title: Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.
abstract: BACKGROUND
  The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist.
  
  
  METHODS
  OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale).
  
  
  RESULTS
  The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P < 0.001) and OR caregiver type (F4, 1,911 = 9.96, P < 0.001).
  
  
  CONCLUSIONS
  Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.
authors.affiliation: The Johns Hopkins University, Department of Anesthesiology and Critical Care Medicine, and Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Tersigni
authors.forename: David
authors.initials: D
authors.lastname: Pryor
authors.forename: Ann
authors.initials: A
authors.lastname: Hendrich
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Christine G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Knight
authors.forename: Yun
authors.initials: Y
authors.lastname: Wu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D000776:Anesthesiology; D001290:Attitude; D003299:Cooperative Behavior; D006801:Humans; D015999:Multivariate Analysis; D009873:Operating Rooms; D010348:Patient Care Team; D010564:Personnel, Hospital; D012449:Safety; D011795:Surveys and Questionnaires; D014481:United States