Communication failure is a leading cause of error and is often due to inhibition of individuals to speak up in interprofessional healthcare environments. The present study sought to evaluate the impact of a multifaceted intervention designed to promote speaking up on teamwork climate in one clinical department of a large community hospital based in Canada. The multifaceted intervention included a role-playing simulation workshop, teamwork climate data feedback and facilitated discussion with the interprofessional team (discussion briefings), and other department-led initiatives to promote trust, teamwork, and speaking up among interprofessional team members. A quasi-experiment (pretest-posttest control group design, using two posttests several months apart) was used to evaluate the impact of the complete intervention on individual teamwork climate perceptions. The intervention was implemented with an intact interprofessional team (the Emergency Department-ED) in 2014. The intensive care unit (ICU) was used as the control unit. Survey response rates were the highest at time 1 (83/102 = 81% for the ED and 29/31 = 94% for the ICU) and the lowest at time 3 (38/105 = 36% for the ED and 14/30 = 47% for the ICU). The results obtained from paired and unpaired analyses suggest that this type of multifaceted approach can improve staff perceptions of teamwork climate. The teamwork climate score in the ED was significantly higher at follow-up (Mt2 = 3.42, SD = 0.66) compared to baseline (Mt1 = 3.13, SD = 0.72), (F(1, 34) = 12.2, p = .001, etap = .263), while baseline and follow-up scores were not significantly different between baseline and follow-up for the ICU group (Mt1 = 4.12, SD = 0.60; Mt2 = 4.15, SD = 0.56; F(1, 34) = 0.06, p = .806, etap = .002). Sustaining high levels of participation in interprofessional initiatives and engaging physicians remain challenging when interventions are used in context. Improving team communication is a broad and challenging area that continues to require attention.

Background This study contributes to a small but growing body of literature on how context influences employee turnover intention. We examine the impact of staff perceptions of supervisory leadership support for safety, teamwork, and mindful organizing on turnover intention. Interaction effects of safety-specific constructs on turnover intention are also examined. Methods Cross-sectional survey data were collected from nurses, allied health professionals, and unit clerks working in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of teamwork were significantly associated with turnover intention ( p < 0.001). Direct associations of supervisory leadership support for safety and mindful organizing with turnover intention were non-significant; however, when staff perceived lower levels of mindful organizing at the frontlines, the positive effect of supervisory leadership on turnover intention was significant ( p < 0.01). Conclusions Our results suggest that, in addition to teamwork perceptions positively affecting turnover intentions, safety-conscious supportive supervisors can help alleviate the negative impact of poor mindful organizing on frontline staff turnover intention. Healthcare organizations should recruit and retain individuals in supervisory roles who prioritize safety and possess adequate relational competencies. They should further dedicate resources to build and strengthen the relational capacities of their supervisory leadership. Moreover, it is important to provide on-site workshops on topics (e.g., conflict management) that can improve the quality of teamwork and consequently reduce employees’ intention to leave their unit/organization. Electronic supplementary material The online version of this article (10.1186/s12960-019-0404-2) contains supplementary material, which is available to authorized users.

This paper examines the clinical utility of the Hospital Anxiety and Depression Scale (HADS) in the context of evaluating the Fibromyalgia Outpatient Education Program at Southlake Regional Health Centre (Newmarket, Canada). A pre-test/post-test design was implemented for data analysis. A total of 232 patients' data were obtained through retrospective patient chart review. Complete pre-post data were available for 70 patients and qualitative analysis was done for 12 patients. Main outcome measures included HADS and Arthritis Self-Efficacy (ASE) scores. At the end of the education program, subgroups of patients (high attendance, high exercise habit, low medication) experienced significant improvement on HADS-depression and ASE scores. Linear regression analysis found that HADS pre-program scores explain far more variance in HADS post-test scores than ASE pre-program scores explain in ASE post-program scores; more variance in ASE post-program scores was explained by other variables. In contrast to the quantitative analysis of the Anxiety subscale of HADS, patients in the focus group indicated that their anxiety level decreased through attending the education program. These findings suggest that HADS is an appropriate tool for evaluating fibromyalgia and related patient education programs. Moreover, patient education programs have positive effects on enhancing patients' psychological well-being and self-confidence in controlling fibromyalgia-related symptoms.

BackgroundThere is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain—for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety.PurposeThe impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario.MethodsCross-sectional survey data were collected from nurses, allied health professionals and unit clerks working on intensive care, general medicine, mental health or emergency department.ResultsHierarchical regression analyses showed that perceptions of senior leadership (p<0.001) and teamwork (p<0.001) were significantly associated with overall perceptions of PS. A non-significant association was found between perceptions of supervisory leadership and the outcome variable. However, when staff perceived poorer senior leadership support for safety, the positive effect of supervisory leadership on overall perceptions of PS became significantly stronger (p<0.05).Practice implicationsOur results suggest that leadership support at one level (ie, supervisory) can substitute for the absence of leadership support for safety at another level (ie, senior level). While healthcare organisations should recruit into leadership roles and retain individuals who prioritise safety and possess adequate relational competencies, the field would now benefit from evidence regarding how to build leadership support for PS. Also, it is important to provide on-site workshops on topics (eg, conflict management) that can strengthen working relationships across professional and unit boundaries.