Sexton J Bryan, Makary Martin A, Tersigni Anthony R, Pryor David, Hendrich Ann, Thomas Eric J, Holzmueller Christine G, Knight Andrew P, Wu Yun, Pronovost Peter J
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.
Anesthesiology. 2006 Nov;105(5):877-84. doi: 10.1097/00000542-200611000-00006.
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.
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).
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).
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.
医疗组织认证联合委员会提议医院从2007年开始对文化进行评估。然而，目前尚无一种可靠且广泛应用于手术室环境的测量工具。
采用安全态度调查问卷对美国60家医院的手术室人员进行了调查。该调查的团队合作氛围领域使用了六个项目，涉及发言困难、冲突解决、医护协作、他人支持感、提问以及重视护士意见。为了证明将每个医院手术室层面的个体水平反应归为单一分数的合理性，作者使用了多层次验证性因素分析、组内相关系数、组内评分者间信度以及克朗巴哈系数。为了检测医院手术室层面和护理人员类型之间的差异，作者使用了多变量方差分析（项目）和方差分析（量表）。
回复率为77.1%。有充分证据表明，通过使用多种统计检验，如比较拟合指数=0.99、近似均方根误差=0.05，以及可接受的组内相关系数、组内评分者间信度值和克朗巴哈系数=0.79，能够将个体水平的受访者归为医院手术室层面。团队合作氛围在不同医院之间（F59, 1,911 = 4.06，P < 0.001）以及手术室护理人员类型之间（F4, 1,911 = 9.96，P < 0.001）存在显著差异。
使用这种心理测量学上合理的团队合作氛围量表，可以对团队合作氛围进行严格评估。该工具和初始基准使其他机构能够将其团队合作氛围与全国平均水平进行比较，以便更多地关注优秀手术团队的优势所在。
