Dr Sarah Beck

Background Teamwork is essential for providing safe, effective and women-centred maternity care and several high profile investigations have highlighted the adverse conseqences of dysfuntional teamwork. Maternity teams may need support to identify the most relevant intervention(s) for improving teamwork. Objective To identify and describe current ‘off-the-shelf’ teamwork interventions freely or commercially available to support improvements to teamworking in UK maternity services and conduct a gap analysis to identify areas for future development. Design Rapid scoping review Methods A multi-component search process was used to identify teamwork interventions, comprising: (1) bibliographic database search (Medline, PsycINFO, CINAHL, MIDRS, NICE evidence research database); (2) identification of relevant policies and UK reports; and (3) expert input from key stakeholders (e.g., maternity service clinicians, managers, policymakers, and report authors). Data were extracted including the scope and content of each intervention and a gap analysis used to map interventions to the integrated team effectiveness model (ITEM) and structure level (macro, meso, micro) and results presented narratively. Findings Ten interventions were identified. Interventions were heterogeneous in their purpose and scope; six were classified as training courses, three were tools involving observational or diagnostics instruments, and one was a programme involving training and organisational re-design. Interventions were focused on teamwork in the context of obstetric emergencies (n=5), enhancement of routine care (n=4) or understanding workplace cultures (n=1). Users of interventions could vary, from whole organisations, to departments, to individual team members. All interventions focused on micro (e.g., team leadership, communication, decision-making, cohesion, and problem solving), with two also focused on meso aspects of teamwork (resources, organisational goals). Evidence for intervention effective on objective outcomes was limited. Conclusions Interventions that address key aspects of teamworking are available, particularly for improving safety in obstetric emergency situations. Most interventions, however, are focused on micro features, ignoring the meso (organisational) and macro (systems) features that may also impact on team effectiveness. Evidence-based team improvement interventions that address these gaps are needed. Such interventions would support team ownership of quality improvement, leading to improvements in outcomes for service users, staff and organisations.

Poor teamwork is often implicated in serious healthcare delivery failings, leading to calls for effective team improvement interventions. Taking a complex, adaptive systems perspective, we adapted an oncology team quality improvement program to make it appropriate for other areas of clinical care. Study phases included: (1) meetings with National Health Service, policy and service user representatives (n = 19), a rapid review of existing maternity teamwork interventions, and mapping of the proposed program content to an evidence-based model of team effectiveness; (2) feasibility and acceptability testing of the team questionnaire component, and content analysis of free-text responses with four maternity teams within two NHS Trusts (n = 26). Meetings with representatives highlighted the importance of non-punitive, continuous team-led assessment, and the ability to compare performance to similar teams while enabling adaptability to different team types. Program content mapped well to known components of team effectiveness. Internal consistency of the questionnaire was acceptable (Cronbach alpha = 0.79–0.92). Most team members (76.9%) reported benefits in identifying priorities for improvement. Preliminary proof of concept was supported but larger-scale evaluation including testing in other clinical areas is warranted.

Work-related rumination, that is, perseverative thinking about work during leisure time, has been associated with a range of negative health and wellbeing issues. The present paper examined the association between work-related rumination and cognitive processes centred around the theoretical construct of executive functioning. Executive functioning is an umbrella term for high level cognitive processes such as planning, working memory, inhibition, mental flexibility; and it underlies how people manage and regulate their goal directed behaviour. Three studies are reported. Study I, reports the results of a cross-sectional study of 240 employees, and demonstrates significant correlations between work-related rumination and three proxy measures of executive functioning: cognitive failures (.33), cognitive flexibility (-.24) and situational awareness at work (-.28). Study II (n = 939), expands on the findings from study 1 and demonstrates that workers reporting medium and high work-related rumination were 2.8 and 5 times, respectively, more likely to report cognitive failures relative to low ruminators. High ruminators also demonstrated greater difficulties with ‘lapses of attention’ (OR = 4.8), ‘lack of focus of attention’ (OR = 3.4), and ‘absent mindedness’ (OR = 4.3). The final study, examined the association between work-related rumination and executive functioning using interview data from 2460 full time workers. Workers were divided into tertiles low, medium and high. The findings showed that high work-related rumination was associated with deficits in starting (OR = 2.3) and finishing projects (OR = 2.4), fidgeting (OR = 1.9), memory (OR = 2.2), pursuing tasks in order (OR = 1.8), and feeling compelled to do things (OR = 2.0). It was argued that work-related rumination may not be related to work demands per se, but appears to be an executive functioning/control issue. Such findings are important for the design and delivery of intervention programmes aimed at helping people to switch off and unwind from work

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.