The evaluation of a multifaceted intervention to promote "speaking up" and strengthen interprofessional teamwork climate perceptions

Communication failure is a leading cause of error and is often due to inhibition of individuals to speak up in interprofessional healthcare environments. The present study sought to evaluate the impact of a multifaceted intervention designed to promote speaking up on teamwork climate in one clinical department of a large community hospital based in Canada. The multifaceted intervention included a role-playing simulation workshop, teamwork climate data feedback and facilitated discussion with the interprofessional team (discussion briefings), and other department-led initiatives to promote trust, teamwork, and speaking up among interprofessional team members. A quasi-experiment (pretest-posttest control group design, using two posttests several months apart) was used to evaluate the impact of the complete intervention on individual teamwork climate perceptions. The intervention was implemented with an intact interprofessional team (the Emergency DepartmentED) in 2014. The intensive care unit (ICU) was used as the control unit. Survey response rates were the highest at time 1 (83/102=81% for the ED and 29/31=94% for the ICU) and the lowest at time 3 (38/105=36% for the ED and 14/30=47% for the ICU). The results obtained from paired and unpaired analyses suggest that this type of multifaceted approach can improve staff perceptions of teamwork climate. The teamwork climate score in the ED was significantly higher at follow-up (Mt2=3.42, SD=0.66) compared to baseline (Mt1=3.13, SD=0.72), (F(1,34)=12.2, p=.001, eta(2)p=.263), while baseline and follow-up scores were not significantly different between baseline and follow-up for the ICU group (Mt1=4.12, SD=0.60; Mt2=4.15, SD=0.56; F(1, 34)=0.06, p=.806, eta(2)p=.002). Sustaining high levels of participation in interprofessional initiatives and engaging physicians remain challenging when interventions are used in context. Improving team communication is a broad and challenging area that continues to require attention.