A mixed methods study to evaluate the effects of a teamwork enhancement and quality improvement initiative on nurses' work environment.

AIMS To test the effect of a teamwork enhancement and quality improvement program named 'Nurturing Effective Teams and Continuous Quality Improvement' on nurses' work environments in the hospital setting. DESIGN Mixed method study with quasi-experimental controlled trial and focus group interviews. METHODS Twelve units from two Philippine tertiary government hospitals will be matched and allocated to have 72 nurses receive the teamwork enhancement and quality improvement program, or no intervention. The program focuses on enhancing nurse autonomy, leadership and management support, teamwork and workload management, delivered in two phases: (1) teamwork enhancement training using Team Strategies and Tools to Enhance Performance and Patient Safety; and (2) implementation of quality improvement projects using the Model for Improvement to identify priority unit issues and change ideas and tested using the Plan-Do-Study-Act cycle. The 6-month implementation include two trainings and seven mentoring sessions with a quality improvement facilitator. Primary outcome is the nurses' work environment and secondary outcomes are job satisfaction, burnout risk, turnover intention and perceived quality of care provided measured at the nurse-level using self-administered survey and measured at 0, 3 and 6 months. Focus group interviews will be conducted among 14-16 nurse subjects to explore their experience during the program, while other stakeholders will be interviewed to reflect the program effects. Generalized equation modelling will be used to identify the program effects on the quantitative outcomes and content analysis will be used for qualitative data. DISCUSSION Establishing measures to improve the nurses' work environments can be used to address poor nurse outcomes in high workload and low resource settings. IMPACT A favorable nurse work environment is the cornerstone to sustainable nursing workforce and positive outcomes. This study will provide explicit evidence to inform the effect of a structured evidence-based protocol in improving nurse work environments given resource-limited context.

[1]  E. Lake.  Development of the practice environment scale of the Nursing Work Index. , 2002, Research in nursing & health.

[2]  José Maria Paganni,et al.  Evaluating the quality of medical care. , 1966, The Milbank Memorial Fund quarterly.

[3]  Anne W. Wojner-Alexandrov,et al.  AACN Synergy Model's characteristics of patients: psychometric analyses in a tertiary care health system. , 2007, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[4]  E. Lake.  The Nursing Practice Environment , 2007, Medical care research and review : MCRR.

[5]  Maura MacPhee,et al.  The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes , 2017 .

[6]  Greta G Cummings,et al.  Interventions aimed at improving the nursing work environment: a systematic review , 2010, Implementation science : IS.

[7]  Matthew D. McHugh,et al.  Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care , 2016, BMJ Quality & Safety.

[8]  Anneke L Francke,et al.  How nurses and their work environment affect patient experiences of the quality of care: a qualitative study , 2014, BMC Health Services Research.

[9]  Mihyun Park,et al.  An ethical leadership program for nursing unit managers. , 2018, Nurse education today.

[10]  Matthew D. McHugh,et al.  Wage, Work Environment, and Staffing: Effects on Nurse Outcomes , 2014, Policy, politics & nursing practice.

[11]  D. P. Baker,et al.  Reducing medical error in the Military Health System: How can team training help? , 2006 .

[12]  K. Kim,et al.  Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea. , 2018, Asian nursing research.

[13]  A. Donabedian,et al.  The quality of care. How can it be assessed? , 1988, JAMA.

[14]  A bi‐cultural analysis of the cost of caring: nursing burnout in the United States and the Philippines , 1997 .

[15]  A. O’Cathain,et al.  Process evaluation of complex interventions: Medical Research Council guidance , 2015, BMJ : British Medical Journal.

[16]  Courtney R Lyles,et al.  Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research. , 2018, Annual review of public health.

[17]  J. Castner,et al.  Strengthening communication to overcome lateral violence. , 2012, Journal of nursing management.

[18]  Peter Griffiths,et al.  Patient satisfaction with hospital care and nurses in England: an observational study , 2018, BMJ Open.

[19]  Holly Wei,et al.  The state of the science of nurse work environments in the United States: A systematic review , 2018, International journal of nursing sciences.

[20]  L. Aiken,et al.  Transformative impact of Magnet designation: England case study. , 2008, Journal of clinical nursing.

[21]  Torsten B Neilands,et al.  The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research , 2006, BMC Health Services Research.

[22]  D. Twigg,et al.  Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. , 2014, International journal of nursing studies.

[23]  Jun Ma,et al.  School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial , 2015, BMJ : British Medical Journal.

[24]  Matthew D. McHugh,et al.  Better Nurse Autonomy Decreases the Odds of 30‐Day Mortality and Failure to Rescue , 2017, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[25]  Jody Hoffer Gittell,et al.  Teamwork methods for accountable care: relational coordination and TeamSTEPPS®. , 2015, Health care management review.

[26]  Yasuko Ogata,et al.  Reliability and validity of the practice environment scale of the nursing work index for Japanese hospital nurses , 2018, Nursing open.

[27]  P. Van Bogaert,et al.  The Productive Ward Program™ , 2017, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[28]  Marla J. Weston.  Strategies for Enhancing Autonomy and Control Over Nursing Practice , 2010, OJIN: The Online Journal of Issues in Nursing.

[29]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[30]  Marieke J Schuurmans,et al.  Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature. , 2015, International journal of nursing studies.