Background
Methods
Definition of central concepts
Teams and teamwork
Clinician occupational well-being
Patient safety
Search strategy
Screening and selection procedure
Quality rating
Data extraction
Framework development
Results
Quality rating
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, R
2
= 0.18, [f
2
= 0.22]b,c 1b) β = −0.44, p < 0.001, R
2
= 0.25, [f
2
= 0.33]b,c 1c) NS 2) β = −0.36, p < 0.05, R
2
= 0.26, [f
2
= 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, R
2
= 0.117, [f
2
= 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, R
2
all 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) |
Study | Topic | Primary topic | Sample & setting | Design & data collection methods | Assessment of variables | Analyses | Findings | Outcomes & effect sizes | Quality scored |
---|---|---|---|---|---|---|---|---|---|
a) observational studies | |||||||||
Burtscher et al., 2010 [61] | Relationships between coordination activities and team performance under differing situational demands | yes | 19 anesthetists and 14 anesthesia nurses, 40 cases, teaching hospital, Switzerland | Video observation of anesthesia induction | Teamwork: observation system used for coding coordination activities & clinical work Patient safety: team performance (self-developed checklist) | Paired-sample t-test | 1) Compared to low-performing teams, high-performing teams increase task management during non-routine events 2) No changes in information management during non-routine events | 1) t(20) = −2.75, p < 0.05, []b 2) NS | 13.5 (15) |
Burtscher et al., 2011 [12] | Relationships between adaptive team coordination during non-routine events and clinical performance during anesthesia induction | yes | 15 anesthesia teams (1 resident, 1 nurse), teaching hospital, Switzerland | Video observation of simulated anesthesia induction | Teamwork: team coordination (structured observation)a Patient safety: decisions and execution latency (expert rating) | Pearson’s correlation | 1) Information management is a) negatively correlated with decision latency b) but not with execution latency 2) No correlations between task management and a) decision latency b) execution latency | 1a) r = −0.49, p = 0.003 1b) NS 2a) NS 2b) NS | 12.5 (15) |
Burtscher et al., 2011 [5] | Team mental model properties moderate link between monitoring behaviors and performance in anesthesia induction | yes | 31 teams (1 anesthesia resident, 1 anesthesia nurse), teaching hospital, Switzerland | Video observation of simulated anesthesia induction | Teamwork: Team mental model similarity and accuracy (concept mapping), monitoring behavior (structured observationa) Patient safety: adherence to anesthesia induction protocol (structured observationa) | Multiple hierarchical regression | 1) Teams with similar mental models perform well irrespective of team monitoring level; teams with dissimilar mental models only perform well when team monitoring is low 2) Team mental model similarity is only related to performance when team mental model accuracy is also high 3) Team performance is high when either team or system monitoring is high and the other is low 4) Mental model accuracy does not moderate relationship between systems monitoring and performance | 1) β = 0.36, p = 0.04, ΔR2 = 0.13, [ƒ2 = 0.21]b 2) β = 0.42, p = 0.02, ΔR2 = 0.17, [ƒ2 = 0.12]b 3) β = −0.36, p = 0.04, ΔR2 = 0.12, [ƒ2 = 0.28]b 4) NS | 14 (15) |
Catchpole et al., 2007 [64] | Relationships between non-technical skills and adverse events in the OR | yes | 42 operations (24 pediatric, 18 orthopedic), 2 hospitals, UK | Live & video observation | Teamwork: non-technical skills (NOTECHSa) Patient safety: Adverse events: minor problems, intraoperative performance, operating time | Multiple linear regression | Non-technical skills negatively predict 1) minor problems but not 2) intraoperative performance or 3) operating time | 1) B = −3.3, t = −2.2, p = 0.035, []b 2) NS 3) NS | 8 (15) |
Catchpole et al., 2008 [62] | Relationships between non-technical skills and errors in the OR | yes | 54 surgeons, anesthetists, and nurses, 48 operations (26 laparoscopic cholecystectomies, 22 carotid endarterectomies), 1 hospital, UK | Live observation of operation | Teamwork: NOTECHSa Patient safety: errors in surgical technique (observation clinical human reliability assessment technique), other procedural problems and errors (checklist), operating time | Multiple linear regression | 1a) Surgical leadership and management negatively predicts operating time, 1b) whereas anesthetic leadership and management in carotid endarterectomy positively predicts operating time 2a) nursing leadership and management negatively predict other procedural problems and errors 2b) whereas nursing leadership and management in carotid endarterectomy positively predicts operating time (2 predictors) 3a) surgical situation awareness negatively predicts errors in surgical techniques (3 predictors) 3b) whereas surgical situation awareness in carotid endarterectomy positively predicts operating time (3 predictors) 4) Teamwork dimensions a) leadership and management b) teamwork and cooperation c) problem solving and decision making d) situation awareness are not associated with patient safety dimensions e) errors in surgical technique f) other procedural problems and error g) operating time | 1a) β = −0.19, p = 0.023 1b) β = 0.81, p < 0.001, R2 = 0.717, [ƒ2 = 2.53]b,c 2a) β = −0.39, p = 0.012 2b) β = 0.41, p = 0.008, R2 = 0.69 [ƒ2 = 2.215]b,c 3a) β = −0.71, p < 0.001 3b) β = 1.97, p < 0.001, R2 = 0.19, [ƒ2 = 0.233]b,c 4ae-dg) 9 non-significant associations | 9 (15) |
Catchpole et al., 2008 [63] | Relationships between non-technical skills and safety threats, errors, and operative duration | yes | Physicians and nurses, 44 operations (24 pediatric, 20 orthopedic), 2 hospitals, UK | Live & video observation | Teamwork: NOTECHSa Patient safety: errors & threats (checklists and free observations) | Spearman’s rank correlation | 1) Positive correlation between non-technical skills and 1a) safety threats 1b) operative duration 1c) but not technical errors in pediatric surgery 2) No correlations between non-technical skills and 1a) safety threats 1b) operating time 1c) technical errors in orthopedic surgery | 1a) ρ = 0.58, p < 0.005 1b) ρ = 0.58, p < 0.005 1c) NS 2a) NS 2b) NS 2c) NS | 10 (15) |
Endacott et al., 2014 [81] | Relationships between leadership, teamwork and performance in medical emergencies | yes | 42 nurses, 15 teams, 1 hospital, Australia | Video observation of simulated emergency | Teamwork: Team Emergency Assessment Measure (TEAM) a Patient safety: performance of key treatment actions | Pearson correlation | Teamwork correlates positively with patient safety in the 1) respiratory distress and 2) hypovolemic shock but not in the 3) chest pain scenario | 1) r = .90, p < 0.001 2) r = .54, p < .05 3) NS | 11.5 (15) |
Kolbe et al., 2012 [65] | Relationships between speaking up and technical team performance/team interaction | no | 31 anesthesia teams (1 nurse, 1 resident), teaching hospital, Switzerland | Video observation of simulated anesthesia induction | Teamwork: Coding scheme for (non-)verbal team interactions Patient safety: technical team performance (adherence to checklist of standard anesthesia induction and target values) | Hierarchical linear regression | 1) Technical team performance is predicted by nurses’ levels of speaking up 2) but not by residents’ levels of speaking up | 1) β = 0.43, p = 0.017, R
2
= 0.18, [f
2
= 0.22]bc (2 predictors) 2) NS | 14 (15) |
Kuenzle et al., 2010 [67] | Relationship between shared leadership and anesthesia team performance under high and low task load | yes | 12 anesthesia teams (1 resident, 1 nurse), teaching hospital, Switzerland | Video observation of simulated anesthesia induction | Teamwork: Coding scheme for content-oriented and structuring leadership behavior Patient safety: performance (reaction time after non-routine event) | ANOVA | 1a) No differences in shared leadership behaviors of high-performing teams between nurses and residents 1b) during high- and low task load situations 2a) Residents show more leadership behaviors than nurses in low performing teams 2b) independent of task load | 1a) F(1, 20) = 0.00, p = 0.971, η2 = 0.000 1b) Interaction: NS 2a) F(1, 20) = 7.14, p = 0.015, η2 = 0.263 2b) Interaction: NS | 12.5 (15) |
Kuenzle et al., 2010 [66] | Relationship between shared leadership and anesthesia team performance under high and low task load | yes | 12 anesthesia teams (1 resident, 1 nurse), 1 hospital, Switzerland | Video observation of simulated anesthesia induction | Teamwork: structuring and content oriented leadership: structured observation Patient safety: performance (speed of correct management after non-routine event = high task load) | Spearman’s rank correlation Kruskal-Wallis-test | 1) Under high task load team performance and a) structuring and b) content-oriented leadership are not correlated 2) Under low task load, team performance and a) structuring, b) but not content-oriented leadership are negatively correlated 3) Interaction of leadership behavior and team experience is not associated with team performance | 1a) NS 1b) NS 2a) ρ = −0.56, p < 0.05 2b) NS 3) NS | 12 (15) |
Lubbert et al., 2009 [68] | Relationship between team organization and treatment errors | yes | 378 video registrations of patients treated in the emergency room, 1 hospital, The Netherlands | Video observation | Teamwork & patient safety: Self-developed checklist measuring adherence to advanced trauma life support (ATLS) guidelines | t-test | 1) Errors in team organization dimension evident leadership are associated with more deviations from treatment protocol, whereas 2) errors in team organization dimension effective leadership are not | 1) p = 0.01 (no other indicators reported) 2) NS | 6 (15) |
Manser et al., 2009 [11] | Relationships between different coordination patterns and team performance | yes | 46 anesthesia residents, 23 teams, USA | Video observation of simulated anesthesia emergency | Teamwork: self-developed coding scheme for coordination Patient safety: clinical performance (adherence to malignant hyperthermia treatment guidelines) | Hierarchical regression analysis | 1) Time spent on coordination dimensions a) task management b) but not information management c) or coordination via work environment negatively predicts performance 2) Time spent on task management categories a) task distribution b) but not planning c) clarification d) initiating action e) or assistance negatively predicts performance 3) Time spent on information management categories a) situation assessment b) but not information transfer c) decision making d) or feedback/acknowledgement negatively predicts performance | 1a) β = −0.47, p < 0.01, ΔR
2
= 0.243, [f
2
= 0.32]b 1b) NS 1c) NS 2a) β = −0.54, p < 0.01, ΔR
2
= 0.340, [f
2
= 0.52]b 2b) NS 2c) NS 2d) NS 2e) NS 3a) β = −0.57, p < 0.05, ΔR
2
= 0.227, [f
2
= 0.29]b 3b) NS 3c) NS 3d) NS | 11.5 (15) |
McCulloch et al., 2009 [6] | Relationships between non-technical skills and technical errors | yes | 54 surgeons, anesthetists and nurses, 48 observations before and 55 observations after training, teaching hospital, UK | Uncontrolled pre-post-training Live observations of operations | Teamwork: NOTECHSa Patient safety: technical errors (Observation Clinical Human Reliability Assessment, OCHRA)a | Spearman’s rank correlation | 1) Negative correlation between a) overall non-technical skills and technical errors b) especially for surgical sub-team 2) Negative correlation between a) situational awareness and technical errors b) especially for surgical sub-team | 1a) ρ = −0.215, p = 0.024 1b) ρ = −0.236, p = 0.013 2a) ρ = −0.300, p = 0.001 2b) ρ = −0.436, p < 0.0001 | 11.5 (18) |
Mishra et al., 2008 [69] | Relationships between non-technical skills and technical errors | yes | 26 observations (nurses, surgeons, anesthetists), teaching hospital, UK | Live observation of operation | Teamwork: NOTECHSa Patient safety: OCHRAa | Spearman’s rank correlation | 1) No correlation between technical errors and a) leadership & management b) teamwork & cooperation c) problem-solving and decision-making in the d) overall team, or e) surgeon f) anesthetists g) and nurses subgroup 2) Negative correlation between situation awareness and technical errors for a) overall team b) surgeon subgroup c) but not anesthetists d) and nurses subgroup | 1ad) NS 1ae) NS 1af) NS 1ag) NS 1bd) NS 1be) NS 1bf) NS 1bg) NS 1 cd) NS 1ce) NS 1cf) NS 1cg) NS 2a) ρ = −0.505, p = 0.009 2b) ρ = −0.718, p = 0.001 2c) NS 2d) NS | 10 (15) |
Ottestad et al., 2007 [70] | Development and psychometric testing of tool to measure resuscitative skills and to compare interns and teams regarding ideal management of septic shock | no | 23 observations (ICU residents), USA | Video observation of emergency simulation | Teamwork: NOTECHSa Patient safety: Adherence to Surviving Sepsis Campaign Guidelines | Pearson’s correlation | Positive correlation between non-technical skills and team sepsis management | r = 0.4, p = 0.05 | 7.5 (15) |
Schmutz et al., 2015 [79] | Relationships between coordination, task type and performance in medical emergencies | yes | 277 nurses, resident and senior physicians, 68 teams, 7 hospitals, Germany | Video observation of simulated pediatric emergency | Teamwork: Coordination behaviors via CoMeT–E (Coordination System for Medical Teams - Emergency) observation toola Patient safety: Clinical performance via key treatment steps checklist | Hierarchical linear regression | 1a) Coordination behavior closed-loop communication is positively associated with clinical performance, whereas 1b) coordination behaviors task distribution and 1c) providing information without request are not. 2a) Task type moderates relationship 1a) in that it is stronger in rule-based compared to knowledge-based tasks 2b) Task type did not moderate relationship 1b) 2c) Task type did not moderate relationship 1c) | 1a) β = .25, p < .05 1b) NS 1c) NS 2a) β = −.52, p < .01 2b) NS 2c) NS | 14 (15) |
Schraagen et al., 2011 [85] | Relationships between non-routine events, teamwork and patient outcomes | yes | 1 pediatric cardiac surgery team, 40 operations, The Netherlands | Cross-sectional self-report questionnaire, live observation of operations, record review | Teamwork: observation tool derived from NOTECHSa, ANTSa, NOTSSa, and OTASa Patient safety: 30-day postsurgical complications, operating time | Pearson’s correlation, ANOVA | 1) Positive correlation between non-technical skills and a) operating time b) but not postsurgical complications 2) Explicit coordination of anesthetists is associated with higher levels of postsurgical complications | 1a) r = 0.45, p < 0.05 1b) NS 2) Muncomplicated = 12.88, Mminor complications = 21.55, []b Mmajor complications = 16.40, F(2,36) = 4.78, p < 0.01, []b | 10 (16) |
Schraagen et al., 2011 [86] | Relationships between non-routine events, teamwork and patient outcomes | yes | 1 pediatric cardiac surgery team, 40 operations, The Netherlands | Cross-sectional self-report questionnaire, live observation of operations, record review | Teamwork: NOTECHSa Patient safety: 30-day postsurgical complications | Pearson’s correlation, ANOVA | Teamwork and cooperation is associated with higher levels of postsurgical complications | Muncomplicated = 3.19, Mminor complications = 3.44, Mmajor morbidity = 3.28, F(2,36) = 3.85, p < 0.05, η2 = 0.18 | 8.5 (16) |
Siassakos et al., 2010 [80] | Relationships between individual team members’ knowledge, skills, and attitudes and team performance | no | 19 teams (physicians and midwives), 6 maternity units, UK | Video observation of obstetric emergency simulation, self-report questionnaire | Teamwork: SAQ subscale team climatea Patient safety: team performance (magnesium administration) | Kendall’s rank correlation | No correlation between teamwork climate and performance | NS | 8 (16) |
Siassakos et al., 2011 [72] | Relationships between teamwork skills and behaviors and team performance in emergency situations | yes | 47 teams (2 physicians and 4 midwives each), 6 maternity units, UK | Video observation | Teamwork: Team analytical toola Patient safety: performing key actions | Kendall’s rank correlation | 1) Positive correlation between speed of magnesium administration and a) skills b) behavior c) and overall teamwork 2) Negative correlation between time needed to put patient in recovery position and a) skills b) behavior c) but not overall teamwork 3) Negative correlation between time needed to administer oxygen and a) skills b) behavior c) and overall teamwork 4) Negative correlation between time needed to sample blood and a) skills b) behavior c) and overall teamwork | 1a) τ = 0.54, p < 0.001 1b) τ = 0.41, p = 0.001 1c) τ = 0.51, p < 0.001 2a) τ = −0.29, p = 0.012 2b) τ = −0.25, p = 0.026 2c) NS 3a) τ = −0.39, p < 0.001 3b) τ = −0.28, p = 0.014 3c) τ = −0.41, p < 0.001 4a) τ = −0.35, p = 0.002 4b) τ = −0.35, p = 0.002 4c) τ = −0.35, p < 0.002 | 8.5 (15) |
Siassakos et al., 2011 [71] | Relationships between teamwork and clinical efficiency in emergency situations | yes | 114 physicians and nurses, 19 teams, 6 maternity units, UK | Video observation | Teamwork: self-developed observation system Patient safety: performing key action (speed of magnesium administration) | Kendall’s rank correlation | 1) Positive correlation between closed-loop communication and clinical efficiency 2) Positive correlation between unambiguous communication and clinical efficiency 3) No correlations between clinical efficiency and a) SBAR communication style b) team coordination c) situational awareness d) leadership style e) supportive language f) task support by senior clinician | 1) τ = 0.46, p = 0.022 2) τ = 0.53, p = 0.004 3a) NS 3b) NS 3c) NS 3d) NS 3e) NS 3f) NS | 8 (15) |
Thomas et al., 2006 [73] | Relationship between teamwork and quality of care | yes | 118 teams (physicians, nurses, respiratory therapists), resuscitation room, teaching hospital, USA | Video observation of neonatal resuscitation | Teamwork: Frequency of different teamwork behaviors Patient safety: Neonatal Resuscitation Program (NRP) Guidelines | Spearman’s rank correlation | 1) Negative correlation between team communication and a) overall quality of resuscitation, b) non-compliance with all NRP steps, and c) non-compliance during preparation and initial steps 2) Negative correlation between team management and a) noncompliance with all NRP steps, and b) noncompliance during preparation and initial steps but not c) overall quality of resuscitation, 3) Negative correlation between team leadership and a) overall quality of resuscitation, but not with b) noncompliance with all NRP steps, and with c) non-compliance during preparation and initial steps | 1a) ρ = −0.236, p = 0.007 1b) ρ = −0.214, p = 0.014 1c) ρ = −0.230, p = 0.008 2a) ρ = −0.201, p = 0.021 2b) ρ = −0.252, p = 0.003 2c) NS 3a) ρ = −0.288, p < 0.001 3b) NS 3c) NS | 9.5 (15) |
Tschan et al., 2006 [74] | Relationships between directive leadership, structuring inquiry and performance regarding different phases | yes | 109 clinicians (nurses, residents, senior physicians), 21 teams, ICU, university hospital, Switzerland | Video observation and transcription of emergency simulation | Teamwork: directive leadership and structuring inquiry Patient safety: clinical performance (key actions, hands-on time) | Pearson’s correlation | 1) Phase 1 (nurses only): positive correlation between performance and a) directive leadership and b) structuring inquiry 2) Phase 2 (residents and nurses): positive correlation between performance and a) resident directive leadership during first 30 s, no correlation between performance and b) resident directive leadership per second c) resident structuring inquiry per second d) resident structuring inquiry during first 30 s 3) Phase 3 (nurses, residents, senior physicians): positive correlation between performance and a) senior physician structuring inquiry, no correlation between performance and b) resident structuring inquiry c) senior physician d) resident directive leadership | 1a) r = 0.445, p < 0.05 1b) r = 0.216, p < 0.05 2a) r = 0.522, p < 0.05 2b) NS 2c) NS 2d) NS 3a) r = 0.428, p < 0.01 3b) NS 3c) NS 3d) NS | 11.5 (15) |
Tschan et al., 2009 [75] | Relationships between team communication and perceptual biases of individuals and accuracy of diagnosis | yes | 53 physicians, 20 teams, university hospital, Switzerland | Video observation of hand-over simulation | Teamwork: coding of communication and behavior Patient safety: diagnostic performance | ANOVA | 1) Groups considering more diagnostic information are not more likely to find the correct diagnosis 2) Groups showing a) more explicit reasoning b) more talking to the room are more likely to find the correct diagnosis | 1) NS 2a) F(2, 15) = 5.750, p = 0.014 2b) χ2 = 8.598, df = 2, p = 0.007 | 11 (15) |
Westli et al., 2010 [76] | Relationship between teamwork skills/shared mental models and clinical performance | yes | 27 trauma teams, Norway | Video observation of emergency simulations | Teamwork: ANTSa and Anti-Air Teamwork Observation Measure (ATOM) Patient safety: Team global medical management, key actions of trauma management | Pearson’s correlation | 1) Negative correlation between supporting behavior and performing key actions 2) Negative correlation between poor coordination and medical management 3) Positive correlation between information exchange and medical management 4) Negative correlation between poor situational awareness and performing key actions 5) Positive correlation between providing information and medical management 6a-u) 21 non-significant correlations between teamwork and patient safety variables | 1) r = −0.37, p < 0.05 2) r = −0.36, p < 0.05 3) r = 0.34, p < 0.05 4) r = −0.40, p < 0.05 5) r = 0.51, p < 0.01 6a-u) NS | 10.5 (15) |
Wiegmann et al., 2007 [77] | Relationship between (teamwork-related) surgical flow disruptions and surgical error | yes | 31 cardiac operations, 1 hospital, USA | Live observation of operation | Teamwork: teamwork-related surgical flow disruptions Patient safety: surgical errors | Multiple regression | Teamwork-related surgical flow disruptions positively predict surgical errors | β = 0.692, p < 0.001, adj. R2 = 0.553, [f
2
= 1.24]bc (5 predictors altogether) | 11 (15) |
Williams et al., 2010 [78] | Relationships between teamwork behaviors and resuscitation errors | yes | 12 resuscitation teams, NICU, teaching hospital, USA | Video observation of resuscitation | Teamwork: frequency of different teamwork behaviors Patient safety: Neonatal Resuscitation Program (NRP) Guidelines | Spearman’s rank correlation, generalized linear mixed model (GLM) | 1) Negative correlation between vigilance and NRP errors 2) No correlation between workload management and NRP errors 3) NRP errors are associated with a) more assertions before the error b) less teaching after the error 4) No associations between NRP errors and a) information sharing before error b) information sharing after error c) inquiry before error d) inquiry after error e) assertion after error f) teaching before error | 1) ρ = −0.62, p = 0.031 2) NS 3a) OR = 1.44, p = 0.008, 95 % CI 1.10 – 1.89 3b) OR = 0.59, p = 0.028, 95 % CI 0.37 – 0.94 4a) NS 4b) NS 4c) NS 4d) NS 4e) NS 4f) NS | 10 (15) |
b) survey studies | |||||||||
Brewer, 2006 [87] | Relationships between culture, team characteristics/processes and patient safety/hospital financial performance | yes | 430 nurses, physicians and other medical care providers, 16 surgical units, 4 acute care hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: Positive team processes: Relational Coordination Scalea Negative team processes scale Patient safety: patient falls (incident reporting system), length of stay (hospital records) | Pearson’s correlation | 1) Positive intra-team processes correlate positively with a) length of stay b) but not with patient falls 2) No correlation between negative team processes and a) length of stay b) patient falls | 1a) r = 0.59, p < 0.05 1b) NS 2a) NS 2b) NS | 10 (16) |
Chan et al., 2011 [88] | Validity of a team-based tool to assess success of a team-based intervention to reduce central line associated blood stream infections (CLABSI) | no | 46 ICUs, 35 hospitals, USA | Secondary analyses of longitudinal RCT, self-report questionnaire, record review | Teamwork: Team check-up tool (TCT) Patient safety: Central line associated bloodstream infections (CLABSI) | Cox regression | No association between teamwork and duration to reach zero CLABSI’s after intervention | NS | 10 (19) |
Chang & Mark, 2009 [89] | Antecedents (teamwork, nurse & patient factors) of severe and non-severe medication errors | yes | 1 671 nurses, 279 units, 146 hospitals, USA | Longitudinal self-report questionnaire, record review | Teamwork: Relational Coordination Scalea Patient safety: medication errors (hospital incident reports) | Generalized estimating equations (GEE) | Relational coordination predicts neither 1) severe nor 2) non-severe medication errors | 1) NS 2) NS | 9 (16) |
Edmondson, 2004 [10] | Relationship between team/organizational characteristics, team leadership and medication errors | yes | 159 nurses, physicians and pharmacists, 8 hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: Team/organizational characteristics and team leadership (self-developed questionnaire) Patient safety: medication error (hospital incident reports & self-reported) | Spearman’s rank correlation | Positive correlation between 1) nurse manager coaching 2) nurse manager direction setting and 3) unit relationship quality and a) detected and b) intercepted medication errors but not with c) non-preventable drug complications | 1a) ρ = 0.74, p < 0.03 1b) ρ = 0.71, p < 0.03 1c) NS 2a) ρ = 0.74, p < 0.03 2b) ρ = 0.83, p < 0.03 2c) NS 3a) ρ = 0.74, p < 0.03 3b) ρ = 0.76, p < 0.03 3c) NS | 11 (16) |
Fasolino et al., 2012 [90] | Relationships between nurse characteristics, nurse practice environment, team member effectiveness and medication error | yes | 163 nurses, 11 surgical units, 1 hospital, USA | Cross-sectional self-report questionnaire, record review | Teamwork: team member effectiveness survey Patient safety: medication errors (hospital incident reports) | Spearman’s rank correlation | Team member effectiveness is positively correlated with medication error | ρ = 0.19, p < 0.01 | 12 (16) |
Hoffer Gittell et al., 2000 [9] | Relationship between relational coordination and quality of care/length of stay | yes | 338 physicians, nurses, and other medical care providers, 9 hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: Relational Coordination Scalea Patient safety: Length of stay | Hierarchical linear regression | Relational coordination is associated with decreased length of stay | B = −53.77, p < 0.001, []b | 13 (16) |
Hwang & Ahn, 2015 [83] | Relationships between teamwork and error reporting | yes | 576 nurses, 2 acute care hospital, South Korea | Cross-sectional self-report questionnaire | Teamwork: Teamwork perceptions questionnaire (TPQ)a Patient safety: occurrence of and reporting medical errors | Logistic regression | Teamwork dimensions 1) team structure, 2) team leadership, 3) situation monitoring, 4) mutual support, and 5) communication are positively associated with error reporting No information on relationship between teamwork and occurrence of medical errors | 1) OR = 0.92, 95 % CI 0.50 –1.692) OR = 1.13, 95 % CI 0.78 –1.623) OR = 0.96, 95 % CI 0.52 – 1.78 4) OR = 1.23, 95 % CI 0.66 – 2.30) 5) OR = 1.82, 95 % CI 1.05 - 3.14 | 12.5 (16) |
Kalisch & Lee, 2010 [60] | Relationship between teamwork and missed nursing care | yes | 2216 nurses, 40 acute care units, 4 hospitals, USA | Cross-sectional self-report questionnaire | Nursing Teamwork Surveya MISSCARE Surveya | Pearson’s correlation Multiple linear regression | 1) Negative correlation between missed nursing care and a) trust b) team orientation c) backup behavior d) shared mental model e) team leadership 2) After controlling for various covariates, overall teamwork scores negatively predict missed nursing care | 1a) r = −0.31, p < 0.01 1b) r = −0.28, p < 0.01 1c) r = −0.31, p < 0.01 1d) r = −0.32, p < 0.01 1e) r = −0.29, p < 0.01 2) B = −0.254, p < 0.001, ΔR
2
= 10.9, [f
2
= 0.124]b | 12.5 (16) |
Leroy et al., 2012 [8] | Mediation and moderation relationships between leader behavioral integrity for safety, team psychological safety, team priority of safety, and treatment errors | yes | 580 nurses and head nurses, 4 hospitals, Belgium | Longitudinal self-report questionnaire | Teamwork: Team Psychological Safety Scalea Patient Safety: head nurses’ reports of treatment errors | Path analysis | 1) Good overall model fit 2) Within path model, team psychological safety at time 1 positively predicts treatment errors at time 2 | 1) χ2 = 6.72, p = 0.03, SRMR = 0.07, RMSEA = 0.02, CFI = 0.98 2) β = 0.28, p = 0.02 | 14 (16) |
Manojlovich et al., 2007 [82] | Relationships between perceived work environments, nurse-physician communication and patient outcomes | yes | 462 nurses, 25 ICUs, 8 hospitals, USA | Cross-sectional self-report questionnaire | Teamwork: parts of ICU Nurse-Physician Questionnairea Patient safety: nurse-reported adverse events (medication errors, ventilator-associated pneumonia, catheter-associated sepsis) | Random intercept multilevel models | Nurse-physician communication negatively predicts 1) ventilator-associated pneumonia 2) catheter-associated sepsis and 3) medication errors | 1) B = −0.045, p < 0.05, R
2
= 0.09, [f
2
= 0.1]b,c 2) B = −0.049, p < 0.05, R
2
= 0.14, [f
2
= 0.16]b,c 3) B = −0.047, p < 0.01, R
2
= 0.11, [f
2
= 0.12]b,c | |
Manojlovich et al., 2009 [91] | Relationship between nurse-physician communication and patient outcomes | yes | 462 nurses, 25 ICUs, 8 hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: ICU Nurse-Physician Questionnairea Patient safety: adverse outcomes ventilator-associated pneumonia, bloodstream infections, and pressure ulcers | Pearson’s correlation | No correlation between nurse-physician communication subscales 1) timeliness 2) accuracy 3) openness and 4) understanding and patient safety indicators a) ventilator-associated pneumonia b) bloodstream infections and c) pressure ulcers | 1a-4c) 12 non-significant associations | 11 (16) |
Ogbolu et al., 2015 [84] | Relationships between nurse work environment and patient safety | no | 222 nurses, Nigeria | Cross-sectional self-report questionnaire | Teamwork: nurse-physician relationsa Patient safety: Patient safety: one item from AHRQa | Generalized linear mixed modeling | Relationship between nurse-physician relations and patient safety not reported (only relationship between aggregate NWI scale and patient safety) | - | 10 (16) |
Taylor et al., 2012 [92] | Relationships between safety climate, teamwork and patient adverse events | no | Nurses in 29 units, 1 hospital, USA | Cross-sectional & longitudinal self-report questionnaire, record review | Teamwork: SAQ subscale team climatea Patient safety: patient falls & injuries, deep vein thrombosis and pulmonary embolism records | Multilevel logistic regression | Positive team climate is associated with 1) fewer decubitus ulcers, but not 2) less patient falls & injuries or 3) pulmonary embolisms and deep vein thrombosis one year later | 1) OR = 0.56, 95 % CI 0.30 - 0.82, p < 0.01 2) NS 3) NS | 13.5 (16) |
Vogus et al., 2007 [93] | Moderation of relationship between team safety organizing behaviors and medication errors by trust in manager and existence of care pathways | yes | 1033 nurses & 78 nurse managers, 78 units, 10 acute-care hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: Safety Organizing Scale (SOS)a Trust in manager: 2 items Care pathways: 1 item Patient safety: medication errors (number of errors reported to unit’s incident reporting system up to 6 months after survey data collection) | Multilevel Poisson regression | 1) Safety organizing negatively predicts medication errors 2) Trust in manager has no impact on reporting of medication errors when level of safety organizing is high. When safety organizing is low and trust in manager is high, more errors are reported 3) Use of care pathways has no impact on reporting of medication errors when safety organizing is low. When safety organizing is high and care pathways are extensively used, fewer errors are reported | 1) β = −0.29, p < 0.01, 95 % CI −0.57 to −0.01 2) β = −0.68, p < 0.001, 95 % CI −1.03 to −0.32 3) β = −0.82, p < 0.001, 95 % CI −1.31 to −0.33 | 13 (16) |
Wheelan et al., 2003 [94] | Relationship between teamwork and patient mortality | yes | 349 healthcare providers, 17 ICUs, 9 hospitals, USA | Cross-sectional self-report questionnaire, record review | Teamwork: Group Development Questionnairea Patient safety: Standardized mortality rates | Pearson’s correlation | Level of group development correlates negatively with mortality rates | r = −0.66, p = 0.004 | 12 (16) |
Yun et al., 2005 [95] | Moderation of relationship between contingent leadership and team effectiveness by severity of patient trauma and team experience | yes | 91 members of trauma resuscitation teams, 1 hospital, USA | Cross-sectional self-report questionnaire, scenario method | Teamwork & patient safety: Team Effectiveness Scalea, Team leadership, severity of trauma and team experience manipulated across scenarios | General linear model (GLM) | 1) Interaction of leadership/severity of injury: Team effectiveness dimension quality health care is high when patient was not severely injured/leadership is empowering or patient was severely injured/leadership was directive 2) Interaction of leadership/team experience: quality health care is highest when leadership is empowering, independent of team experience 3) 3-way-interaction: quality health care is highest when team is experienced and leadership is empowering, independent of patient condition. When team is inexperienced, quality health care is highest when leadership is empowering and patient is not severely injured, or when leadership is directive and patient is severely injured | 1) Severely injured patient: Mdirective leaders = 3.06, 95 % CI 2.83 – 3.27, Mempowering leaders = 2.72, 95 % CI 2.50 – 2.95. Non-severely injured patient: Mempowering leaders = 3.91, 95 % CI 3.69 – 4.13, Mdirective leaders = 2.16, 95 % CI 1.94 – 2.38, F = 119.48, p < 0.01, η2 = 0.26. 2) Experienced team: Mempowering leadership = 3.65, 95 % CI 3.42 - 3.82, Mdirective leadership = 2.48, 95 % CI 2.25 - 2.70. Inexperienced team: Mempowering leadership = 2.99, 95%CI 2.76 - 3.21, Mdirective leadership = 2.74, 95 % CI 2.51 - 2.96, F = 23.19, p < 0.01, η2 = 0.06. 3) Inexperienced team/severely injured patient: Mdirective leadership = 3.19, 95 % CI 2.89 - 3.49, Mempowering leadership = 2.13, 95 % CI 1.82 - 2.44. Inexperienced team/non-severely injured patient: Mempowering leadership = 3.85, 95 % CI 3.57 - 4.12, Mdirective leadership = 2.28, 95 % CI 2.00 - 2.56, F = 7.31, p < 0.01, η2 = 0.04. | 14.5 (16) |
Study | Topic | Primary topic | Sample & setting | Design & data collection methods | Assessment of variables | Analyses | Findings | Outcomes & effect sizes | Quality scored |
---|---|---|---|---|---|---|---|---|---|
Arakawa et al., 2011 [98] | Relationships between nurses’ work, health, and lifestyle characteristics and medical errors and incidents | yes | 6445 nurses, 99 hospitals, Japan | Cross sectional self-report questionnaire | Well-being: SF-36 scales mental health and vitalitya Patient safety: Number of incidents and errors during the previous 6 months | Logistic regression | No association between 1) mental health 2) vitality and medical errors and incidents | 1) NS 2) NS | 9 (16) |
Arimura et al., 2010 [99] | Relationships between work characteristics, sleepiness, mental health state and self-reported medical errors | yes | 454 nurses, 2 general hospitals, Japan | Cross sectional self- report questionnaire | Well-being: GHQ-28a, daytime sleepiness (Epworth sleepiness scale) Patient safety: medical errors during past month | Multiple logistic regression | 1) Poorer mental health is associated with higher occurrence of medical errors 2) Daytime sleepiness is not associated with higher occurrence of medical errors | 1) OR = 1.1, p < 0.05, 95 % CI 1.0 – 1.1 2) NS (8 predictors altogether) | 105 (16) |
Chen et al., 2013 [114] | Relationships between burnout, job satisfaction and medical malpractice | yes | 809 physicians, Taiwan | Cross-sectional self-report questionnaire | Well-being: MBIa Patient safety: experiences of medical malpractice | Univariate logistic regression | 1) Emotional exhaustion is associated with higher risk of medical malpractice, whereas 2) depersonalization and 3) personal accomplishment are associated with lower risk of medical malpractice | 1) OR = 1.50, 95 % CI 0.68 –1.95 2) OR = 0.74, 95 % CI 0.40 –1.36 3) OR = 0.76, 95 % CI 0.07 –1.05 | 6 (16) |
Cimiotti et al., 2012 [104] | Relationships between nurse staffing, burnout, and hospital infections | yes | 7076 nurses, 161 hospitals, USA | Cross-sectional self-report questionnaire, hospital records | Well-being: MBIa Patient safety: catheter-associated urinary tract & surgical site infections | Linear regression | Burnout is positively associated 1) catheter-associated urinary tract and 2) surgical site infections | 1) β = 0.82, p < .05 2) β = 1.56, p < .01 | 10.5 (16) |
Fahrenkopf et al., 2008 [106] | Relationships between depression, burnout, and medication errors | yes | 123 residents, 3 pediatric hospitals, USA | Cross-sectional self-report questionnaire, record review | Well-being: MBIa Patient safety: medical errors (self-report & chart reviews) | Cluster adj. Poisson analysis, Fisher’s exact test | 1) Burnt out residents perceive their number of errors to be higher than residents who are not burnt out 2) Burnt out residents are more likely to attribute errors to sleep deprivation 3) No significant differences in error rates detected in chart reviews between both groups | 1) Mhigh burnout = 2.3, Mlow burnout = 1.0, p = 0.002 2) 29 % vs. 10 %, p = 0.05 3) NS []b | 8 (16) |
Garrouste-Orgeas et al., 2015 [116] | Relationships between medical errors, burnout, depression, and safety culture | yes | 1534 nurses, physicians, & other healthcare staff, 31 ICUs, France | Cross-sectional self-report questionnaire, hospital records and observations | Well-being: MBIa Patient safety: Medical error | Negative binomial regression | Burnout is not associated with medical error | NS | 10.5 (15) |
Halbesleben et al., 2008 [22] | Relationships between nurse burnout and patient safety perceptions/reporting behavior | yes | 148 nurses, 1 hospital, USA | Cross sectional self- report questionnaire | Well-being: Emotional Exhaustion and Depersonalizationa Patient safety: AHRQ Patient Safety Culture Surveya & frequency of incident reports | Multiple linear regression | 1) Emotional exhaustion and depersonalization predict patient safety dimensions a) safety grade b) safety perception c) near-miss reporting frequency 2a) Emotional exhaustion and b) depersonalization do not predict patient safety dimension event reports | 1a) βexhaustion = −0.40, p < 0.01, βdepersonlization = −0.16, p < 0.05, R
2
= 0.22, [f
2
= 0.28]b,c 1b) βexhaustion = −0.84, p < 0.001, βdepersonlization = −0.26, p < 0.05, R
2
= 0.36, [f
2
= 0.56]b, c 1c) βexhaustion = −0.14, p < 0.05, βdepersonlization = −0.36, p < 0.01, R
2
= 0.18, [f
2
= 0.22]b, c 2a) NS 2b) NS | 13.5 (16) |
Halbesleben & Rathert, 2008 [107] | Relationship between physician burnout and patient satisfaction and patient recovery time after hospital discharge | yes | 178 patient and physician dyads, 1 hospital, USA | Cross-sectional self- report questionnaire | Well-being: MBIa, patients’ perception of physician depersonlization Patient safety: recovery time: 1-item patient self-report | Path analysis, Pearson’s correlation | 1) Good overall model fit 2) Positive correlation between patient recovery time and a) depersonalization b) but not emotional exhaustion c) or personal accomplishment 3) Positive correlation between patients’ perception of physician depersonalization and recovery time 4) No correlation between physician emotional exhaustion and recovery time | 1) GFI = 0.99, CFI = 1.00, NNFI = 1.02, AIC = −2.98, BIC = −8.45, RMSEA = 0.00 2a) r = 0.44, p < 0.05 2b) NS 2c) NS 3) r = 0.32, p < 0.05 4) NS | 12 (16) |
Hayashino et al., 2012 [108] | Hope moderates relationship between distress and medical errors | yes | 836 physicians, Japan | Longitudinal self-report questionnaire | Well-being: MBIa (time 1) Medical errors: self-report (time 2) | Poisson regression | High scores in 1) emotional exhaustion 2) depersonalization and low scores in 3) personal accomplishment at time 1 are associated with medical errors at time 2 | 1) IRR = 2.34, p < 0.0001 2) IRR = 2.72, p < 0.0001 3) IRR = 0.62, p = 0.001 | 9.5 (16) |
Hunziker et al., 2012 [109] | Influence of self-reported, biochemical and physiological stress on cardio-pulmonary resuscitation (CPR) performance | yes | 28 residents, teaching hospital, Switzerland | Self-report questionnaire, video observation of simulated resuscitation | Well-being: Stress/overload index (self-report; blood cortisol, heart rate) Patient safety: performance (time until CPR is started and hands-on time) | Multiple linear regression | 1) Stress/overload is positively associated with a) time to start CPR b) but not hands-on-time during resuscitation 2) Heart rate is positively associated with a) hands-on-time b) and negatively with time to start CPR during resuscitation 3a) Cortisol level and b) heart rate variability do not predict c) hands-on-time and d) time to start CPR 4) The difference of a) stress/overload b) cortisol level c) heart rate variability before to during resuscitation do not predict d) hands-on-time or e) time to start CPR 5) The difference of heart rate before to during resuscitation predicts a) hands-on-time and b) time to start CPR | 1a) β/B = 12.01, 95 % CI 0.65 – 23.36, p = 0.04 1b) NS 2a) β/B = 2.22, 95 % CI 0.53 – 3.92, p = 0.015 2b) β/B = −0.78, 95 % CI 1.44 to −0.11, p = 0.027 3 ac) NS 3ad) NS 3bc) NS 3bd) NS 4ad) NS 4ae) NS 4bd) NS 4be) NS 4 cd) NS 4ce) NS 5a) β/B = 2.73, 95 % CI 0.48 – 4.99, p = 0.022 5b) β/B = −1.12, 95 % CI −1.91 to −0.33, p = 0.01 (no information regarding standardization of coefficients) | 12.5 (15) |
Jones et al., 2012 [100] | Effect of incident seriousness and work-based support on negative positive affect | yes | 171 nurses, 4 hospitals, UK | Cross-sectional & longitudinal between & within-person design, diary study | Well-being: Positive & Negative Affect Scale (PANAS) and mood diary entriesa Patient safety: nurse-reported incidents | Random-effects multilevel model | 1) Interaction of incident occurrence and seriousness leads to elevated negative affect during remainder of shift 2a) Incident occurrence 2b) but not incident seriousness lead to reduced positive affect during remainder of shift | 1) β = 0.07, z = 3.5, p < 0.005 2a) β = −2.39, z = 1.99, p < 0.05 2b) NS | 13 (16) |
Kirwan et al., 2013 [105] | Relationships between working environment, burnout and patient safety | no | 1397 nurses, 108 wards, 30 hospitals, Ireland | Cross-sectional self-report questionnaire | Well-being: MBIa Patient safety: one item from AHRQa, adverse events | Multilevel regression | Emotional exhaustion on ward level does not predict 1) nurse-rated patient safety or 2) reporting of adverse events | 1) NS 2) NS | 12.5 (16) |
Klein et al., 2010 [110] | Relationship between burnout and self-reported quality of care | yes | 1311 surgeons, 489 hospitals, Germany | Cross sectional self- report questionnaire | Well-being: Copenhagen Burnout Inventory (CBIa) Patient safety: Quality of care: frequency of diagnostic and therapeutic errors (Chirurgisches Qualitätssiegel survey CQS) | Multivariate logistic regression | 1) Burnout is associated with 1a) lower quality of diagnosis/therapy 1b) more diagnostic errors 1c) more therapeutic errors among males 2) Unclear association of burnout with 2a) lower quality of diagnosis/therapy 2b) more diagnostic errors 2c) more therapeutic errors among females | 1a) OR = 1.71, 95 % CI 1.10 – 2.64 1b) OR = 1.94, 95 % CI 1.35 – 2.79 1c) OR = 2.56, 95 % CI 1.66 – 3.96 2a-c) contradictory information regarding significance in text and table | 10.5 (16) |
Maiden et al., 2011 [101] | Relationship between moral distress, compassion fatigue, and causes of medication errors | yes | 205 nurses, ICU, USA | Cross sectional self-report questionnaire, focus group | Well-being: Moral distress scalea Compassion fatigue: Professional Quality of Life Scalea Patient safety: Medication Administration Error Surveya | Pearson’s correlation | 1) Positive correlation between moral distress and a) transcription related medication errors and b) physician communication related medication errors c) but not with medication packaging d) pharmacy processes 2) Compassion fatigue is positively correlated with a) transcription related medication errors but not with medication error due to b) physician communication c) medication packaging d) pharmacy processes | 1a) r = 0.20, p = 0.05 1b) r = 0.24, p = 0.01 1c) NS 1d) NS 2a) r = 0.15, p = 0.05 2b) NS 2c) NS 2d) NS | 9 (16) |
Merlani et al., 2011 [13] | Relationships between hospital, patient, and clinician characteristics and burnout/stress | yes | 3052 physicians, nurses, and nurse-assistants, 74 ICUs, Switzerland | Cross-sectional self-report questionnaire, record review | Well-being: MBIa, 1 stress item Patient safety: mortality rates and length of stay (unit records) | Multivariate logistic regression | 1) Mortality is associated with higher level of burnout 2) Length of stay is not associated with burnout | 1) OR = 1.060, p = 0.04, 95 % CI 1.003 – 1.120 2) NS | 12.5 (16) |
Prins et al., 2009 [97] | Relationships between self-reported errors, burnout, and engagement | yes | 2115 residents, The Netherlands | Cross-sectional self- report questionnaire | Well-being: Utrecht Burnout Scale (UBOS)a, Utrecht Work Engagement Scale (UWES)a Patient safety: medical errors | Pearson’s correlation | 1) Errors due to wrong actions/inexperience a) are positively correlated with emotional exhaustion b) depersonalization c) and negatively correlated with personal accomplishment 2) Errors due to wrong actions/inexperience are not correlated with d) vigor e) dedication f) absorption 3) Errors due to lack of time a) are positively correlated with emotional exhaustion b) depersonalization c) and negatively correlated with personal accomplishment 4) Errors due to lack of time are negatively correlated with a) vigor b) dedication c) absorption | 1a) r = 0.20, p < 0.001 1b) r = 0.29, p < 0.001 1c) r = −0.05, p < 0.001 2a) NS 2b) NS 2c) NS 3a) r = 0.43, p < 0.001 3b) r = 0.42, p < 0.001 3c) r = −0.08, p < 0.001 4a) r = −0.23, p < 0.001 4b) r = −0.24, p < 0.001 4c) r = −0.11, p < 0.001 | 10.5 (16) |
Ramanujam et al., 2008 [102] | Relationship between nurses’ work characteristics, burnout, and patient safety | yes | 430 nurses, 2 hospitals, USA | Cross sectional self- report questionnaire | Well-being: Not described, although it can be deducted from the paper that the MBIa was used Patient safety: nurses’ safety perception | Path analysis | 1) Unsatisfactory initial model fit statistics, final model statistics not reported 2) Positive association between depersonalization and perceived patient safety 3) No association between emotional exhaustion and perceived patient safety | 1) χ2 = 1100.60, df = 455, χ2/df = 2.419, CFI = 0.876, RMSEA = 0.058 2) β = 0.189, p < 0.001 3) NS | 8.5 (16) |
Shanafelt et al., 2002 [112] | Prevalence of burnout in medical residents and the relationship to self-reported patient care practices | yes | 115 internal medicine residents, USA | Cross sectional self- report questionnaire | Well-being: MBIa Patient safety: self-developed patient care practices measure | Stepwise logistic regression | 1) Overall burnout score is associated with higher levels of a) monthly b) weekly suboptimal patient care practices 2) Depersonalization is associated with higher levels of a) monthly b) weekly suboptimal patient care practices 3) No associations between a) emotional exhaustion b) personal accomplishment and c) monthly d) weekly suboptimal patient care practices | 1a) OR = 8.3, p < 0.001, 95 % CI 2.6 – 26.5 1b) OR = 4.0, p = 0.036, 95 % CI 1.1 – 14.2 2a) OR = 5.8, p < 0.001, 95 % CI 2.2 – 15.4 2b) OR = 2.8, p = 0.041, 95 % CI 1.1 – 7.7 3 ac) NS 3ad) NS 3bc) NS 3bd) NS | 10.5 (16) |
Shanafelt et al., 2010 [111] | Relationship between burnout, quality of life, depression and perceived major medical errors | yes | 7905 surgeons, USA | Cross sectional self- report questionnaire | Well-being: MBIa Patient safety: medical errors | Logistic regression | 1a) Emotional exhaustion and b) depersonalization are associated with higher odds of reporting an error 2) Personal accomplishment is associated with lower odds of reporting an error | 1a) OR = 1.048, p < 0.0001, 95 % CI 1.042 – 1.055 1b) OR = 1.109, p < 0.0001, 95 % CI 1.096 – 1.122 2) OR = 0.965, p < 0.0001, 95 % CI 0.955 – 0.975 | 9 (16) |
Squires et al., 2010 [103] | Relationships between nurse leadership, work environment, safety climate, and nurse and patient outcomes | no | 600 acute care nurses, USA | Cross sectional self- report questionnaire | Well-being: Emotional Exhaustiona Patient safety: medication errors and ulcers | Path analysis | 1) Very good final model fit 2) No association between pressure ulcers and emotional exhaustion 3) Positive association between medication errors and emotional exhaustion | 1) χ2 = 217.6, p < 0.001, SRMR = 0.054, CFI = 0.947, RMSEA = 0.047, PCLOSE = 0.67 2) NS 3) β = 0.14, p < 0.05 | 12 (16) |
Teng et al., 2010 [14] | Interactions between time pressure and burnout on patient safety | yes | 458 nurses, 90 units, 2 medical centers, Taiwan | Cross sectional self- report questionnaire | Well-being: MBIa Patient safety: frequency of adverse events scale | Multiple linear regression | 1) Burnout negatively predicts patient safety 2) The interaction of burnout and time pressure negatively predict adverse events | 1) β = −0.25, p = 0.00 2) β = −0.08, p = 0.03 R
2
= 0.06 [f
2
= 0.06]b, c (7 predictors altogether) | 13 (16) |
Welp et al., 2015 [117] | Relationships between burnout, demographic and unit characteristics, and patient safety | yes | 1425 nurses and physicians, 54 intensive care units, Switzerland | Cross-sectional self-report questionnaire, hospital records | Well-being: MBIa Patient safety: standardized mortality ratios, length of stay, clinician-rated patient safety | Hierarchical (multilevel) linear regression | 1a) Emotional exhaustion and 1b) depersonalization are negatively associated with clinician-rated patient safety; c) personal accomplishment is positively associated with clinician-rated patient safety 2a) Emotional exhaustion, but not 2b) depersonalization or 2c) personal accomplishment is positively associated with standardized mortality ratios 3a) Emotional exhaustion, 3b) depersonalization, and 3c) personal accomplishment are not associated with length of stay | 1a) B = −0.13, p < .001 1b) B = −0.07, p < .05 1c) B = 0.16, p < .01 2a) β = 0.39, p < .05 2b) NS 2c) NS 3a) NS 2b) NS 2c) NS | 15 (16) |
West et al., 2006 [113] | Relationships between distress, quality of life and medical errors | yes | 184 internal medicine residents, teaching hospital, USA | Longitudinal cohort study, self-report questionnaire | Well-being: MBIa, fatigue and sleepiness: 2 items Patient safety: medical errors | Generalized estimation equations (GEE) | 1) Higher levels of a) emotional exhaustion b) depersonalization are associated with major medical errors in the c) previous d) following 3 months 2) Lower levels of personal accomplishment are associated with higher levels of major medical error in the a) previous b) following 3 months | 1 ac) PE = 4.58, p = 0.002 1bc) PE = 2.45, p = 0.002 1ad) OR = 1.07, p = < 0.001, 95 % CI 1.03 – 1.12 1bd) OR = 1.10, p = 0.001, 95 % CI 1.04 – 1.16 2a) PE = −2.59, p = 0.002 2b) OR = 0.93, p = 0.02, 95 % CI 0.88 – 0.99 | 12 (16) |
West et al., 2009 [23] | Relationships between fatigue, distress, and medical errors | yes | 380 internal medicine residents, teaching hospital, USA | Longitudinal cohort study, self-report questionnaire | Well-being: MBIa, fatigue and sleepiness: 2 items Patient safety: medical errors | Generalized estimation equations (GEE) | Higher levels of 1) sleepiness 2) fatigue 3) emotional exhaustion 4) depersonalization and 5) lower levels of personal accomplishment are associated with subsequent medical errors | 1) OR = 1.10, p = 0.002, 95 % CI 1.03 – 1.16 2) OR = 1.14, p < 0.001, 95 % CI 1.08 – 1.21 3) OR = 1.06, p < 0.001, 95 % CI 1.04 – 1.08 4) OR = 1.09, p < 0.001, 95 % CI 1.05 – 1.12 5) OR = 0.94, p < 0.001, 95 % CI 0.92 – 0.97 | 13 (16) |
Wetzel et al., 2010 [115] | Relationships between stress and surgical performance | yes | 30 surgeons, 1 hospital, UK | Cross-sectional self-report questionnaire, observation of simulated operations | Well-being: State-Trait Anxiety Inventory (STAI)a, heart rate, cortisol, oberver rating Patient safety: OTASa, End Product Assessment Rating Scale (EPA) | Linear regression | Non-crisis simulation: No relationship between 1) STAI 2) heart rate 3) cortisol 4) observer stress rating and a) OTAS b) EPA Crisis simulation: 5) no results reported on relationships between the above variables 6) Interaction between low experience and “stress” (not clear how variable was calculated) predicts lower a) EPA and b) OTAS | 1a) NS 1b) NS 2a) NS 2b) NS 3a) NS 3b) NS 4a) NS 4b) NS 5) N/A 6a) β = .54, p < .01 6b) β = .65, p < .001 | 10 (15) |
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) |