title: Variation in caregiver perceptions of teamwork climate in labor and delivery units.
abstract: 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.
  
  
  METHODS
  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 alpha = 0.78). 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA. jsexton2@jhmi.edu
authors.forename: J B
authors.initials: JB
authors.lastname: Sexton
authors.forename: C G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: P J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: E J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: McFerran
authors.forename: J
authors.initials: J
authors.lastname: Nunes
authors.forename: D A
authors.initials: DA
authors.lastname: Thompson
authors.forename: A P
authors.initials: AP
authors.lastname: Knight
authors.forename: D H
authors.initials: DH
authors.lastname: Penning
authors.forename: H E
authors.initials: HE
authors.lastname: Fox
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003299:Cooperative Behavior; D003696:Delivery Rooms; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D015279:Organizational Culture; D011247:Pregnancy; D011594:Psychometrics; D012938:Social Perception