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Obstetrics Practice Survey: Perceived Barriers to Collaborative Inter-Professional Care
Abstract Number: S-41
Abstract Type: Original Research
Introduction: Collaborative inter-professional (IP) practice is a necessary component of safe clinical care on a high-volume, high-risk obstetric (OB) unit.(1) We analyzed safety & teamwork climate survey results (incl. qualitative data) to identify perceived barriers to teamwork among 4 major IP groups, as a first step to identifying opportunities to improve IP practice on a busy OB unit.
Methods: Providers (faculty, staff, resident trainees) in 4 disciplines (OB, nursing, anesthesiology, midwifery) on an inpatient OB unit were contacted by e-mail, and asked to complete an anonymous survey (14 open-ended questions, 40 agreement statements, demographic data) evaluating perceptions of teamwork & safety (incl. subset of Safety Attitude Questionnaire).(2) Data were analyzed after the 4-week survey period concluded. All three investigators coded answers independently, negotiated differences, and identified dominant themes. Analysis was facilitated by qualitative data management software (NVivo9, QRS Internat’l Pty Ltd). This analysis is limited to one question: “Describe at least one factor you think has prevented you from collaborating effectively with others.”
Results: Response rate was 122/254 (52%), including 21 partially completed surveys. Dominant themes are presented (see table), & include interpersonal / communication issues (verbal, written, attitude/behaviors), systems issues (work load; staff availability; physical layout; process/complexity, various communication delays), and cultural/social issues (power relationships/hierarchy, disregard for input, role confusion).
Conclusions: Analysis of rich textual data provided insight into perspectives of front-line providers in a complex practice setting, a labor & delivery unit. While many findings were not surprising, detailed description & examples help provide deeper understanding of the true nature of barriers, and shed light on potential solutions.(3) The anonymous nature of this survey may have encouraged identification & description of barriers not otherwise voiced—e.g. disregard of input, clinical priority conflicts, disrespect, harmful power relationship effects, role confusion. The results all suggest potential opportunities for improving collaboration among team members, and will serve to inform improvement initiative planning.
Ref: 1) Manser T. Acta Anaesthesiol Scand 2009;53:143-51; 2) Sexton JB, et al. BMC Health Serv Res 2006;6:44; 3) O’Leary KJ, et al. Qual Saf Health Care 2010;19:117-21