The evaluation of a multifaceted intervention to promote “speaking up” and strengthen interprofessional teamwork climate perceptions

Abstract

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.

A systematic review exploring the content and outcomes of interventions to improve psychological safety, speaking up and voice behaviour

“…Ginsburg and Bain [38] used simulation as part of their multifaceted intervention to promote speaking up behaviour and teamwork in an emergency department (ED). This intervention took place within the context of the hospital's new Accountability Framework, which holds staff accountable to speak up in the face of unsafe or unprofessional behaviour.…”

“…2, mixed results were found for the impact of the interventions on outcomes related to psychological safety, speaking up and voice. Five studies [38,39,41,43,44] reported improved and three studies [35,40,43] found mixed results for "questioning, challenging, reporting or speaking up". One further study [36] found no significant relationship.…”

“…Three studies [39,46,47] reported improved and one study [48] found mixed results for "communication and collaboration" following interventions. Five studies [38,40,42,44,45] reported positive evaluations by participants postinterventions. Three studies had "Psychological safety" as an outcome, with one of these reporting mixed results for the impact of the intervention on psychological safety [48] and the other two reporting improvement [37,47].…”

“…The limitations associated with educational interventions may explain the mixed outcomes from studies in this review. Some educational studies suggested that there would have been more improvement if interventions had been conducted over a longer period of time [38,41] and O'Leary [48] highlights how having core team members who are meeting regularly supported the development of psychological safety. These findings suggest that educational interventions may benefit from more regular, longitudinal and multifaceted interventions for improving psychological safety, speaking up and voice.…”

“…In line with this, key stakeholders and leaders were involved in many of the studies reviewed here, either as a participant in the study or in facilitating the interventions. Leaders were involved in interventions through their behaviour facilitating psychological safety [37,48] or through showing their support and commitment to the intervention [38,40,41,47]. Since the search for this systematic review was conducted, a case study intervention focused on understanding voice and improving the response to disruptive behaviours has been published by Dixon-Woods et al Leaders played a key role within this case study by becoming more open and willing to listen and to take staff concerns on board and by completing training in skills for encouraging voice and having difficult conversations.…”