Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, PO Box 92019, Auckland, 1142 New Zealand.
BMJ Qual Saf. 2011 Mar;20(3):216-22. doi: 10.1136/bmjqs.2010.041913. Epub 2011 Jan 5.
Teamwork failures contribute to adverse events causing harm to patients. Establishing and maintaining a team and managing the tasks are active processes. Medical education largely ignores teamwork skills. However, lack of robust instruments to measure teamwork limits evaluation of interventions to improve it. The authors aimed to develop and validate an instrument to measure teamwork behaviours.
From existing literature, the authors developed an instrument, gaining rater consensus that the final 23 items were comprehensive, comprehensible and observable. Data on the instrument were obtained from three expert raters who scored videotaped simulations of 40 critical care teams (one doctor, three nurses) participating in four simulated emergencies. Exploratory Factor Analysis, Generalisability Analysis and rater interviews on assessor performance provided information on the properties of the instrument.
Exploratory Factor Analysis found items clustered into three factors: Leadership and Team Coordination; Mutual Performance Monitoring; and Verbalising Situational Information. Internal consistencies (Cronbach's α) for these factors were 0.917, 0.915 and 0.893, respectively. The Generalisability coefficient for overall team behaviour was 0.78 and the G coefficients for the three factors were 0.85, 0.4 and 0.37, respectively. Variance Components and interview data provided insight into individual item performance. Significantly improved performance with time and seniority supported construct validity.
The instrument performed well as an overall measure of team behaviour and reflected three dimensions of teamwork. Triangulation of information on the instrument, the factors and individual items will allow a methodical and informed approach to further development of the instrument. The ultimate goal is an instrument that can robustly evaluate interventions to improve team function in healthcare.
团队合作失败会导致对患者造成伤害的不良事件。建立和维持团队以及管理任务是积极的过程。医学教育在很大程度上忽略了团队合作技能。然而，缺乏强大的工具来衡量团队合作限制了对改善团队合作的干预措施的评估。作者旨在开发和验证一种用于衡量团队合作行为的工具。
从现有文献中，作者开发了一种工具，并获得了评分者的共识，即最后 23 个项目是全面的、可理解的和可观察的。该工具的数据来自三名专家评分者，他们对参与四个模拟紧急情况的 40 个重症监护团队（一名医生，三名护士）的视频模拟进行了评分。探索性因素分析、可概括性分析和评分者对评估者绩效的访谈提供了有关工具特性的信息。
探索性因素分析发现项目聚类为三个因素：领导力和团队协调；相互绩效监测；和情境信息的口头表达。这些因素的内部一致性（Cronbach's α）分别为 0.917、0.915 和 0.893。总体团队行为的可概括性系数为 0.78，三个因素的 G 系数分别为 0.85、0.4 和 0.37。方差分量和访谈数据提供了对个别项目表现的深入了解。随着时间和资历的推移，绩效显著提高支持了结构有效性。
该工具作为团队行为的整体衡量标准表现良好，反映了团队合作的三个维度。该工具、因素和个别项目的信息三角化将允许对工具的进一步发展采用系统和知情的方法。最终目标是开发一种能够稳健评估改善医疗保健团队功能的干预措施的工具。
