Variation in caregiver perceptions of teamwork climate in labor and delivery units

Objective: To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data. Design: Cross-sectional survey of labor and delivery caregivers in 44 hospitals in diverse regions of the US, using the Safety Attitudes Questionnaire teamwork climate scale. Results: The response rate was 72% (3382 of 4700). The teamwork climate scale had good internal reliability (overall α0.78). Teamwork climate scale factor structure was confirmed using multilevel confirmatory factor analyses (CFI=0.95, TLI=0.92, RMSEA=0.12, SRMR_within=0.04, SRMR_between=0.09). Aggregation of individual-level responses to the L&D unit-level was supported by ICC (1)=0.06 (P<0.001), ICC (2)=0.83 and mean r_wg(j)=0.83. ANOVA demonstrated differences between caregivers F (7, 3013)=10.30, P<0.001 and labor and delivery units, F (43, 1022)=3.49, P<0.001. Convergent validity of the scale scores was measured by correlations with external teamwork-related items: collaborative decision making (r=0.780, P<0.001), use of briefings (r=0.496, P<0.001) and perceived adequacy of staffing levels (r=0.593, P<0.001). Conclusion: We demonstrate a psychometrically sound teamwork climate scale, correlate it to external teamwork-related items, and provide labor and delivery teamwork benchmarks. Further teamwork climate research should explore the links to clinical and operational outcomes.