Article

Canadian Journal of Nursing Research

0(0): 1–19
The Role of Interpersonal Relations in ! The Author(s) 2017
Reprints and permissions:

Healthcare Team Communication and sagepub.com/journalsPermissions.nav

DOI: 10.1177/0844562117699349

Patient Safety: A Proposed Model of journals.sagepub.com/home/cjn

Interpersonal Process in Teamwork

Charlotte Tsz-Sum Lee, RN, CON(C), PhD1, and Diane Marie Doran, RN, PhD2

Abstract
Patient safety is compromised by medical errors and adverse events related to miscommunications among healthcare
providers. Communication among healthcare providers is affected by human factors, such as interpersonal relations. Yet,
discussions of interpersonal relations and communication are lacking in healthcare team literature. This paper proposes a
theoretical framework that explains how interpersonal relations among healthcare team members affect communication and
team performance, such as patient safety. We synthesized studies from health and social science disciplines to construct a
theoretical framework that explicates the links among these constructs. From our synthesis, we identified two relevant
theories: framework on interpersonal processes based on social relation model and the theory of relational coordination.
The former involves three steps: perception, evaluation, and feedback; and the latter captures relational communicative
behavior. We propose that manifestations of provider relations are embedded in the third step of the framework on
interpersonal processes: feedback. Thus, varying team-member relationships lead to varying collaborative behavior, which
affects patient-safety outcomes via a change in team communication. The proposed framework offers new perspectives for
understanding how workplace relations affect healthcare team performance. The framework can be used by nurses, admin-
istrators, and educators to improve patient safety, team communication, or to resolve conflicts.

Keywords
Interpersonal communication, teamwork, interprofessional working, patient safety, organizational behavior, leadership

healthcare team members and disciplinary differences

Introduction
Healthcare errors and adverse events (AEs) jeopardize
the safety of patients; yet, they are preventable.
Awareness of healthcare errors is growing due to the
high cost of AEs in human and economic terms. AEs
are ‘‘unintended injury or complications . . . that is
caused by healthcare management rather than by the
patient’s underlying disease process’’ (Baker et al.,
2004, p. 1679).
AEs are not rare and incur significant costs for health-
care systems and patients (Aspden, Wolcott, Bootman,
& Cronenwett, 2007; Baker et al., 2004). AEs are pre-
ventable because they are related to communication
failures, often due to lack of care cohesiveness (Ardoin
& Broussard, 2011). When interdependence among
are poorly managed, communication fails. Studies have
demonstrated this and confirmed the benefits of a coor-
dinated, multidisciplinary team care approach (Brock
et al., 2013), including reduced AE risk (Ardoin &
Brossard, 2011). Subsequently, studies have aimed to
1
Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON,
Canada
2
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
Toronto, ON, Canada
Corresponding Author:
Charlotte Tsz-Sum Lee, Daphne Cockwell School of Nursing, Ryerson
University, Podium Room 481, 350 Victoria Street, Toronto, ON, Canada
M5B 2K3.
Email: lee.charlotte@ryerson.ca
2 Canadian Journal of Nursing Research 0(0)
enhance communication within teams, primarily through
training (e.g., De Meester, Verspuy, Monsieurs, & Van
Bogaert, 2013) and changing physical work environ-
ments (e.g., Wachter, 2010). However, work culture, atti-
tudes, and values within each healthcare discipline
cannot be changed easily (Lingard et al., 2004). The
impact of these human factors is underdocumented in
the health sciences literature. As individual healthcare
providers are often placed on teams with little choice
or knowledge of other members, these factors are unpre-
dictable, not well accounted for, and may have signifi-
cant impacts on team communication and performance
(DeBourgh, 2012).
Relevance to nursing practice
Most nurses work in teams with other nurses and with
other professionals, and are prone to relational issues
that may affect communication and patient safety.
Being cognizant of how interpersonal factors may
affect patient safety is an important first step to improve
quality of patient care.
Methods and procedures
This paper aims to introduce a framework that explains
the association between interpersonal relations and com-
munication, which ultimately explains collaborative
behaviors for patient safety. We begin with a description
of relevant literature on communication and interper-
sonal relations at work, followed by a proposal of how
interpersonal relationships are connected with communi-
cation in healthcare team setting. Finally, we suggest
how this framework aids the understanding of behav-
ioral issues associated with patient safety. We do not
provide a literature review on workplace relations
and patient safety, because there is no known literature
on this topic. Although there are studies that examine
cultures of safety among healthcare providers
(Armstrong, Lashinger, & Wong, 2009), these studies
do not explicate interpersonal relationships within such
cultures.
Interpersonal relations and
communication: Current state
of knowledge
We conducted a narrative (traditional) literature review
and did not find literature within healthcare settings that
delineates interpersonal relations, communication, and
team performance in healthcare teams (see Appendices
1 and 2). The few studies that offered relevant theoretical
approaches used a social cognitive underpinnings, which
laid the foundation of our framework and will be
described in the next section. Findings on how
interpersonal relationship affects care provision are sum-
marized below.
Positive relationships within non-healthcare work
teams improve employees’ attitudes to their jobs which
improves communication on uncertainties (Madlock,
2012) and enhancing communications (McCormack
et al., 2011). Within the health sciences, relationships
between patients and care providers are the most fre-
quently studied. The quality of these relationships
affects various patient-care outcomes, such as involve-
ment in treatment decision-making and adherence
(Ciechanowski, Katon, Russo, & Walker, 2001).
For relations among care providers within healthcare
teams, studies demonstrated that positive relations
among team members engender higher job satisfaction
among newly graduated nurses (Read & Laschinger,
2015) and better team performance in acute care
(Davis, Lind, & Sorensen, 2013). Unlike teams in other
employment settings, healthcare team members do not
necessarily consider themselves equal. Indeed, they order
themselves in a hierarchy of health professionals, which
inhibits communication and collaboration (Baker, Egan-
Lee, Martimianakis, & Reeves, 2011).
Most literature on relationships among care providers
concerns relations between physicians and nurses, or
among nurses. In these studies, collegial relationships
promote efficacious teamwork which leads to improved
patient and provider outcomes (e.g., Moore, Leahy,
Sublett, & Lanig, 2013). Nursing-administration
researchers suggest work relationships affect team per-
formance and patient safety (Laschinger & Leiter,
2006). In this paper, we aim to theorize the role of inter-
personal relations more broadly beyond role-related
relationships.
Gaps in the literature
As noted earlier, our literature review did not yield any
empirical studies that explicate the association between
interpersonal relationship and communication in health-
care. Most reviewed studies did not offer considerations
of workplace relations with the exception of few
that examined intragroup conflicts (Laschinger, Wong,
Grau, Read, & Pineau Stam, 2012). This contradicts the
approach from social sciences, where relationship and
communication are distinct and equally important con-
cepts that are to be considered separately (Conville &
Rogers, 1998). Related to this issue of conceptual
ambiguity was a lack of theoretical underpinnings in
explaining interpersonal relations in the context of
team communication and performance. There was a
strong focus on organizational factors (Baker et al.,
2011) instead of human factors in explaining team per-
formance. We also found communication and teamwork
are inconsistently measured in the literature: teamwork
Lee and Doran 3

as performance measure (Cox, 2001), as intragroup con-

flict in a study of incivility (Read & Laschinger, 2013),
and as empowerment as an indicator for highly func-
tional team with strong leadership (Laschinger et al.,
2012).
Proposed framework for interpersonal
relations in healthcare
Given the literature gaps, and in an attempt to address
how interpersonal relations affect work, we propose a
framework for describing these relations that guides
future research on patient safety and other healthcare
quality improvements. First, we discuss the connection
between interpersonal relations and communication.
Next, we describe interpersonal-behavior processes that
result in the establishment of relationship. Then, we inte-
grate the theory of relational coordination (an outcome
of interpersonal relations, which is also one of the few
relevant theories found in our literature review) into the
framework of interpersonal processes. Finally, we pro-
pose a framework for studying interpersonal relations
and behaviors that foster patient safety (see Figure 1).
Our framework uses systems theory (Von Bertalanffy,
1968) to guide the structure of interpersonal processes
(i.e., perception, evaluation, feedback) which gives rise
to interpersonal relationship and explains communica-
tive behavior. Social relation model (SRM; Kenny,
1994) provides details about the perception phase of
interpersonal process. Resulting communicative behav-
ior from relational ties is captured by the theory of rela-
tional coordination (Gittell, 1999).
Interpersonal relations and interpersonal processes
Despite its frequent use in the social sciences and huma-
nities, the concept of relations (or relationships) remains
broad, inarticulately defined, and ambiguous (Conville &
Rogers, 1998; Muldary, 1983). We take a social cognitive
perspective in understanding interpersonal relations
because our literature search results suggested this
approach (Baker et al., 2011; Havens, Vasey, Gittell, &
Lin, 2010; Lee, 2013); and, it is relevant to explaining
human behavior in an interactive, social setting, which
aligns with our focus on healthcare teams (see Appendix
1). From this perspective, relationships are outcomes of
interpersonal-behavior processes and communication is
a manifestation of relationship. These concepts are
dynamic and mutually reinforcing (Jehn & Shah, 1997;
Kenny, 1994). Also, sociologists argue that attributes
within different types of relationship differ, these differ-
ences account for different communication patterns
(Conville & Rogers, 1998).
Proposition 1: Processes of interpersonal behavior
affect interpersonal relations and healthcare
teams’ performance
Jehn and Shah (1997) published their seminal study that
suggested friendship and acquaintance led to different
performance outcomes via varying work processes
(e.g., information sharing, building morale). They sug-
gested attributes such as affinity, cohesion, and trust are
always present in friendship but not among acquaint-
ance. Similarly, Rogers’ relational communication
theory (2008) provided foundation of communication

• Influenced by perceptual context, perceived person and perceiver.

• Example: A colleague calls in sick, nurses judge differently based on time of year
(holiday season), tone of voice of colleague during call, prior history of sick calls,
Perception
personal belief.
Interpersonal
• Occurs when perceptions are organized and used. processes explain the
building of relationship
• Example: One nurse makes the judgment that colleague is not ill and feels
Evaluation negative about this colleague.

• Behavioural outcomes such as relational coordination.

• Example: The nurse not being forthcoming with changes in infusion pump setup (a
lack of timely communication) based on her negative evaluation torwards this Relational
Feedback
colleague. coordination reflects
communication
related to
• Performance includes efficiency and patient safety.
relationships, explains
• Example: The colleague may not realize the change and makes an error with team performance
Performance setting up the infusion pump. A medication was administered at the wrong rate.

Figure 1. A proposed framework of interpersonal relations and performance in healthcare teams.

4 Canadian Journal of Nursing Research 0(0)
based on personal relations such as family, friendship,
and romantic relationship. Their theory suggested com-
munication changes according to relationship.
Parallel to Rogers’ work is Kenny’s SRM, which
helps explicate interpersonal processes that build rela-
tionship (Kenny, 1994). Rooted in systems theory (Von
Bertalanffy, 1968), SRM decomposes the effect of
human perception into perceiver, target, and relational
effects. These effects explain the overall perception in
interpersonal interaction by taking into account the
reciprocal nature of relationships. Drawing from
Kenny’s work, interpersonal processes can be expressed
in sequence using systems theory. There are three
phases within interpersonal processes: perception,
evaluation, and feedback. They are interdependent,
dynamic, and iterative because ongoing life experiences
influence perceptions (Conville & Rogers, 1998). The
perception and feedback phases are key foci of this
framework.
Perception. Perceptions of individuals in healthcare
organizations are characterized by unique information-
processing activities necessary for everyday operation:
selection (e.g., membership on a nursing task force),
organization (e.g., streamlining referrals to decrease
wait times), and stabilization (e.g., preprinted work
orders). These three processes are influenced by the char-
acteristics of contexts, perceived individuals, and per-
ceivers themselves.
Subproposition 1a: Specific characteristics of the
perceptual context, perceived individuals, and
perceivers themselves can influence perceptions
Based on the components of SRM (Kenny, 1994), per-
ceptual context has both physical (e.g., time and loca-
tion) and social (relationships between two or more
individuals and interactive processes) features that deter-
mine appropriate behavior in each context. Perceived
individual refers to the perceptual stimuli presented by
individuals when interacting with others and this is
mutual between the perceiver and perceived. For exam-
ple, when nurses interact with colleagues, their charac-
teristics affect coworkers’ responses, and vice versa.
These characteristics fall into three categories: physical
features and artifacts (e.g., hair color, clothing), nonver-
bal behavior (e.g., emotions, affect), and verbal behavior
(e.g., tone of voice).
Finally, we consider perceivers themselves. They are
central in predicting the outcomes of perception because
they observe and interpret all the earlier characteristics
before evaluating them. Different perceivers may
yield divergent observations and interpretations, and
these may vary greatly from the actual situation.
Psychologists believe this divergence arises from individ-
uals’ natural tendency to selectively process the informa-
tion they receive (Adler, Rodman, & Cropley, 1991).
Proposition 2: Processes of interpersonal behavior
change over time
Evaluation. After perceivers observe and interpret charac-
teristics of others and the environment, they evaluate
these characteristics. This process directly influences
feedback and consequent behaviors, thus affecting inter-
personal relations. Evaluations are often crucial in deter-
mining a perceiver’s response, and can change depending
on the aforementioned perception factors. For example,
a nurse may react negatively (e.g., not forthcoming
about equipment changes) to a colleague who calls in
sick around the holiday season because he or she
assumes this colleague is not ill. This judgment maybe
based on the tone of voice of this colleague, time of year
of this call, and prior history of sick days.
Feedback. After evaluating what they perceive, individuals
give feedback based on their evaluation through commu-
nication. Although communication can be considered a
behavior, not all behaviors are communicative. They only
become so after the perceived person has processed them.
Verbal communication is neither comprehensive nor
specific enough to capture all behavioral outcomes asso-
ciated with work relationships. As there is no agreed def-
inition of communicative behaviors (Ardoin &
Broussard, 2011; Lingard et al., 2004), we suggest that
the concept of relational coordination may address com-
municative behavior related to workplace relations.
Relational coordination, communicative behavior,
and team performance
Proposition 3: Relational coordination comprises the
communication and behavioral outcomes of the interpersonal
behavior processes. Gittell’s (1999) concept of relational
coordination comprises three main assumptions: (a) it
explains the effects of interpersonal relationships on
coordination in work teams, (b) coordination is a behav-
ioral outcome of teamwork that mediates performance
improvements, and (c) relational coordination is influ-
enced by mechanisms of coordination and control as
well as practices in industrial relations and human
resources. In sum, relational coordination captures the
behavioral outcomes of interpersonal relations at work.
Examples of such behavioral outcomes are timeliness and
accuracy of communications, problem solving, and per-
ceived mutual respect. These are also expected outcomes
from the interpersonal-behavior process of feedback (see
Appendix 2).
Lee and Doran
Proposition 4: Positive interpersonal relations positively correlate
with better team performance and patient safety via improved
relational coordination. Relational coordination positively
correlates with quality of care, including safety (e.g.,
fewer medication errors, hospital-acquired infections)
in various settings (Gittell, Weinberg, Pfefferle, &
Bishop, 2008; Havens et al., 2010), but little is known
about the antecedents of relational coordination. We
propose that perception, evaluation, and feedback are
the antecedents. Our framework thus integrates the
three interpersonal behavior processes with relational
coordination. It will therefore predict positive team per-
formance, as suggested by literature on relational
coordination.
Our proposed model of interpersonal relations
and team performance
Integrating the processes of interpersonal behavior and
relational coordination yields a new framework that
explains interpersonal relations and its association with
team performance. Returning to the example of a col-
league who calls in sick, communication outcomes
resulting from the nurse’s perception and evaluation
(interpersonal processes) may affect the whole team’s
performance, ultimately affecting patient safety.
Specifically, if the nurse is not forthcoming about new
infusion pumps (unprompted, timely communication is
an example of relational coordination), this communica-
tion pattern may delay identification of the colleague’s
error in setting up infusion pump, and a patient may
suffer the adverse effects of receiving medication at the
wrong rate. While this causal relationship has not been
established, Lee (2013) reported that interpersonal rela-
tions are positively associated with care coordination in
outpatient clinics.
Discussion
In this paper, we reviewed literature demonstrating the
importance of interpersonal relations and healthcare
team communication to patient safety. We also dis-
cussed how communication is posited within the con-
cept of interpersonal relations. From our synthesis, we
proposed a theoretical framework to guide future stu-
dies on the effect of interpersonal relations in work
teams, such framework may help improve patient
safety.
One limitation of our framework is that it does not
consider virtual relationships and communication.
Colocation of healthcare work teams is less likely in
the future with online communication technologies,
such as Telehealth, webcasts, and email consultations.
We would also like to acknowledge the existence of
5
other theoretical perspectives in understanding relation-
ship and communication within social sciences and
humanities disciplines. For instance, the interpersonal
circumplex theory (Leary, 1957), which explains inter-
personal relations and communicative behavior from a
micro perspective, focusing on the influence of personal-
ity on interpersonal ties.
With increasing focus on team building and interdis-
ciplinary collaboration in healthcare, studying interper-
sonal relations is timely. Our proposed framework
addresses an important question within the teamwork
literature: How does interpersonal relations affect the
quality of patient care? We hope that a better under-
standing of such mechanism will produce strategies for
administrators, educators, and policy makers to create
conditions for effective teamwork that promote collab-
orative patient care.
Implications for nursing
Using our proposed framework, nurses can reflect on
their growth in insight about how their interpretation
of colleagues’ behaviors affects team interactions and
problem solving and how, in turn, team conflicts may
influence patient care. Nurses can also identify charac-
teristics that they can change to prevent misunder-
standings. While training nurses or mediating
conflicts, educators and administrators can target pro-
cesses outlined in our proposed framework to medi-
ate discourse and enhance patient safety. Future
research is needed to validate this framework with
empirical data, and to explore factors embedded
within our framework that are specific to healthcare
teams.
Appendix 1: Literature search strategies
and flow chart
Our literature search was guided by this research ques-
tion: ‘‘What do we know about the impact of interper-
sonal relationships on communication and patient care
outcomes, such as patient safety?’’
Search terms related to our key areas of ‘‘interper-
sonal relationship,’’ ‘‘patient safety,’’ and ‘‘communi-
cation’’ were generated with assistance from health
science librarian, with Boolean operators ‘‘AND’’
and ‘‘OR’’ whenever appropriate. Mapping of MeSH
terms were conducted to ensure identification of all
relevant materials. Searches were conducted in
Medline and Web of Science (Social Science,
Nursing) between June and August of 2014. We lim-
ited our search to English-only articles in peer-
reviewed publications (including theses and
6 Canadian Journal of Nursing Research 0(0)

dissertations) that were published within the past 15 Exclusion criteria for inclusion of our review were
years (i.e., between 2000 and 2014). Abstracts and nonempirical literature.
full text of search results were reviewed manually by The table below summarizes our search results from
research assistant and investigator for relevance. two databases.

Web of Science Refine search:

Research domain ! Social
Medline sciences; Research areas ! Nursing
Search term No. of matches No. of matches

Initial search on interpersonal relations

Interpersonal relationship 553 1,610
Interpersonal relations 56,176 4,620
Nurse-patient relationship 2 2,857
Physician-nurse relationship 16 301
Physician-nurse relations 0 1,563
Searches on collaboration and patient care
Collaboration AND patient outcomes 384 381
Medical collaboration AND patient outcomes 1 114
Medical collaboration AND patient safety 1 50
Follow-up searches on interpersonal relations
Professional-patient relationship 15,292 1,607
Interpersonal relationship OR interpersonal relations 55,647 4,819
Nurse-patient relationship OR nurse-patient relations 30,481 22,742
Physician nurse relationship OR physician-nurse relations 1,977 2,535
Professional patient relationship OR professional-patient relations 36,104 4,549
Searches on patient outcomes
Patient safety 17,579 3,787
Accident falls 9 321
Accidents 87,302 3,715
Patient harm 591 0
Home accidents OR Accidents, Home 4,072 0
Searches on communication (verbal and nonverbal)
Communication 62,340 0
Communication AND patient safety 2,004 635
Nonverbal communication 3,506 0
Verbal behavior 16,129 0
Negotiating 4,780 0
Searches on interpersonal relations and communication
Interpersonal relationship AND patient safety AND communication 0 29
Interpersonal relations AND patient safety AND communication 9 51
Interpersonal relations AND patient harm AND communication 0 13
Nurse-patient relationship AND communication 362 789
Physician-nurse relations AND communication 279 613
Nurse-patient relations AND patient safety AND communication 15 118
Searches on teamwork and communication and outcomes
Interpersonal relations AND outcomes AND outpatient 30 260
Teamwork AND patient safety AND communication 289 591
Lee and Doran 7

Below is a flow chart that illustrates literature search results:

Identification Matches through

database searches
(Medline, PysINFO, Web
of Science)
(n=6377)

Matches after duplicates

were removed
Screening

(n=3002)
Excluded because: non-
empirical, non-English
full-text, unrelated to care
Abstract screened Abstract excluded delivery (e.g., vehicle
(n=3002) (n=2488) safety)

Excluded because: did

not focus on care
Eligibility

Full text reviewed Full text excluded delivery, non-empirical,

(n=514) (n=483) focused solely on safety
(e.g., described nature of
medical errors) or
communication (e.g.,
described pattern)

Studies included in Common foci: patient-provider relationship,

Included

literature summary communication tool and healthcare outcomes,

n=31 intragroup conflicts and burnout
Appendix 2: Relevant literature on interpersonal relations, communication and team performance.
Citation Objective(s)
1. Anthony and Study of the communication
Preuss (2002) role of nurses in terms of
the nature of clinical infor-
mation, environmental vari-
ables, communication
behaviors, current labor and
safety issues, and the effects
of delivery models and
technology.
2. Ardoin and To propose a practice change
Broussard (2011) and implement and maintain
this change regarding hand-
off communication in a
community hospital using
the SBAR tool as a standar-
dized handoff communica-
tion tool for nurses to
decrease errors and pro-
mote patient safety.
3. Catalano (2009) To promote patient safety and
quality care through using a
standardized way for hand
off communication.
Sample/population/ Independent variables Dependent variables
Design setting (and measurement) (and measurement) Findings
Descriptive/ Nurses working in n/a n/a Proposed a framework to
exploratory inpatient units; better understand the rela-
nurse leaders tionships between commu-
nication/sharing of
information among nurses
and adverse events among
patients.
Four concepts: Information
decay (value); information
salience (clarity of impor-
tance); information funnel-
ing; failure to rescue.
Also explored the importance
of smooth, efficient, and
adequate handoff of infor-
mation associated with
patient care through the use
of electronic information
technology.
Pilot testing/ 17-bed inpatient rehab SBAR tool used Satisfaction surveys from The pilot testing yielded posi-
study nursing unit (not measured) nurses and doctors. tive results and made the
nurses and physicians satis-
fied with their communica-
tion when the SBAR tool is
used.
Medication reconciliation upon
admission improved from
67% to 82%.
Risk management reports
showed a decrease of med-
ical errors that resulted
from communication
failures.
Descriptive Inpatient surgical n/a n/a Recommended the implemen-
unit (pre and post). tation of the practice guide-
lines of The Joint
Commision (2006) about
having a standardized
approach to hand-off com-
munication, including an
opportunity to ask and
respond.
(continued)
 Appendix 2: Continued.
Citation Objective(s)
4. Guarascio-Howard To examine whether adding
(2011) wireless communication
technology will improve
team communication and
response times to patient
calls.
5. Rice, Zwarenstein, To report findings about the
Conn, Kenaszchuk, implementation of an
Russell, and Reeves interprofessional interven-
(2010) tion designed to improve
communication and colla-
boration in a general
internal medicine setting.
6. Makowsky, Schindel, To determine the effects of
Rosenthal, Campbell, the Capturing Outcomes of
Tsuyuki, and Madill Clinical Activities Performed
(2009) by a Rounding Pharmacist
Practicing in a Team
Environment
(COLLABORATE) study
and impact of assigning a
clinical pharmacist to work
with the medical team on
patient and process of care
outcomes.
Sample/population/ Independent variables Dependent variables
Design setting (and measurement) (and measurement) Findings
Experimental Med-surg Unit Baseline study technology: Communication data and ‘‘Caregiver team efficiency
nurse-locating system; safety indicators before increased because of
call lights located outside and after decreased of response time
patients’ room; comm. to patient calls and bed
Audio stations & physical status alarms. Wireless tech
arrival of the caregiver offers advantages for com-
Follow-up study: all of the municating the status of
above and addition of wire- patients and fall risk
less communication device factors.’’
Qualitative/ Two General Internal Interprofessional 8-week observation and There were positive initial
pilot study medicine wards; most intervention interviews and work reactions to the interven-
testing patients were elderly shadowing; Thematic tion, some were not as
and treated w/ multiple analysis enthusiastic but most are
comorbidities cooperative. But at the end
of the implementation
period, some aspects of the
GIM setting posed signifi-
cant barriers to the imple-
mentation of the
interprofessional interven-
tion and was therefore
ineffective (shortage of time
and pressure on their
work—intervention cannot
fit in their normal routine or
schedule; interprofessional
hierarchies—doctors having
more authority; communi-
cation skills).
Qualitative/ Hospitalized patients Inpatient internal medicine and Reflective journaling Four major themes emerged:
phenomenology/ admitted to two inpati- primary healthcare units; (pharmacists) and - Team processes
controlled trial ent internal medicine hospitalized patients current key informant - Impact on patient care
and two inpatient pri- condition and history; med- interviews - Organizational and
mary healthcare teams ical team (medical team) practice structure
(PHCT) at three ter- - Professional development
tiary care teaching ‘‘The integration of pharmacists
hospitals into core health care teams
in internal and family medi-
cine teams appeared to
facilitate positive patient
outcomes, better team
decision-making around
drug therapy, improved
continuity of care and
improved patient safety.’’
(continued)
 Appendix 2: Continued.
Citation Objective(s)
7. Weller, Boyd, The authors did an extensive
and Cumin review of literature to
(2014) identify the requirements of
an effective healthcare team
related to communication
or information sharing. They
explored this based on
educational, psychological,
and organizational
frameworks.
Sample/population/ Independent variables Dependent variables
Design setting (and measurement) (and measurement) Findings
Review Various Various Various The authors found that effec-
tive communication and
teamwork are necessary to
consistently deliver best
patient care. The authors
proposed seven interven-
tions to overcome barriers
to team communication in
healthcare. The article
included a review of the
challenges and possible
strategies/interventions to
address these challenges.
‘‘Sharing information and
agreeing goals were consid-
ered fundamental to good
decision making, but the
working environment and
differing perspectives could
make this difficult to
achieve.’’
‘‘The need to maintain an
environment in which open
communication could take
place was acknowledged as
important for patient safety,
but there were some bar-
riers to achieving this.’’
(continued)
 Appendix 2: Continued.
Sample/population/ Independent variables Dependent variables
Citation Objective(s) Design setting (and measurement) (and measurement) Findings

8. O’Leary, Wayne, 1. Assess the impact of the
Haviley, Slade, Lee, structured-interdisciplinary
and Williams rounds (SIDR) interventions
(2010) on both the nurses’ and
physicians’ ratings of colla-
boration and teamwork and
safety climate.
2. Assess the feasibility of the
intervention.
3. Assess the impact of the
intervention on hospital
length of stay (LOS) and
cost.
9. Despins (2009) To implement a proposed
change in the ICU team
collaboration using crew
resource management
(CRM) training that was
adopted from the
aviation industry.
Controlled General medicine SIDR; SIDR communication Patient characteristics
trial of the patient care units tool; working group; (LOS and cost) were
intervention (2 units-control patients also tabulated and
unit & intervention unit) Questions used in the SIDR statistically analyzed.
communication tool (p.
827): The working group
(physicians, nurses,
1. Overall plan of care? (dis- pharmacists, social
charge, tests?, patient’s chief worker) met weekly for
concern, etc) 12 weeks and provided
a completed survey
2. Discharge plans (placement?, after each meeting to
transportation?) assess ratings of colla-
boration and teamwork.
3 Patient safety (on VTE pro-
phylaxis, can we discontinue
PICC lines, Falls risk, etc.)
Implementation ICU CRM training Measurement:
group and control 1. Surveys from members
group of the team who
underwent CRM
training (84% of
respondents thought
that training helped to
create a stronger
team . . .)
2. Team members received
positive feedback from
chief medical officer,
state regulators, and
admin leaders.
‘‘SIDR significantly improved
provider’s ratings of colla-
boration and teamwork.
SIDR provided a facilitated
forum for interdisciplinary
discussion, exchange of cri-
tical clinical info, and colla-
boration on the plan of care.
Improved satisfaction with
teamwork.
Findings are significant because
poor communication could
lead to preventable adverse
events in hospitals. ‘‘Higher
ratings of collaboration and
teamwork has been assoc
with better patient out-
comes in observational
studies.’’
Ratings were not significantly
different between units.
There was no significance to
LOS or cost with the use of
SIDR.
Improved attitudes of partici-
pants or healthcare team
members toward patient
safety and teamwork.
CRM training taught members
of the team how to identify
subtle warning signs like
confusion among team
members about patient care
plans or conflicting input of
medications. Also, the
training involved improving
interpersonal skills within
the team, conflict resolu-
tion, and critiquing team
performance in a nonthrea-
tening way.
(continued)
 Appendix 2: Continued.
Citation Objective(s)
10. Sutcliffe, Lewton, To describe how communica-
and Rosenthal tion failures can lead
(2004) to medical mishaps.
11. Zwarenstein, Rice, To understand the mechanisms
Gotlib-Conn, by which current patterns of
Kenaszchuk, and interprofessional communi-
Reeves (2013) cation may impact on
patient care.
12. Lyndon ‘‘To identify evidence on the
(2006) role of assertiveness and
teamwork and the applica-
tion of aviation industry
techniques to improve
patient safety for inpatient
obstetric care.’’
Design
Qualitative Medical residents at a
Qualitative study; General internal medicine
observation and one
on one shadowing;
ethnographic and
semistructured
interviews
Review of 13 studies n/a
(5 studies of teamwork,
communication,
and safety attitudes
in aviation; 2 studies
comparing these factors
in aviation and health-
care; 6 studies of asser-
tive behavior and
decision-making by
nurses)
Sample/population/ Independent variables Dependent variables
setting (and measurement) (and measurement) Findings
n/a Measurement: the study Their findings show that medi-
600-bed U.S. teaching involved a semistruc- cal mishaps are linked to
hospital tured, face to face poor and faulty communi-
interviews with resi- cation. However, it is not
dents about their work solely caused by poor com-
environments and dif- munication because com-
ferent activities, medical munication is far more
mishaps they have complex that relate to hier-
recently been involved archical differences, con-
and its contributing flicting roles and roles
factors. ambiguity, and interpersonal
power and conflict.
n/a Measurement: one on one ‘‘Non-physician observations
wards of two urban shadowing, observation, were often overlooked and
teaching hospitals in and ethnographic, semi- interprofessional discussion
Canada structured interviews was rare.’’
with physicians, nurses,
and allied health Physicians do not engage as
professionals. much in nonmedical discus-
sions that can improve effi-
ciency, patient
centeredness, and out-
comes of care. Physicians
just mostly interact with
their fellow physicians.
‘‘Interprofessional interactions
between allied health pro-
fessionals and nurses were
frequent and deliberate but
few discussions involved
physicians.’’
n/a n/a ‘‘Adaptation of training con-
cepts and safety methods
from other fields will have
limited impact on perinatal
safety without an examina-
tion of the contextual
experiences of nurses and
other health care providers
in working to prevent
patient harm.’’
(continued)
 Appendix 2: Continued.
Sample/population/ Independent variables Dependent variables
Citation Objective(s) Design setting (and measurement) (and measurement) Findings

13. De Meester ‘‘The aim of this study was to Pre and post study 16 hospital wards’ nurses Patient records were checked Questionnaire was used to ‘‘After introducing SBAR we
et al. (2013) determine the effect of trained to use SBAR to for SBAR items up to 48 h measure nurse–physi- found increased perception
SBAR (situation, back- communicate to before a serious adverse cian communication and of effective communication
ground, assessment, recom- physicians event. collaboration and collaboration in nurses,
mendation) on the incidence an increase in unplanned
of serious adverse events in ICU admissions and a
hospital wards.’’ decrease in unexpected
deaths.’’
14. Koh, Brach, To propose a Health Literate Discussion/ n/a n/a n/a n/a
Harris, and Care Model that would theoretical
Parchman (2013) weave health literacy stra-
tegies into the widely
adopted Care Model (also
known as the Chronic Care
Model). Focus is not on
collaborative but more
enhancing patient’s health
literacy to facilitate com-
munication with providers
15. Wachter (2010) Provides a summary of pro- Discussion article n/a n/a n/a n/a
gress on efforts since the
Institute of Medicine Report
‘‘To Err is Human.’’ This
summary discusses
increased level of standards
which includes training for
team communication.
16. Lingard et al. To document and characterize Observational study Operating room team n/a n/a 129 communication events
(2004) the nature of communica- members, operating were noted as failure (a
tion failure in operating room total of 421 communication
room. events were noted). The
nature of failures includes:
poor timing, inaccurate
content, key audience
excluded, team tension, and
procedural error. Did not
delve closely into relational
issues.
17. Ciechanowski ‘‘To improve understanding of Observational, Diabetic patients Attachment style, patient–pro- Adherence Dismissive attachment style and
et al. (2001) both patient and provider survey study vider communication poor patient–provider com-
factors involved in lack of munication are associated
adherence to treatment in with poor adherence.
diabetic patients by using
the conceptual model of
attachment theory’’
(continued)
 Appendix 2: Continued.
Citation Objective(s)
18. DeBourgh To examine the effectiveness
(2012) of a partnership program
between academic and
clinical services. This
includes education on
teamwork behavior.
19. Havens et al. To ‘‘examined nurse reports
(2010) of relational coordination
between nurses and other
providers and the impact
of relational coordination
on patient care quality.’’
20. McCaughey, ‘‘To investigate support service
Halbesleben, employees’ perceptions of
Savage, Simons, safety leadership and social
and McGhan support as well as the rela-
(2013) tionship of safety perception
to levels of reported
injuries.’’
Design
‘‘A descriptive pilot study Prelicensure nursing stu-
design with a conveni-
ence sample of students,
measured students’
safety and quality
knowledge and the stu-
dents’ perceptions of
team behaviors and
communication
effectiveness.’’
‘‘Direct care registered ‘‘Direct care registered
nurses (RNs) (n ¼ 747)
completed surveys to
assess relational coordi-
nation across five provi-
der functions and six
types of patient care
units. Nurses also
reported perceptions
about patient care
quality.’’
Nonexperimental survey Hospital support service
study examined: ‘‘(1)
relationships between
safety leadership
(supervisor and organi-
zation) and individual
and unit safety percep-
tions; (2) the moderat-
ing effect of social
support (supervisor and
coworker) on individual
and unit safety percep-
tions; and (3) the rela-
tionship of safety
perception to reported
injury rates.’’
Sample/population/ Independent variables
setting (and measurement)
Education program
dents (N ¼ 24)
Relational coordination
nurses (RNs) (n ¼ 747),
across six types of
patient care units.’’
Leadership; social support;
employees (n ¼ 1,272) safety perception.
‘‘The survey items in this study
were based on the items
from the AHRQ Patient
Safety Culture Survey and
the U.S. National Health
Care Surveys.’’
Dependent variables
(and measurement)
Communication and Moderate to large effect sizes in
effectiveness
Quality of care including ‘‘In all analyses, relational coor-
medication errors
As relational coordination
Safety perceptions (indivi- Safety leadership (supervisor
dual and unit level);
injury rates
Findings
gains for safety and quality
knowledge and for students’
increased confidence in
their impact on patient care
outcomes.
dination between nurses
and other providers was
significantly related to over-
all quality, in the expected
directions.
increased, nurses reported
decreases in adverse events
such as hospital-acquired
infections and medication
errors.’’
and organization) was found
to be positively related to
individual safety perceptions
and unit safety grade as was
supervisor and coworker
support. Coworker support
was found to positively
moderate the following
relationships: supervisor
safety leadership and safety
perceptions, supervisor
safety leadership and unit
safety grade, and senior
management safety leader-
ship and safety perceptions.
Positive employee safety
perceptions were found to
have a significant relation-
ship with lower reported
injury rates.
(continued)
 Appendix 2: Continued.
Citation Objective(s)
21. Davis et al. ‘‘To investigate differences in
(2013) burnout among oncology
nurses by type of work set-
ting, coping strategies, and
job satisfaction.’’
22. Baker et al. To explore the perspectives
(2011) and the experiences of par-
ticipants and the power
relations between health
and social care professionals
using Witz’s model of pro-
fessional exposure (1992)
23. Laschinger and ‘‘To test a theoretical model of
Leiter (2006) professional nurse work
environments linking condi-
tions for professional nur-
sing practice to burnout
and, subsequently, patient
safety outcomes.’’
24. Laschinger ‘‘To examine the influence of
et al. (2012) senior nurse leadership
practices on middle and
first-line nurse managers’
experiences of empower-
ment and organizational
support and ultimately on
their perceptions of patient
care quality and turnover
intentions.’’
Sample/population/
Design setting
Descriptive Cancer centre nurses
(N ¼ 74)
Qualitative, interviews Health and social care pro-
fessionals (N ¼ 25)
Observational, survey Hospital-based nurses
study (N ¼ 8,597)
Secondary data analysis of ‘‘Data from 231 middle and
self-reported survey 788 first-line Canadian
data acute care managers’’
Independent variables
(and measurement)
Burnout, coping strategies, job
satisfaction, and oncology
work setting (inpatient vs.
outpatient and adult versus
pediatric).
n/a
Measures of worklife (Practice
Environment Scale of the
Nursing Work Index)
Leadership practices
Dependent variables
(and measurement)
n/a ‘‘Social context within the work
n/a ‘‘Findings from this work high-
Burnout (Maslach Burnout ‘‘Nursing leadership played a
Inventory-Human
Service Scale), report of
frequency of adverse
patient events
Empowerment, organiza- ‘‘Transformational leadership
tional support, quality of
care, intent to leave
Findings
environment may impact
emotional exhaustion and
depersonalization, and that
demographics may be more
significant in determining
burnout than setting.’’
light how professionals’
views of interprofessional
interactions, behaviors and
attitudes tend to either
reinforce or attempt to
restructure traditional
power relationships within
the context of an IPE
initiative.’’
fundamental role in the
quality of worklife regarding
policy involvement, staffing
levels, support for a nursing
model of care (vs. medical),
and nurse/physician rela-
tionships. Staffing adequacy
directly affected emotional
exhaustion, and use of a
nursing model of care had a
direct effect on nurses’ per-
sonal accomplishment. Both
directly affected patient
safety outcomes.’’
practices of senior nurses
empower middle- and first-
line nurse managers, leading
to increased perceptions of
organizational support,
quality care and decreased
intent to leave.’’
(continued)
 Appendix 2: Continued.
Citation Objective(s)
25. Lee (2013) To examine the association
between social capital
(resources embedded
within relationships) and RC
in outpatient clinics
26. Moore et al. To ‘‘explore how direct-care
(2013) nurses relate to each other
in everyday interactions on
patient care units.’’
27. Read et al. To ‘‘explore correlates of new
(2013) graduate nurses’ experi-
ences of workplace
mistreatment.’’
Sample/population/ Independent variables Dependent variables
Design setting (and measurement) (and measurement) Findings
Observational, survey Outpatient nurses and Social capital (relational ties) Relational coordination ‘‘Social capital predicted both
study physicians (N ¼ 342) (relational behavior in factors of RC (b ¼ 0.70 and
teams) 0.81, p < 0.001) and team
tenure predicted social
capital (b ¼ 0.13, p < 0.05).
Also, the association
between team tenure and
RC (b ¼ 0.09, p < 0.05) was
found to be partially
mediated by social capital.’’
‘‘Characteristics within
relational ties are predictive
of informal coordination.
The strength and pattern of
these associations provide a
better understanding in how
relationships may facilitate
interprofessional
teamwork.’’
Observation, survey study, Staff registered nurses n/a n/a ‘‘Participants had considered
themes extracted from (N ¼ 82) leaving the profession, and
qualitative responses had considered leaving or
(themes extracted) had left a nursing unit
because of poor nurse rela-
tionships. Participants iden-
tified environmental
characteristics necessary for
good relations. The crucial
role nurse managers play in
establishing good nurse
relations was highlighted.’’
Observational, survey New graduate nurses Authentic leadership, structural Workplace incivility, bully- ‘‘Workplace incivility and bully-
study (N ¼ 342) empowerment, worklife fit, ing, burnout, job ing were significantly related
psychological capital satisfaction to authentic leadership,
structural empowerment,
worklife fit, and psychologi-
cal capital. Bullying was
more strongly related to job
satisfaction, emotional
exhaustion, and mental and
physical health outcomes
than supervisor and cowor-
ker incivility’’
(continued)
 Appendix 2: Continued.
Citation Objective(s)
28. Read and ‘‘To examine a theoretical
Laschinger model testing the effects of
(2015) authentic leadership, struc-
tural empowerment and
relational social capital on
the mental health and job
satisfaction of new graduate
nurses over the first year of
practice.’’
29. Oyeleye, Hanson, To examine ‘‘the relationships
O’Connor, among perceived workplace
and Dunn (2013) incivility, stress, burnout,
perceived turnover inten-
tions, and perceived level of
psychological
empowerment’’
30. McCormack et al. To develop an approach to
(2011) measure patient-centered
communication in cancer
care
31. Madlock (2012) To examine the relationship
between relational mainte-
nance behavior and work-
related attitudes of job
satisfaction, organizational
commitment, communica-
tion satisfaction, and work
alienation (NON
HEALTHCARE)
Note. Citations in bold text presented relevant content on interpersonal relations in healthcare teams.
Design
Longitudinal survey study Nursing students (N ¼ 191)
Observation, survey study Acute care nurses
Literature review n/a
Observational, survey Business professionals
study
Sample/population/ Independent variables
setting (and measurement)
n/a (path analysis)
n/a
n/a
Relational maintenance practice
(N ¼ 276) Modified Relational
Maintenance Scale
Dependent variables
(and measurement)
Structural empowerment, ‘‘Structural empowerment
authentic leadership,
relational social capital,
mental health symp-
toms, and job
satisfaction
Stress, burnout, workplace ‘‘Significant relationships among
incivility, turnover
intentions, and psycho-
logical empowerment.
Perceived Stress Scale
(PSS10); Maslach
Burnout Inventory;
Spreitzer Psychological
Empowerment Scale
(PES)
n/a ‘‘Six core functions specified in
Job satisfaction, organiza- ‘‘Significant relationships were
tional commitment,
communication satisfac-
tion, work alienation
Organizational
Commitment
Questionnaire;
Abridged Job in General
Scale; Interpersonal
Communication
Satisfaction Inventory
Findings
mediated the relationship
between authentic leader-
ship and nurses’ relational
social capital, which in turn
had a negative effect on
mental health symptoms and
a positive effect on job
satisfaction. All indirect
paths in the model were
significant.’’
workplace incivility, stress,
burnout, turnover inten-
tions, total years of nursing
experience, and RN educa-
tion levels.’’
the PCC conceptual frame-
work: exchanging informa-
tion, fostering healing
relationships, recognizing
and responding to emo-
tions, managing uncertainty,
making decisions, and
enabling patient self-
management’’
found between coworker
relational maintenance
behaviors and the work-
related attitudes of job
satisfaction, organizational
commitment, communica-
tion satisfaction, and work
alienation.’’
18
Acknowledgment
We sincerely thank Drs. Neil Fleshner, Glenn Regehr,
AnnTourangeau for their feedback regarding the development
of this framework.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial sup-
port for the research, authorship, and/or publication of this
article: This work was modified from Charlotte Lee’s doctoral
dissertation which was partially funded by the Co-Investigator
Small Grant Competition at the Nursing Health Services
Research Unit at the Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto.
References
Adler, R. B., Rodman, G. R., & Cropley, C. (1991).
Understanding human communication. Fort Worth, TX:
Holt, Rinehart, and Winston.
Ardoin, K. B., & Broussard, L. (2011). Implementing hand-
off communication. Journal for Nurses in Staff
Development—JNSD, 27, 128–135.
Anthony, M. K., & Preuss, G. (2002). Models of care: The
influence of nurse communication on patient safety.
Nursing Economics, 20(5), 209.
Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace
empowerment and magnet hospital characteristics as pre-
dictors of patient safety climate. Journal of Nursing Care
Quality, 24(1), 55–62.
Aspden, P., Wolcott, J., Bootman, L., & Cronenwett, L. R.
(2007). Preventing medication errors. Washington, DC:
National Academies.
Baker, L., Egan-Lee, E., Martimianakis, A., & Reeves, S.
(2011). Relationships of power: Implications for interprofes-
sional education. Journal of Interprofessional Care, 25,
98–104. doi:10.3109/13561820.2010.505350
Baker, G. R., Norton, P.G., Flintoft, V., Blais, R., Brown, A.,
Cox, J., . . . ;Tamblyn, R. (2004). The Canadian adverse
events study: The incidence of adverse events among hos-
pital patients in Canada. Canadian Medical Association
Journal, 170, 1678–1686. doi:10.1503/cmaj.1040498
Brock, D., Abu-Rish, E., Chiu, C. R., Hammer, D., Wilson, S.,
Vorvick, L., . . . ;Zierler, B. (2013). Interprofessional educa-
tion in team communication: Working together to improve
patient safety. BMJ Quality & Safety, 22, 414–423.
doi:10.1136/bmjqs-2012-000952
Catalano, K. (2009). Hand-off communication does affect
patient safety. Plastic Surgical Nursing, 29(4), 266–270.
Ciechanowski, P. S., Katon, W. J., Russo, J. E., & Walker, E.
A. (2001). The patient-provider relationship: Attachment
theory and adherence to treatment in diabetes. The
American Journal of Psychiatry, 158, 29–35.
Conville, R. L., & Rogers, L. E. (1998). The meaning of ‘‘relation-
ship’’ in interpersonal communication. Westport, CT: Praeger.
Canadian Journal of Nursing Research 0(0)
Cox, K. B. (2001). The effects of unit morale and interpersonal
relations on conflict in the nursing unit. Journal of Advanced
Nursing, 35, 17–25.
Davis, S., Lind, B., & Sorensen, C. (2013). A comparison
of burnout among oncology nurses working in adult and
pediatric inpatient and outpatient settings. Oncology
Nursing Forum, 40(4), E303–E311. doi:10/1188/13.ONF.
E303-E311
DeBourgh, G. A. (2012). Synergy for patient safety and qual-
ity: Academic and service partnerships to promote effective
nurse education and clinical practice. Journal of
Professional Nursing, 28, 48–61. doi:10.1016/j.profnurs.
2011.06.003
De Meester, K., Verspuy, M., Monsieurs, K. G., & Van
Bogaert, P. (2013). SBAR improves nurse-physician com-
munication and reduces unexpected deaths: A pre and
post intervention study. Resuscitation, 84, 1192–1196.
Despins, L. A. (2009). Patient safety and collaboration of the
intensive care unit team. Critical Care Nurse, 29(2), 85–91.
Gittell, J. H. (1999). Coordinating patient care improves qual-
ity of care, efficiency. Interview by Therese Droste.
Executive Solutions for Healthcare Management, 2, 10–12.
Gittell, J. H., Weinberg, D., Pfefferle, S., & Bishop, C. (2008).
Impact of relational coordination on job satisfaction and
quality outcomes: A study of nursing homes. Human
Resource Management Journal, 18, 154–170. doi:10.1111/
j.1748-8583.2007.00063.x
Guarascio-Howard, L. (2011). Examination of wireless tech-
nology to improve nurse communication, response time to
bed alarms, and patient safety. HERD: Health Environments
Research & Design Journal, 4(2), 109–120.
Havens, D. S., Vasey, J., Gittell, J. H., & Lin, W. T. (2010).
Relational coordination among nurses and other providers:
Impact on the quality of patient care. Journal of Nursing
Management, 18(8), 926–937.
Jehn, K. A., & Shah, P. P. (1997). Interpersonal relationships
and task performance: An examination of mediation pro-
cesses in friendship and acquaintance groups. Journal of
Personality and Social Psychology, 72(4), 775.
Kenny, D. A. (1994). Interpersonal perception: A social rela-
tions analysis. New York, NY: Guilford Press.
Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L.
(2013). A proposed ‘health literate care model’would con-
stitute a systems approach to improving patients’ engage-
ment in care. Health Affairs, 32(2), 357–367.
Laschinger, H. K., & Leiter, M. (2006). The impact of nursing
work environments on patient safety outcomes: The mediat-
ing role of burnout engagement. Journal of Nursing
Administration, 36, 259–267.
Laschinger, H. K., Wong, C. A., Grau, A. L., Read, E. A., &
Pineau Stam, L. (2012). The influence of leadership prac-
tices and empowerment on Canadian nurse manager out-
comes. Journal of Nursing Management, 20, 877–888.
doi:10.1111/j.1365-2834.2011.01307.x
Leary, T. (1957). Interpersonal diagnosis of personality. New
York, NY: Ronald Press.
Lee, C. T. (2013). Social capital and relational coordination in
outpatient clinics: An interprofessional analysis. Journal of
Interprofessional Care, 27, 81–87. doi:10.3109/13561820.
2012.736094
Lee and Doran
Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G. R.,
Reznick, R., . . . ;Grober, E. (2004). Communication failures
in the operating room: An observational classification of
recurrent types and effects. Quality and Safety in Health
Care, 13, 330–334.
Lyndon, A. (2006). Communication and teamwork in patient
care: How much can we learn from aviation? Journal of
Obstetric, Gynecologic, & Neonatal Nursing, 35(4), 538–546.
Madlock, P. E. (2012). The influence of relational maintenance
strategies among coworkers. International Journal of
Business Communication, 49, 21–47. doi:10.1177/00219436
11425237
Makowsky, M. J., Schindel, T. J., Rosenthal, M., Campbell,
K., Tsuyuki, R. T., & Madill, H. M. (2009). Collaboration
between pharmacists, physicians and nurse practitioners: a
qualitative investigation of working relationships in the
inpatient medical setting. Journal of Interprofessional Care,
23(2), 169–184.
McCaughey, D., Halbesleben, J. R., Savage, G. T., Simons, T.,
& McGhan, G. E. (2014). Safety leadership: Extending
workplace safety climate best practices across health care
workforces. In Leading in Health Care Organizations:
Improving Safety, Satisfaction and Financial Performance
(pp. 189–217). Emerald Group Publishing Limited.
McCormack, L. A., Treiman, K., Rupert, D., Williams-Piehota,
P., Nadler, E., Arora, N. K., . . . ;Street, R. L., Jr. (2011).
Measuring patient-centered communication in cancer care:
A literature review and the development of a systematic
approach. Social Science and Medicine, 72, 1085–1095.
Moore, L. W., Leahy, C., Sublett, C., & Lanig, H. (2013).
Understanding nurse-to-nurse relationships and their
impact on work environments. Medsurg Nursing, 22,
172–179. Retrieved from http://europepmc.org/abstract/
med/23865278
Muldary, T. W. (1983). Interpersonal relations for health pro-
fessionals: A social skills approach. New York, NY:
Macmillan.
O’Leary, K. J., Wayne, D. B., Haviley, C., Slade, M. E., Lee,
J., & Williams, M. V. (2010). Improving teamwork: impact
of structured interdisciplinary rounds on a medical teaching
unit. Journal of General Internal Medicine, 25(8), 826–832.
Oyeleye, O., Hanson, P., O’Connor, N., & Dunn, D. (2013).
Relationship of workplace incivility, stress, and burnout on
nurses’ turnover intentions and psychological empower-
ment. Journal of Nursing Administration, 43, 536–542.
doi:10.1097/NNA.0b013e3182a3e8c9
Rice, K., Zwarenstein, M., Conn, L. G., Kenaszchuk, C.,
Russell, A., & Reeves, S. (2010). An intervention to improve
interprofessional collaboration and communications: a
comparative qualitative study. Journal of Interprofessional
Care, 24(4), 350–361.
19
Read, E. A., & Laschinger, H. (2013). Correlates of new gradu-
ate nurses’ experiences of workplace mistreatment. Journal
of Nursing Administration, 43, 221–228. doi:10.1097/NNA.
0b013e3182895a90
Read, E. A., & Laschinger, H. (2015). The influence of authen-
tic leadership and empowerment on nurses’ relational social
capital, mental health and job satisfaction over the first year
of practice. Journal of Advanced Nursing, 71, 1611–1623.
doi:10.1111/jan.12625
Rogers, E. (2008). Relational communication theory. In
L. Baxter & D. O. Braithwaite (Eds.), Engaging theories in
interpersonal communication: Multiple perspectives
(pp. 335–347). Thousand Oaks, CA: Sage.
Sutcliffe, K. M., Lewton, E., & Rosenthal, M. M. (2004).
Communication failures: an insidious contributor to medi-
cal mishaps. Academic Medicine, 79(2), 186–194.
Von Bertalanffy, L. (1968). General systems theory. New York,
NY: George Braziller.
Wachter, R. M. (2010). Patient safety at ten: Unmistakable
progress, troubling gaps. Health Affairs, 29, 165–173.
doi:10.1377/hlthaff.2009.0785
Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes
and patient safety: overcoming barriers to effective team-
work in healthcare. Postgraduate Medical Journal,
90(1061), 149–154.
Zwarenstein, M., Rice, K., Gotlib-Conn, L., Kenaszchuk, C.,
& Reeves, S. (2013). Disengaged: a qualitative study of com-
munication and collaboration between physicians and other
professions on general internal medicine wards. BMC
Health Services Research, 13(1), 494.
Author Biographies
Charlotte Tsz-Sum Lee is an assistant professor at the
Daphne Cockwell School of Nursing at Ryerson
University in Toronto, Canada. Her research focuses
on health services evaluation and interprofessional
teams, including the examination of how interpersonal
relationships affect teamwork processes and outcomes in
health care.
Diane Doran is an international expert on health services
research, outcomes measurement, patient safety and e-
health. She has more than 80 peer-reviewed publications
to her credit. One of the former home care nurse’s areas
of scholarly interest is the safety of home care clients. She
is a recipient of a Ministry of Health and Long-Term
Care Nursing Senior Career Research Award.