and shared mental model; 6 items, leadership and role modelling; 5 items, trust and accountability) and resulted in dropping 5 redundant items. The final 17-item, three factor solution was confirmed by confirmatory factor analysis, revealing satisfactory goodness of fit. Cronbach's alpha was high for the full survey (α = 0.947), and each subscale (communication, α = 0.887; leadership, 6 items, α = 0.911; trust, α = 0.872).
Conclusions: These data provide evidence to support the validity and reliability of the Teamwork Perceptions Survey as a measure of staff perceptions of teamwork and leadership in the operating theatre. This new measurement tool for the functional and relational components of teamwork and leadership in the operating theatre has the potential for both measuring and driving quality improvement initiatives in teamwork and patient safety.
... Each item is scored using a five-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). An average score of 3 or higher is indicative of acceptable teamwork [35,36]. The Persian version of this tool has demonstrated acceptable structural validity and internal reliability, with a reported Cronbach's alpha coefficient of 0.96 [37]. ...
Background
In the demanding environment of the neonatal intensive care unit (NICU), quality nursing care hinges on effective teamwork and communication among nurses. However, this requirement for close cooperation can expose nurses to significant levels of moral distress. This study aims to explore the connection between the quality of teamwork and the experience of moral distress among NICU nurses.
Methods
Employing a cross-sectional, multicenter descriptive correlational design, this study surveyed female NICU nurses across the cities of Khorramabad and Semnan. Census sampling was utilized over five months, from July to November 2023, resulting in the participation of 190 nurses. Tools for data collection included demographic questionnaires, the Team-STEPPS Teamwork Perception Questionnaire (T-TPQ), and the Moral Distress Scale-Revised (MDS-R) for nurses.
Results
The findings revealed an average teamwork score of 3.73 ± 0.78, denoting an acceptable level, and an average moral distress score of 91.2 ± 56.7, indicating a low level. In multiple linear regression, marital status showed a direct positive correlation (β = 38.5, SE (β) = 9.3, p < 0.001), while the number of children (β = -14.6, SE (β) = 4.9, p = 0.003) and the teamwork score (β = -1.1, SE (β) = 0.12, p < 0.001) were inversely correlated with moral distress.
Conclusion
The study’s results suggest that stronger teamwork among nurses correlates with reduced moral distress. Enhancing teamwork within NICUs could lead to policy development focused on the safety and quality of newborn care, also potentially alleviating moral distress experienced by nurses.
... Initial quantitative data collection occurred through email, with potential participants receiving a consent letter and link to the survey (completed through REDCap ® software). The survey included three measures: the Measure of Moral Distress for Healthcare Professionals scale (MMD-HP), 21 the Connor-Davidson Resilience 10-Item Scale (CD-RISC-10) [6], and the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) [7]. All the surveys were carried out based on the STROBE method that includes three types of studies namely, cohort-based, crosssectional studies. ...
Manifestations of Moral Distress in nurses encompass psychological feelings of frustration, guilt, and inner conflict. Especially following the pandemic, addressing moral distress is crucial for ethical decision-making and nurse well-being.
... To manage these deteriorations, there must be modifications not only in the communication approaches among healthcare workers but also in the organizational culture in which healthcare services are delivered [30]. Team strategies and tools to enhance performance and patient safety (TeamSTEPPS) is a team-training intervention that offers assurance in helping the alleviation of medical mistakes [31]. ...
Background
An intravesical gas explosion is a rare complication of transurethral resection of the prostate (TURP). It was first reported in English literature in 1926, and up to 2022 were only forty-one cases. Injury from an intravesical gas explosion, in the most severe cases appearing as extraperitoneal or intraperitoneal bladder rupture needed emergent repair surgery.
Case presentation
We present a case of a 75-year-old man who suffered an intravesical gas explosion during TURP. The patient underwent an emergent exploratory laparotomy for bladder repair and was transferred to the intensive care unit for further observation and treatment. Under the medical team’s care for up to sixty days, the patient recovered smoothly without clinical sequelae.
Conclusions
This case report presents an example of a rare complication of intravesical gas explosion during TURP, utilizing root cause analysis (RCA) to comprehend causal relationships and team strategies and tools to improve performance and patient safety (TeamSTEPPS) method delivers four teamwork skills that can be utilized during surgery and five recommendations to avoid gas explosions during TURP to prevent the recurrence of medical errors. In modern healthcare systems, promoting patient safety is crucial. Once complications appear, RCA and TeamSTEPPS are helpful means to support the healthcare team reflect and improve as a team.
... Non-technical skills such as communication, leadership, situation monitoring, and mutual support are needed in successful clinical interactions and, when neglected or improperly used, can contribute to patient safety events (3,4). Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a robust framework for evaluating such skills. ...
Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.
Purpose
Effective teamwork is crucial for patient safety in healthcare. The TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) is a widely used tool for assessing teamwork perceptions. The T-TPQ has been adapted and validated for hospital setting use in several countries. This study aimed to translate and validate the T-TPQ into French for use among Tunisian healthcare professionals, enhancing teamwork assessment and patient safety initiatives.
Design/methodology/approach
A rigorous process ensured cultural and linguistic adaptation of the T-TPQ, including back-translation, expert panel review, and pilot testing. 459 healthcare professionals from four hospitals in Kairouan, Tunisia participated. Confirmatory factor analysis (CFA) compared the original five-factor structure with a revised structure based on exploratory factor analysis (EFA).
Findings
Both CFA models demonstrated good fit, with no significant difference between them (∆χ ² = 22.51, p = 0.79). The original five-factor structure was retained due to its established theoretical foundation. The French T-TPQ exhibited strong internal consistency (α = 0.9). Two-way Random ICCs indicated fair to good test-retest reliability for all the five dimensions (0.633–0.848).
Research limitations/implications
Several limitations should be acknowledged. The use of a questionnaire as a data collection tool is the source of a reporting bias, for fear of being identified or for reasons of “social desirability”. Nevertheless, this social desirability was minimal, as Baker et al. (2010) took steps to mitigate this during the instrument's development. Additionally, for assessing attitudes and perceptions, self-reported measures are deemed more effective, whereas objective measures are advocated for behavioral assessments. Furthermore, the participants were informed of the absence of good or bad answers, the importance of answering as closely as possible, and the confidentiality. Moreover, considering the data collection period, the COVID- 19 pandemic and its potential impact on recruitment, data collection, and participant responses. Although the sample size of 459 met the recommended criteria for conducting confirmatory factor analysis, as suggested by Bentler and Chou (1987) and (Floyd and Widaman, 1995), the COVID-19 pandemic presented challenges in recruitment. The increased workload and stress on healthcare professionals, coupled with staff redeployment and research restrictions within hospitals and care units, likely hindered achieving an even larger sample size. These circumstances also necessitated adjustments to data collection methods to ensure safety and adherence to pandemic protocols. This involved incorporating online surveys option with paper-based questionnaires and implementing stricter hygiene measures during in person data collection. Furthermore, the pandemic impacted the teamwork perceptions as significantly redefined the healthcare environment, placing immense pressure on professionals due to surging patient volumes, staff shortages, and the emotional burden of caring for critically ill individuals. This heightened stress and workload likely influenced teamwork dynamics, potentially fostering both positive adaptations, such as increased cohesion and support, as well as negative consequences like communication breakdowns and decreased morale (Terregino et al. , 2023).
Practical implications
We outline significant practical implications for leaders in health care for improving teamwork and patient safety. Or, healthcare leaders can significantly enhance teamwork and patient safety by incorporating the validated French T-TPQ into their improvement strategies. This reliable tool enables the assessment of staff perceptions regarding teamwork strengths and weaknesses, specifically in areas like communication and leadership. By identifying these crucial areas, leaders can implement targeted training programs and interventions. In fact, the existing body of research consistently demonstrates the positive impact of team training interventions, on both teamwork processes and patient outcomes. These interventions have been shown to enhance teamwork skills (Baker et al. , 2010; Thomas and Galla, 2013; Weaver et al. , 2014). In areas such as communication, leadership, situation monitoring, and mutual support, leading to decreased mortality and morbidity rates (Weaver et al. , 2014). Implementing team training programs fosters trust and collaboration around shared goals, contributing to a more effective and safer healthcare environment for both patients and professionals. Additionally, the culturally adapted T-TPQ not only benefits individual healthcare settings but also unlocks opportunities for broader research and collaboration on a global scale. By enabling cross-cultural comparisons and benchmarking, the T-TPQ can deepen our understanding of how teamwork dynamics vary across diverse healthcare environments and cultural contexts. This knowledge is invaluable for tailoring teamwork interventions and training programs to specific populations and settings, ensuring their effectiveness and cultural relevance. Moreover, integrating teamwork training into continuing professional development, interprofessional and medical education initiatives is crucial for cultivating collaborative competencies and building high-performing healthcare teams. Research has shown that interprofessional teamwork experiences significantly enhance collaborative competencies among nursing and medical students, emphasizing the importance of incorporating teamwork training early in healthcare education. This approach equips future healthcare professionals with the necessary skills to navigate complex team environments, ultimately improving patient care quality and mitigating workload issues that contribute to burnout (Simin et al. , 2010; Ceylan, 2017; Fox et al. , 2018).
Originality/value
The French version of the T-TPQ was semantically equivalent and culturally relevant with adequate test-retest reliability as compared to the English version, expanding its applicability and contributing to understanding teamwork perceptions in this context. The French T-TPQ offers a valuable tool for assessing teamwork, identifying areas for improvement, and implementing interventions to enhance teamwork and patient safety in Tunisia and potentially other French-speaking regions.
Author Affiliations: National Center for Patient Safety, Department of Veterans Affairs (Mss Neily and West and Drs Mills, Young-Xu, Carney, Mazzia, Paull, and Bagian) and Department of Psychiatry, Dartmouth Medical School (Drs Mills and Young-Xu), Hanover, New ...
The National Strategy for Quality Improvement in Health Care (the National Quality Strategy) sets a course for improving the quality of health and health care for all Americans. It serves as a blueprint for health care stakeholders across the country - patients, providers, employers, health insurance companies, academic researchers, and local, State, and Federal governments - that helps prioritize quality improvement efforts, share lessons, and measure our collective success. The initial National Quality Strategy, published in March 2011, established three aims and six priorities for quality improvement (see Exhibit 1). This report details some of the work conducted in public and private sectors over the past year to advance and further refine those aims and priorities.
FOR YEARS, medical and nursing students have been taught Florence Nightingale's dictum—first, do no harm.1 Yet evidence from a number of sources, reported over several decades, indicates that a substantial number of patients suffer treatment-caused injuries while in the hospital.2-6
In 1964 Schimmel2 reported that 20% of patients admitted to a university hospital medical service suffered iatrogenic injury and that 20% of those injuries were serious or fatal. Steel et al3 found that 36% of patients admitted to a university medical service in a teaching hospital suffered an iatrogenic event, of which 25% were serious or life threatening. More than half of the injuries were related to use of medication.3 In 1991 Bedell et al4 reported the results of an analysis of cardiac arrests at a teaching hospital. They found that 64% were preventable. Again, inappropriate use of drugs was the leading cause of