Variation in caregiver perceptions of teamwork climate in labor and delivery units

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To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data.


Cross-sectional survey of labor and delivery caregivers in 44 hospitals in diverse regions of the US, using the Safety Attitudes Questionnaire teamwork climate scale.


The response rate was 72% (3382 of 4700). The teamwork climate scale had good internal reliability (overall α = 0.78). Teamwork climate scale factor structure was confirmed using multilevel confirmatory factor analyses (CFI = 0.95, TLI = 0.92, RMSEA = 0.12, SRMRwithin = 0.04, SRMRbetween = 0.09). Aggregation of individual-level responses to the L&D unit-level was supported by ICC (1) = 0.06 (P<0.001), ICC (2) = 0.83 and mean rwg(j) = 0.83. ANOVA demonstrated differences between caregivers F (7, 3013) = 10.30, P<0.001 and labor and delivery units, F (43, 1022) = 3.49, P<0.001. Convergent validity of the scale scores was measured by correlations with external teamwork-related items: collaborative decision making (r = 0.780, P<0.001), use of briefings (r = 0.496, P<0.001) and perceived adequacy of staffing levels (r = 0.593, P<0.001).


We demonstrate a psychometrically sound teamwork climate scale, correlate it to external teamwork-related items, and provide labor and delivery teamwork benchmarks. Further teamwork climate research should explore the links to clinical and operational outcomes.

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