title: Hospital ethical climate and teamwork in acute care: the moderating role of leaders.
abstract: BACKGROUND
  Health care delivery teams have received much attention in recent years from researchers and practitioners. Recent empirical research has demonstrated that objective and subjective outcomes tend to be improved when care teams function smoothly and efficiently. However, little is known about how the work environment, or care context, influences team processes that lead to better outcomes.
  
  
  OBJECTIVE
  The purposes of this study were to explore acute care staff's perceptions of how two components of the work environment, the ethical climate and continuous quality improvement leadership, influence teamwork and to begin to identify actionable approaches for improving teamwork. Although ethical climate influences have been studied in several sectors, research is lacking in health care.
  
  
  METHODS
  A cross-sectional field study explored how the ethical climate impacted teamwork in an acute care setting and how continuous quality improvement leadership behaviors moderated the relationship between the ethical climate and teamwork.
  
  
  RESULTS
  Results indicated that clinicians who perceived the ethical climate to be benevolent were significantly more likely to say that teamwork was better. Furthermore, we found that continuous quality improvement leadership styles moderated the relationship between the ethical climate and teamwork.
  
  
  CONCLUSIONS
  Although a benevolent ethical climate appears to be associated with effective teamwork, it appears that the proximate continuous quality improvement behaviors exhibited by leaders have a significant impact as well, above and beyond the climate. Implications for research and practice are discussed.
authors.affiliation: Health Services Management, Center for Health Ethics, Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, USA. RathertC@health.missouri.edu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rathert
authors.forename: David A
authors.initials: DA
authors.lastname: Fleming
mesh_terms: D001291:Attitude of Health Personnel; D026686:Beneficence; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics; D017598:Efficiency, Organizational; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008505:Medical Staff, Hospital / Q000941:ethics / Q000523:psychology*; D009014:Morals; D009741:Nursing Staff, Hospital / Q000941:ethics / Q000523:psychology*; D015279:Organizational Culture; D010348:Patient Care Team / Q000941:ethics* / Q000592:standards; D017749:Total Quality Management; D014481:United States; D017132:Workplace / Q000523:psychology / Q000592:standards