What is teamwork? A qualitative study on the perception of teamwork in a specialized neonatal resuscitation team

Introduction: Neonatal resuscitation is common; approximately 10% of infants require resuscitation at birth, with 1% receiving more extensive measures such as endotracheal intubation and chest compressions. Effective and timely neonatal resuscitation is a team-based activity involving many decisions, tasks, and procedures conducted in a high-stress environment. Non-technical factors, such as teamwork, is increasingly recognized as having an impact on how well neonatal resuscitation is performed, and therefore on the outcomes of at-risk infants. Existing studies on teamwork in neonatal resuscitation have focused on quantifying interpersonal behaviors and the effect of team-based training on these behaviors; there are limited qualitative studies on healthcare providers’ own perception of teamwork in this specialized environment. Further, there are limited studies on the perceptions of teamwork within a multidisciplinary neonatal resuscitation team in a high-resourced, tertiary perinatal centre.

Methods: In this descriptive qualitative study, semi-structured interviews were conducted with members of the multidisciplinary neonatal resuscitation team at the Royal Alexandra Hospital in Edmonton, Alberta, from July to September 2020. This team specializes in attending high risk deliveries of preterm infants and at-risk term infants (e.g. fetal distress, congenital anomalies, etc) in a regional referral center. Participants included registered nurses, registered respiratory therapists, neonatal transport nurses, neonatal nurse practitioners, neonatal-perinatal medicine resident physicians and neonatologists. Thematic analysis was used to create data-driven codes and identify key themes through an iterative consensus-building process.

Results: Nine participants were interviewed, representing all disciplines. Participants have a range of clinical experience (median 7 years, IQR 5-21). Seven themes were identified, including: 1) Team composition (including experience, familiarity and role delegation); 2) Effective communication; 3) Team Leadership (i.e. the importance of the team leader and their effect on team functioning); 4) Hierarchy (i.e. impact of hierarchy within the team on performance and on speaking up); 5) Team training (including simulation and multidisciplinary training); 6) Debriefing (i.e. the importance of debriefing of critical events to assist with learning, coping and interpersonal interactions); and 7) Physical Environment (i.e. the effect of the physical environment on team co-ordination.) Themes were shared across disciplines and range of experience.

Conclusions: By exploring team members’ perception of teamwork in a multidisciplinary neonatal resuscitation team, seven themes were identified. These themes align with existing frameworks of effective clinical teamwork. Themes will be used to inform a sequential exploratory mixed-methods study on barriers and mediators to effective teamwork during neonatal resuscitation.

Keywords: neonatal resuscitation, teamwork, qualitative