A Quality Improvement Initiative to Enhance Nursing Teamwork: An Element of Excellence

Health care is changing at a rapid pace to meet the needs and expectations of consumers across the United States. The desire for improved quality of care while reducing costs has led to increased attention on team composition, relationships, and culture. There is growing evidence to support the importance of quality workplace relationships and teamwork (Brunetto et al., 2013). Research indicates a positive relationship between a culture of teamwork and quality performance measures in the health care setting (Meterko, Mohr, & Young, 2004). Teamwork in the acute inpatient care nursing team deserves more attention (Kalisch, Lee, & Rochman, 2010). Evidence of the impact of nursing teamwork on staff satisfaction, patient satisfaction, inpatient falls, or staff perceptions of nursing teamwork was lacking at the unit level within a large health care system in the Midwest. A dashboard of unit level nursing teamwork variables was created using nursing teamwork survey (NTS) results along with personal job satisfaction and perceptions of teamwork among nursing team members, patient satisfaction, and patient falls. Dashboard results were used to determine if an intervention to enhance nursing teamwork was needed. The project found that a significant relationship between patient falls and nursing teamwork exists. Fifty percent of nursing units evaluated were not meeting the national benchmark for patient falls and could benefit from an intervention to enhance nursing teamwork. Dashboard results will be disseminated to nursing leadership at the large Midwestern health care system to facilitate recommendation of evidence-based teamwork interventions. Five themes emerged during the analysis of perceptions of teamwork collected through interviews with nursing staff and assisted in the creation of a potential evidence-based intervention. Themes were consistent with The Big Five in Teamwork model by Eduardo Salas and colleagues (Kalisch, Lee, & Salas, 2010; Salas, Sims, & Burke, 2005)