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Teamwork in acute patient care: How team processes and clinicians’ perceptions of teamwork affect patient safety

English title Teamwork in acute patient care: How team processes and clinicians’ perceptions of teamwork affect patient safety
Applicant Manser Tanja
Number 128616
Funding scheme SNSF Professorships
Research institution Département de Psychologie Université de Fribourg
Institution of higher education University of Fribourg - FR
Main discipline Psychology
Start/End 01.12.2010 - 30.09.2015
Approved amount 1'490'195.00
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Keywords (14)

teamwork; team performance; group process analysis; adaptive coordination; clinician well-being; safety; human factors; clinical performance; team climate; acute patient care teams; patient safety; coordination; well-being; human performance

Lay Summary (English)

Lead
Lay summary
Recent research shows that the challenges to patient safety are mostly organisational not just clinical. Based on systematic incident analyses in healthcare, teamwork has been identified as a key area of patient safety interventions with human factors research - such as this research programme - being integral to achieving this goal.Research in high-risk industries such as aviation shows that a performance critical feature of effective teamwork is coordination and that high performing teams adapt their coordination patterns to changing task requirements (e.g. in case of emergencies). Recent studies in acute care settings provide first empirical evidence on coordination behaviours that help to maintain good clinical performance in the management of a non-routine or critical event. For surgery, however, no empirical investigation of characteristics of coordination processes has been conducted. In order to improve the teamwork of the overall operating room team, measures to assess adaptive coordination in the anaesthesia and surgical sub-crew need to be developed and then used in concert for future research and training development.The first two projects of this research programme aim at identifying coordination processes that support high clinical performance. The first project builds on our previous findings on adaptive coordination in anaesthesia crews and will use a series of simulation-based studies to systematically investigate team and task characteristics that might influence the effects of these coordination mechanisms on team performance in anaesthesia crews. The second project will investigate adaptive coordination in surgical crews using a combination of interviews, observations and surgical simulations. Both projects will help to identify performance critical aspects of coordination and feed into in medical education and training.The third project focuses on aspects of organizational climate such as clinicians' perceptions of teamwork that form the foundation on which team processes are enacted. Although clinicians' perceptions of teamwork have been shown to be associated with clinician well-being and with patient safety, the potentially complex interrelations of these concepts have not yet been investigated systematically. The results of this project will advance our understanding of the impact of psychological concepts such as team climate on clinician well-being and patient safety. This will feed into practical recommendations for management approaches that consider staff well-being and patient safety as synergistic outcomes.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Adaptive coordination in surgical teams: an interview study
2. Bogdanovic J. Perry J. Guggenheim M. & Manser T. (2015), Adaptive coordination in surgical teams: an interview study, in BMC Health Services Research, 15(128), 1-12.
Effective coordination in medical emergency teams: The moderating role of task type
Schmutz J. Hoffmann F. Heimberg E. & Manser T. (2015), Effective coordination in medical emergency teams: The moderating role of task type, in European Journal of Work and Organizational Psychology,, 24(5), 1-16.
Structured performance assessment in three pediatric emergency scenarios: a validation study
Schmutz J. Manser T. Keil J. Heimberg E. & Hoffmann F. (2015), Structured performance assessment in three pediatric emergency scenarios: a validation study, in The Journal of Pediatrics, 166, 1329-1332.
Teamwork in healthcare organizations
Schmutz J. Welp A. & Kolbe M. (2015), Teamwork in healthcare organizations, in Örtenblad A. & Abrahamson Löfström C. & Sheaff R. (ed.), Routledge, London, 359-377.
Assessment of non-technical skills in the operating room – one assessment tool per specialty?
Wisborg Torben, Manser Tanja (2014), Assessment of non-technical skills in the operating room – one assessment tool per specialty?, in Acta Anaesthesiologica Scandinavica, 58, 773-774.
Five Steps to Develop Clinical Performance Checklists: A Systematic Approach
Schutz Jan, Eppich W. J., Hoffmann F., Heimberg E., Manser T. (2014), Five Steps to Develop Clinical Performance Checklists: A Systematic Approach, in Academic Medicine, 89(7), 996.
Satisfaction among Chairs of Surgery from Europe and North America
Tschuor C., Raptis D. A., Morf M., Staffelbach B., Manser T., Clavien P.-A. (2014), Satisfaction among Chairs of Surgery from Europe and North America, in Surgery, 156(5), 1069-1077.
Zwischen Standardisierung und ärztlicher Kunst: Führt ein dritter Weg zu mehr Sicherheit?
Manser. T. (2014), Zwischen Standardisierung und ärztlicher Kunst: Führt ein dritter Weg zu mehr Sicherheit?, in Vollmer A., Manser T., Dick M., Clases C. (ed.), Papst, Lengerich, 309-318.
Do team processes really have an effect on clinical performance? A systematic literature review
Schmutz Jan, Manser Tanja (2013), Do team processes really have an effect on clinical performance? A systematic literature review, in British Journal of Anaesthesia, 110(4), 529-544.
Teamwork and collaboration
Xiao Y., Henrickson Parker S., Manser T. (2013), Teamwork and collaboration, in Reviews of Human Factors and Ergonomics, 8(1), 55-102.
Strengths and Weaknesses of Specific Interview Methods and Qualitative Data Analysis Strategies in Identifying Team Performance Requirements
Manser Tanja, Mitchell Lucy (2012), Strengths and Weaknesses of Specific Interview Methods and Qualitative Data Analysis Strategies in Identifying Team Performance Requirements, in Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2012 , Boston.
Verhalten ist messbar: Behavioural Marker Systeme und Kompetenzentwicklung
Manser Tanja, Perry Juliana, Schmutz Jan (2012), Verhalten ist messbar: Behavioural Marker Systeme und Kompetenzentwicklung, in M. St. Pierre & G. Breuer (ed.), Springer, Heidelberg, 169-182.
Emotional exhaustion and workload predict clinician-rated and objective patient safety
Welp Annalena, Meier Laurenz, Manser Tanja, Emotional exhaustion and workload predict clinician-rated and objective patient safety, in Frontiers in Psychology.
Studying patient safety and quality from different methodological angles and perspectives
Wiig Siri, Manser Tanja, Studying patient safety and quality from different methodological angles and perspectives, in Aase Karina (ed.), Ashgate, Aldershot.
Teambuilding
Manser Tanja, Teambuilding, in Flaatten Hans, Valentin A., Guidet B. (ed.), Cambridge University Press, Cambridge.

Collaboration

Group / person Country
Types of collaboration
Schweizer Gesellschaft für Intensivmedizin SGI Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
University of Sydney Australia (Oceania)
- Exchange of personnel
Clinical Safety Research Unit, Imperial College London (Dr. Nick Sevdalis) Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Klinik für Plastische Chirurgie und Handchirirurgie (Prof. Giovanoli), Universitätsspital Zürich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
PAEDSIM e.V. Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
InSiM: das Interdisziplinäre Symposium zur Simulation in der Medizin Talk given at a conference Wie kommt die Forschung zurück ins Training? 15.10.2015 Munich, Germany Manser Tanja;
BSAS – 9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Poster Adaptive coordination in surgical teams in response to case complexity: an observational study 09.10.2015 Bonn, Germany Bogdanovic Jasmina; Pasarakonda Surabhi; Bogdanovic Jasmina; Manser Tanja; Schmutz Jan;
BSAS – 9th International Meeting on Behavioural Sciences Applied to Surgery and Acute Care Settings Talk given at a conference Teamwork is the connecting factor between clinician burnout and patient safety – a longitudinal study 09.10.2015 Bonn, Germany Manser Tanja; Welp Annalena;
Research seminar Individual talk Am I safe here as a patient? 24.09.2015 Fribourg, Switzerland Manser Tanja; Welp Annalena;
14th Congress of the Swiss Psychological Society Poster Influence of team size on coordination and performance in medical emergency teams 07.09.2015 Geneva, Switzerland Manser Tanja; Schmutz Jan;
9. Fachgruppentagung Arbeits-, Organisations- und Wirtschaftspsychologie Talk given at a conference Zu viele Köche verderben den Brei: Der Effekt von Teamgrösse auf Koordination und klinische Leistung in medizinischen Notfallteams 01.09.2015 Mainz, Germany Manser Tanja; Schmutz Jan;
6th International Conference on Applied Human Factors and Ergonomics Talk given at a conference Integrating teamwork, clinician well-being, and patient safety 26.07.2015 Las Vegas, United States of America Manser Tanja; Welp Annalena;
6th International Conference on Applied Human Factors and Ergonomics Talk given at a conference Too many cooks spoil the broth: Influence of team size on coordination and clinical performance in emergency teams 26.07.2015 Las Vegas, United States of America Schmutz Jan; Manser Tanja;
INGroup Conference 10th annual meeting Individual talk Too many cooks spoil the broth: Influence of team size on coordination and clinical performance in pediatric emergency teams 01.07.2015 Pittsburgh, United States of America Schmutz Jan; Manser Tanja;
17th Conference of the European Association of Work and Organizational Psychology Talk given at a conference Relationships between teamwork, clinician burnout and patient safety – a longitudinal study 20.05.2015 Oslo, Norway Welp Annalena; Manser Tanja;
Annual Meeting of the Swiss Society for Intensive Care Medicine Talk given at a conference Differences in teamwork, clinician well-being and patient safety in Swiss intensive care units 29.10.2014 Interlaken, Switzerland Welp Annalena; Manser Tanja;
31st Conference of the International Society for Quality in Health Care Poster Relationships between burnout, individual and unit factors, and patient safety in intensive care 05.10.2014 Rio de Janeiro, Brazil Welp Annalena; Manser Tanja;
3rd Nordic Conference on Research in Patient Safety and Quality in Healthcare Talk given at a conference Methodological challenges in patient safety research 02.10.2014 Stavanger, Norway Manser Tanja;
International Commission of Occupational Health - Work and Psychosocial Factors Talk given at a conference Teamwork in health care and patient safety: the mediating role of clinician burnout 17.09.2014 Adelaide, Australia Welp Annalena; Manser Tanja;
28th Conference of the European Health Psychology Society Talk given at a conference Teamwork in health care: relationships with work stress and patient safety 26.08.2014 Innsbruck, Austria Manser Tanja; Welp Annalena;
European Academy of Occupational Health Psychology conference Poster Identifiying different coordination requirements in medical teams using a hierarchical task analysis 31.07.2014 London, Great Britain and Northern Ireland Schmutz Jan; Manser Tanja;
6e Congrès Santé dans le Monde du Travail Talk given at a conference Patientensicherheit & Arbeitsstress: Zusammenhänge mit Teamarbeit auf Schweizer Intensivstationen 20.06.2014 Lausanne, Switzerland Welp Annalena; Manser Tanja;
Well-med –1st International meeting on wellbeing and performance in clinical practice Talk given at a conference Relationships between teamwork, clinician well-being and patient safety – what and who is the “team”? 28.05.2014 Alexandropoulis, Greece Welp Annalena; Manser Tanja;
131. Kongress der Deutschen Gesellschaft für Chirurgie Talk given at a conference Was leistet die Versorgungs-forschung für mehr Patientensicherheit in der Praxis? 25.03.2014 Berlin, Germany Manser Tanja;
Human Factors and Ergonomics Society, Symposium on Human Factors and Ergonomics in Health Care Poster Adaptive coordination in surgical teams: an interview study 16.03.2014 Chicago, United States of America Perry Juliana; Manser Tanja; Bogdanovic Jasmina;
Human Factors and Ergonomics Society, Symposium on Human Factors and Ergonomics in Health Care Poster What Needs To Be Coordinated, When, and By Whom? A Hierarchical Task Analysis for Clinical Teams 16.03.2014 Chicago, United States of America Schmutz Jan; Manser Tanja;
Human Factors and Ergonomics Society, Symposium on Human Factors and Ergonomics in Health Care Poster Teamwork, clinician well-being and patient safety – a call for an integrative approach 16.03.2014 Chicago, United States of America Welp Annalena; Manser Tanja;
Human Factors and Ergonomics Society, Symposium on Human Factors and Ergonomics in Health Care Poster The Interdependency of Team Coordination, Team Experience, and Performance in Medical Teams 16.03.2014 Chicago, United States of America Schmutz Jan; Manser Tanja;
Human Factors and Ergonomics Society, Symposium on Human Factors and Ergonomics in Health Care Poster Development of an observation system for coordination processes in surgical teams 16.03.2014 Chicago, United States of America Bogdanovic Jasmina; Clack Lauren Catherine; Manser Tanja;
The International Meeting for Simulation in Healthcare Talk given at a conference Investigating adaptive coordination across clinical settings 26.01.2014 San Francisco, United States of America Manser Tanja; Schmutz Jan;
The International Meeting for Simulation in Healthcare Poster Effective Teamwork in Pediatric Emergency Care: The Moderating Role of Team and Leader Experience 25.01.2014 San Francisco, United States of America Manser Tanja; Schmutz Jan;
The International Meeting for Simulation in Healthcare Poster Five Steps to Develop Checklists for Evaluating Clinical Performance: An Integrative Approach 25.01.2014 San Francisco, United States of America Schmutz Jan; Manser Tanja;
7th International meeting on Behavioural Science Applied to Surgery and Acute Care Settings Poster Development of an observation system for coordination processes in surgical teams 18.10.2013 Stockholm, Sweden Manser Tanja; Clack Lauren Catherine; Bogdanovic Jasmina;
6th Seminar on Positive Occupational Health Psychology Talk given at a conference Teamwork, clinician well-being and patient safety - development & test of an integrative framework 12.09.2013 Leuwen, Belgium Welp Annalena; Manser Tanja;
2nd World Congress of Clinical Safety Talk given at a conference The Influence of Team Experience on Teamwork and Performance in Emergency Care 12.09.2013 Heidelberg, Germany Manser Tanja; Schmutz Jan;
2nd World Congress of Clinical Safety Talk given at a conference A Systematic Approach to Develop Clinical Performance Checklists 12.09.2013 Heidelberg, Germany Manser Tanja; Schmutz Jan;
19th Annual Meeting of the Society in Europe for Simulation Applied to Medicine (SESAM) Talk given at a conference Effective teamwork in emergency care: the influence of team experience 11.06.2013 Paris, France Schmutz Jan; Manser Tanja;
19th Annual Meeting of the Society in Europe for Simulation Applied to Medicine (SESAM) Talk given at a conference Simulation-based research approaches to investigate team performance 11.06.2013 Paris, France Manser Tanja; Schmutz Jan;
Euroanaesthesia Talk given at a conference Performance in the operating room: Team performance factors 01.06.2013 Barcelona, Spain Manser Tanja;
17. Schweizer Notfallsymposium Talk given at a conference Patientensicherheit 25.05.2013 Bern, Switzerland Manser Tanja;
16th congress of the European Association of Work and Organizational Psychology Talk given at a conference Using hierarchical task analysis to identify different coordination requirements in paediatric emergency scenarios 22.05.2013 Münster, Germany Manser Tanja; Schmutz Jan;
5th International Pediatric Simulation Symposia and Workshops Talk given at a conference Using in situ simulation to assess adherence to management guidelines for pediatric septic shock in German children's hospitals 23.04.2013 New York, United States of America Schmutz Jan; Manser Tanja;
5th International Pediatric Simulation Symposia and Workshops Talk given at a conference Using in situ simulation to assess adherence to management guidelines for pediatric septic shock in German children’s hospitals 23.04.2013 New York, United States of America Manser Tanja; Schmutz Jan;
Anästhesiekongress SIGA „Patientensicherheit in der Anästhesie“ Talk given at a conference Teamarbeit und Teamtraining: Was ist der Beitrag der Simulation in Forschung und Praxis? 20.04.2013 Lucerne, Switzerland Manser Tanja;
19th Annual Meeting of the Society in Europe for Simulation Applied to Medicine (SESAM) Talk given at a conference Five Steps to Develop Clinical Performance Checklists: A Systematic Approach. 11.04.2013 Paris, France Schmutz Jan; Manser Tanja;
PAEDSUN, Keynote lecture Talk given at a conference Effektives Teamwork in Notfallsituationen 30.11.2012 Munich, Germany Manser Tanja;
10th Anniversay of the Center of Advanced Medical Simulation and Training (CAMST); Keynote lecture Talk given at a conference Looking back, looking ahead: Patient safety through simulation-based training and research 09.11.2012 Stockholm, Sweden Manser Tanja;
6th International Workshop on Behavioural Science in Acute Care Settings Poster A method to design clinical performance checklists: The Delphi technique 01.11.2012 Copenhagen, Denmark Manser Tanja; Schmutz Jan;
3rd Swiss Conference on Standardized Patients and Simulation in Health Care Poster Assessing Performance in Pediatric Emergency Scenarios – Using an Adapted Delphi-Method to Design Clinical Performance Checklists 31.10.2012 Lausanne, Switzerland Manser Tanja; Schmutz Jan;
SimHealth 2012, Keynote lecture Talk given at a conference Effective teamwork in healthcare – what we know and what we should find out 11.09.2012 Sydney, Australia, Australia Manser Tanja;
Annual Meeting of the Society in Europe for Simulation Applied to Medicine (SESAM), Keynote lecture Talk given at a conference Looking back, looking ahead: Patient safety through simulation-based research 14.06.2012 Stavanger, Norway Manser Tanja;
CareArt 2012, Keynote lecture Talk given at a conference „Dream teams are made, not born“. Effektive Teamarbeit im Spital 14.03.2012 Basel, Switzerland Manser Tanja;
International Congress “Patient safety – moving forward!”; Eingeladener Vortrag Talk given at a conference Teamarbeit und Teamtraining: Was ist der Beitrag der Simulation in Forschung und Praxis? 29.11.2011 Basel, Switzerland Manser Tanja;


Self-organised

Title Date Place
International Workshop on Behavioural Science Applied to Acute Care Teams 20.10.2011 Zürich, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Healthcare live! 05.11.2014 Bonn, Germany Manser Tanja;
4. OP-Management-Symposium 26.09.2014 Davos, Switzerland Manser Tanja;
Tagung Pflege und MTTB 2014 Innovativ bleiben: Bestmögliche Qualität mit beschränkten Ressourcen 26.08.2014 Zürich, Switzerland Manser Tanja;
Weiterbildung des ärztlichen und pflegerischen Personals der Intensivstationen, Kinderspital Zürich 04.07.2013 Zurich, Switzerland Manser Tanja;
SGI Workshop, Swiss Society for Intensive Care Medicine 16.04.2013 Bern, Switzerland Manser Tanja; Welp Annalena;
Blockkurs “Human Factors / Safety”, Departement Anästhesie, Universitätsspital, Basel 22.01.2013 Basel, Switzerland Manser Tanja;
Anästhesiepflege als eigenständigen und verlässlichen Kompetenzpartner des interprofessionellen Behandlungs49. Berner Anästhesie Symposium „Interprofessionalität, Anästhesiepflege & Skillmix im Fokus“ 23.11.2011 Bern, Switzerland Manser Tanja;


Self-organised

Title Date Place
Zusammenhänge zwischen Teamarbeit, Burnout und Patientensicherheit 25.06.2015 Olten, Switzerland

Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) Do team processes really have an effect on clinical performance? A systematic literature review. BJA Podcast International 2013
Media relations: print media, online media Jeder Handgriff zählt universitas - LE MAGAZINE DE L’UNIVERSITE DE FRIBOURG Western Switzerland German-speaking Switzerland 2012

Awards

Title Year
Best presentation (2nd place); BSAS - Behavioural Sciences Applied to Acute and Surgery Settings 2015
Best presentation Swiss Society for Intensive Care Medicine / Beste freie Mitteilung SGI-SSMI 2014
Best Research Award 2013; Society in Europe for Simulation Applied to Medicine 2013

Associated projects

Number Title Start Funding scheme
116673 Adaptive coordination in anaesthesia teams and its relationship to clinical performance 01.05.2007 Project funding (Div. I-III)

Abstract

There is an increasing recognition that the challenges to patient safety are mostly organisational not just clinical. Based on systematic incident analyses, teamwork has been identified as a key area of patient safety interventions with human factors research being integral to achieving this goal. Research in high-risk industries such as aviation shows that a performance critical feature of effective teamwork is coordination and that high performing teams adapt several aspects of their coordination process to the changing requirements of different task situations (e.g. increased coordination requirements in case of non-routine / critical events). Studies in medicine provide first empirical evidence on coordination behaviours that help to maintain good clinical performance in the management of a non-routine or critical event. For surgery, however, no empirical investigation of characteristics of coordination processes has been conducted. In order to improve the teamwork of the overall operating room team, measures to assess adaptive coordination in the anaesthesia and surgical sub-crew need to be developed and then used in concert for future research and training development. In addition to team process characteristics, recent research highlights the importance of perceptions of teamwork quality related to clinician well-being and patient safety. From a theoretical perspective, aspects of organizational climate such as clinicians’ perceptions of teamwork form the foundation on which team processes are enacted. In the past, clinicians’ perceptions of teamwork have been shown to be associated with clinician well-being and with patient safety. However, the potentially complex interrelations of these concepts including temporal characteristics and changes over time have not yet been investigated systematically.The proposed research programme is structured into three closely related projects. Together these projects will contribute to scientific knowledge concerning the relationships between teamwork and patient safety by identifying coordination processes that support high clinical performance (project A and B) and by investigating the influence of clinicians’ perceptions of teamwork that form the background on which these team processes are enacted on clinician well-being and patient safety (project C). Project A is closely related to our previous research by analysing the robustness of our findings on adaptive coordination in anaesthesia crews. We will systematically investigate team characteristics (i.e. level of experience) and task characteristics (i.e. type of incident) that might influence the effects of these coordination mechanisms on team performance in anaesthesia crews. A series of three simulation-based studies will be carried out in collaboration with the PaedSim Network for interdisciplinary and multiprofessional paediatric simulation. Types of incidents will be distinguished a) using a task-analytic approach based on Rasmussen’s taxonomy of skill-based, rule-based, and knowledge-based tasks (Rasmussen, 1983) and b) by including not only medical crisis situations but also non-routine events. In a fourth study, a simulation-based team training intervention focusing on adaptive coordination will be developed based on the results of our research. The effects of this intervention on clinical performance will be tested experimentally. Project B will investigate adaptive coordination in surgical crews. This is an important next step to understand the effective and safe functioning of the various sub-crews and the overall operating room team. Project B aims at developing measures to assess adaptive coordination in surgical crews based on interviews and a review of taxonomies for team behaviours within and outside surgery. An observational field study in the same two surgical settings will be conducted in collaboration with the Division of Plastic and Reconstructive Surgery, University Hospital Zurich, to test the taxonomy for adaptive coordination in surgical crews and to uncover team and task characteristics that require adaptive coordination in surgical crews. Using video-recordings of surgical simulations and clinical performance data (both provided by the Clinical Safety Research Unit, Imperial College London), we will test for the relationships between patterns of adaptive coordination and clinical performance in surgical crews. This project goes beyond our previous research by expanding it to a new group of clinicians. Thus, it will contribute to methodological developments and to the identification of performance critical aspects of coordination specific to surgical practice that should be integrated in surgical education and training. Project C will investigate the relationship between teamwork and patient safety at a different level by focusing on clinicians’ subjective perceptions of teamwork. This level of analysis has been included in the research programme because past research shows that clinicians’ perceptions of teamwork are associated with clinician well-being and with patient safety. We will conduct surveys of clinicians from different professional groups working in relatively stable teams. Our analyses will focus on the relationships of clinicians’ perceptions of teamwork, clinician well-being, and measures of patient safety. We will investigate differences between different professional groups (i.e. nurses and physicians) and the influence of team and organizational characteristics. A longitudinal approach will be chosen to analyse changes over time for selected teams. From a theoretical perspective, the results of this research will advance our understanding of how psychological concepts such as team climate influence clinician well-being and patient safety. The results of this project will feed into practical recommendations for the management of healthcare teams that consider staff well-being and patient safety as synergistic outcomes.
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