Health Quality Improvement Using Instructional Communication and Teamwork Videos: An Outcome Study


Many factors contribute to errors that occur during emergency Cesarean birth under general anesthesia. The Joint Commission of Accreditation of Health Care Organizations (JACO) reports that 70% of sentinel events in obstetric practice are attributable to errors in communication and teamwork. Our objective was to develop a video training module to address these deficiencies, and measure its effectiveness. A webbased learning resource was created using professionally made videos that depicted effective and non-effective communication/teamwork techniques in an obstetrical event. This resource could be accessed by a facilitator of small group sessions or by self directed learners. Obstetrical nurses watched this learning resource and were then debriefed by a facilitator to highlight examples of how human factors contribute to the evolution of adverse events. The knowledge and skills, as well as, perceptions of their own behaviors and of other health professionals in the team, were evaluated preand post intervention. The performance of a subgroup of participants in a high-fidelity simulation of an emergency Cesarean birth was assessed to measure the outcome of intervention. Ninety-five obstetrical nurses were given the pre-intervention questionnaires, and 52 completed the post-intervention questionnaires one year later. Participants had significantly higher scores post-intervention (M = 0.78, SD = 0.09) as compared to pre-intervention (M = 0.73, SD = 0.12; t(53) = ?3.07, p <0.003, d = .47). Following intervention, participants were more conscious of the behaviors of those they worked with (t(51) = ?4.99, p < 0.001, d = ?0.66). Ten months after intervention, nurses indicated that they were able to identify challenges in teamwork and communication in their practice, and were more willing to speak up and be more assertive, and use strategies of conflict resolution and communication that they had learned. There was an improvement in performance of a sub-group of participant when assessed using a simulation scenario. The video web-based learning resource used in small group sessions effectively improved performance of obstetrical nurses as evaluated using questionnaires and high fidelity simulation. Future work will determine if the web-based version will be as effective in orienting new staff to the challenges of working in acute care obstetrical practice.

Share and Cite:

Cowie, N. , Bowen, A. , Kuling, S. , Premkumar, K. , Burbridge, M. & Martel, J. (2014). Health Quality Improvement Using Instructional Communication and Teamwork Videos: An Outcome Study. Creative Education, 5, 36-45. doi: 10.4236/ce.2014.51008.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] American College of Obstetricians and Gynecologists Committee on Patient Safety and Quality Improvement. (2009). ACOG Committee Opinion No. 447: Patient Safety in Obstetrics and Gynecology. Obstetrics & Gynecology, 114, 1424.
[2] McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United States. The New England Journal of Medicine, 348, 2635-2645.
[3] B-line Medical Sim capture. (2009).
[4] Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J., Etchells, E., Chali, W. A., Hebert, P., Majumdar, S. R., O’Beirne, M., Palacios-Derflingher, L., Reid, R. J., Sheps, S., & Tamblyn, R. (2004). The canadian adverse events study: The incidence of adverse events among hospital patients in Canada, Canadian Medical Association Journal, 170, 1678-1686.
[5] Beaubien, J. M., & Baker, D. P. (2004). The use of simulation for training teamwork skills in health care: How low can you go? Quality and Safety in Health Care, 13, I51-I56.
[6] Becker, L. A. (2000). Effect size calculators.
[7] Bloom, S. L., Spong, C. Y., Weiner, S. J., Landon, M. B., Rouse, D. J., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., O’Sullivan, M. J., Sibai, B., Langer, O., & Gabbe, S. G. (2005). Complications of anesthesia for cesarean delivery. Obstetrics & Gynecology, 106, 281-287.
[8] Blum, R. H., Raemer, D. B., Carroll, J. S., Dufresne, R. L., & Cooper, J. B. (2005). A method for measuring the effectiveness of simulationbased team training for improving. BMJ Quality and Safety, 21, 7882.
[9] Burke, C. S., Salas, E., Wilson-Donnelly, K., & Priest, H. (2004). How to turn a team of experts into an expert medical team: Guidance from the aviation and military communities, Quality and Safety in Health Care, 13, I96-I104.
[10] Gallagher, C. J., & Tan, M. (2010). The current status of simulation in the maintenance of certification in Anesthesia, International Anesthesiology Clinics, 48, 83-99.
[11] Blum, R. H., Raemer, D. B., Carroll, J. S., Dufresne, R. L., & Cooper, J. B. (2005). A method for measuring the effectiveness of simulationbased team training for improving communication skills. Anesthesia & Analgesia, 100, 1375-1380.
[12] Cowie, N., Premkumar, K., Bowen, A., Kuling, S., Kawchuk, J., Rooney, M., Morris, G., Burbridge, M., Martel, J., Sivertson, J., Campbell, D., Coupal, C., & Boechler, K. (2012). Teamwork and communication in acute care: A teaching resource for health pratitioners. MedEdPortal.
[13] Cyna, A. M., & Dodd, J. (2007). Clinical update: Obstetric anaesthesia. Lancet, 370, 640-642.
[14] Draycott, T., Sibanda, T. Owen L, et al. (2006). Does training in obstetric emergencies improve neonatal outcome? BJOG: An International Journal of Obstetrics and Gynecology, 113, 177-182.
[15] Endsley, M. (1995). Toward a theory of situation awareness in dynamic systems. Human Factors, 37, 32-64
[16] Barrett, L. F., & Russell, J. A. (1999). Structure of current affect. Current Directions in Psychological Science, 8, 11.
[17] Frank, J. R., & Brien, S. (2008) The safety competencies: Enhancing patient safety across the health professions. on behalf of The Safety Competencies Steering Committee. Ottawa: Canadian Patient Safety Institute.
[18] Gaba, D., Fish, K. J., & Howard, S. K. (1993) Crisis management in anesthesiology, London: Churchill Livingston.
[19] Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. H., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., & Gawande, A. A. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. The New England Journal of Medicine, 360, 491-499.
[20] Helmreich, R. L., Merritt, A. C., & Wilhelm, J. A. (1999). The evolution of crew resource management training in commercial aviation. International journal of aviation psychology, 9, 19-32.
[21] WHO. (2009). Human factors in patent safety review of topics and tools report for methods and measures working group of WHO patent safety.
[22] Institute for Healthcare Improvement, SBAR Toolkit, (2011).
[23] Joint Commission on Accreditation of Healthcare Organizations. (2004). JCAHO sentinel event alert #30.
[24] King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2008). Team STEPPS. Team strategies and tools to enhance performance and patient safety. In: K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady, (Eds.), Advances in patient safety: New directions and alternative approaches (Vol 3: performance and tools). Rockville, MD: Agency for Healthcare Research and Quality (US): Advances in Patient Safety.
[25] Klein, G., Moon, B., & Hoffman, R. R. (2006). Making sense of sensemaking 1: Alternative perspectives. IEEE Intelligent Systems, 21, 7073.
[26] Kohn, L.T., Corrigan, J. M., & Donaldson, M. S. (1999). To err is human: Building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine. Washington DC: National Academy Press.
[27] Kozlowski, S. W. J. (1998). Training and developing adaptive teams: Theory, principles, and research. In J. A. Cannon-Bowers, & E. Salas (Eds.), Making decisions under stress: Implications for individual and team training (pp. 115-153). Washington, DC: American Psychological Association.
[28] Miller, K. K., Riley, W., Davis, S., & Hansen, H. (2008). In situ simulation. A method of experiential learning to promote safety and team behavior. Journal of Perinatal & Neonatal Nursing, 22, 105-113.
[29] Mann, S., Marcus, R., & Sachs, B. (2006). Lessons from the cockpit: GrandRounds: How team training can reduce errors on L&D. Contemporary OB/GYN, 51, 34-36, 39-42.
[30] McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., Decristofaro, A., & Kerr, E. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348, 2635-2645.
[31] Merien, A. E., van de Ven, J., Mol, B. W., Houterman, S., & Oei, S. G. (2010). Multidisciplinary team training in a simula tion set ting for acute obstetric emergencies: A systematic review. Obstetrics and Gynecology, 115, 1021-1031.
[32] Morgan, P. J., Pittini, R., Regehr, G., Marrs, C., & Haley, M. (2007). Evaluating teamwork in a simulated obstetric environment. Anesthesiology, 106, 907-915.
[33] Morgan, P. J., Tregunno, D., Pittini, R., Tarshis, J., Regehr, G., Desousa, S., Kurrek, M., & Milne, K. (2012). Determination of the psychometric properties of a behavioral marking system for obstetrical team training using high-fidelity simulation. BMJ Quality & Safety, 21, 78-82.
[34] Practice guidelines for obstetric anesthesia: An updated report by the American society of anesthesiologists task force on obstetric anesthesia. (2007). Anesthesiology, 106, 843-863.
[35] Premkumar, K., Cowie, N., Coupal, C. M., & Boechler, K. (2013). Software for annotating videos-A resource to facilitate active learning in the digital age. Creative Education, 4, 465-469.
[36] Reason, J. (2000). Human error: Models and management. British Medical Journal, 320, 768-767.
[37] Haynes, A. B., Weiser, T. G., et al. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360, 491-499.
[38] Salas, E., Sims, D. E., Klein, C., & Burke, C. S. (2003). Can teamwork enhance patient safety? Forum Risk Management Foundation Harvard Medical Institutions.
[39] Saugstad, O. D. (2011). Reducing global neonatal mortalityis possible. Neonatology, 99, 250-257.
[40] Sexton, J. B., Holzmueller, C. G., Pronovost, P. J., Thomas, E. J., McFerran, S., Nunes, J., Thompson, D. A., Knight, A. P., Penning, D. H., & Fox, H. E. (2006). Variation in caregiver perceptions of teamwork climate in labor and delivery units. Journal of Perinatology, 26, 463-470.
[41] Shaw, C. D. (1990). Perioperative and perinatal death as measures for quality assurance. International Journal for Quality in Health Care, 2, 235-241.
[42] St. Pierre, M., Hofinger, G., & Buerschaper, C. (2008). Crisis management in acute care settings. Berlin: Springer.
[43] Stout, R. J., Cannon-Bowers, J. A., Salas, E., & Milanovich, D. M. (1999). Planning, shared mental models, and coordinated performance: An empirical link. Human Factors, 41, 61-71.
[44] The confidential enquiry into maternal and child health, 7th annual report. (2000). London: Maternal and ChildHealth Research Consortium.
[45] The Joint Commission center for transforming healthcare releases targeted solutions tool for hand-off communications. (2012). Joint Commission perspectives, 32, 1.
[46] Tregunno, D., Pittini, R., Haley, M., & Morgan, P. J. (2009). The development and usability of a behavioral marking system for performance assessment of obstetrical teams. Quality and Safety in Health Care, 18, 393-396.
[47] Tsen, L. C., Pitner, R., & Camann, W. R. (1998). General anesthesia for cesarean section at a tertiary care hospital 1990-1995: Indications and implications. International Journal of Obstetric Anesthesia, 7, 147-152.
[48] Wass, V., Van der Vleuten, C., Shatzer, J., & Jones, R. (2001). Assessment of clinical competence. Lancet, 357, 945-949.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.