title: Quality management and perceptions of teamwork and safety climate in European hospitals.
abstract: OBJECTIVE
  This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians.
  
  
  METHODS
  We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods.
  
  
  METHODS
  Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians.
  
  
  METHODS
  Perceived teamwork and safety climate.
  
  
  RESULTS
  Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate.
  
  
  CONCLUSIONS
  Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.
authors.affiliation: Central Denmark Region and Department of Clinical Medicine, Danish Clinical Registries, Aalborg University, Aalborg, Denmark.
authors.forename: Solvejg
authors.initials: S
authors.lastname: Kristensen
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne, Köln, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Hammer
authors.affiliation: Danish Clinical Registries, Central Denmark Region and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Paul
authors.initials: P
authors.lastname: Bartels
authors.affiliation: Avedis Donabedian University Institute, Universitat Atonoma de Barcelona, Red de Investigación en Servicios de Salud en Enfermedadescrónicas (REDISSEC), Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Suñol
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Groene
authors.affiliation: Department of Epidemiology, Palo Alto Medical Foundation Research Institute, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Polish Society for Quality Promotion in Health Care, Kraków, Poland.
authors.forename: Halina
authors.initials: H
authors.lastname: Kutaj-Wasikowska
authors.affiliation: Quality and Patient Safety Department, University Hospital of Lyon, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
authors.affiliation: Netherlands Institute for Health Services Research, Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D015279:Organizational Culture; D011786:Quality Control; D017751:Safety Management; D011795:Surveys and Questionnaires
keywords: clinical quality activities; human factors; patient safety; quality management systems; safety climate; teamwork climate