Vol 5 No 11 (2019): International Journal For Research In Business, Management And Accounting (ISSN: 2455-6114)

Teamwork Climate among Resident Physicians in Two Departments of an Egyptian Hospital

Basem Abdel-Aziz
Alexandria University
Published November 8, 2019
  • Teamwork Climate,
  • Team Climate Inventory,
  • Validation,
  • Confirmatory Factor Analysis,
  • Exploratory Factor Analysis,
  • Healthcare organizations
  • ...More
How to Cite
Abdel-Aziz, B. (2019). Teamwork Climate among Resident Physicians in Two Departments of an Egyptian Hospital. International Journal For Research In Business, Management And Accounting (ISSN: 2455-6114), 5(11), 01-44. Retrieved from https://gnpublication.org/index.php/bma/article/view/1112


Teamwork climate (TWC) is crucial for organizations’ success, including healthcare organizations. Fourteen-itemed Team Climate Inventory (TCI-14) was used to measure TWC among resident physicians in two departments in an Egyptian University Hospital. Confirmatory factor analysis via structural equation modeling and exploratory factor analysis (in a confirmatory mode) were employed to construct validate the four-factor model of TCI-14. Factorial validity was established thru global and local fit diagnostics. Convergent validity was demonstrated via adequate subscales alpha coefficients, composite reliabilities, variances extracted, and weight and significance of item loadings. Discriminant validity was verified by moderate interfactor correlations and subscales composite reliabilities were greater than average variance extracted. The validated model was utilized to calibrate and grade the level of global TWC, its four subscales and indicators, which were found to belong to the “Good” category. TWC was not contingent upon physicians' personal characteristics like, age, sex, or length of employment. Specific and all-purpose educational and training programs were recommended to improve TWC.


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  1. Accreditation Council for Graduate Medical Education. (2008). Summative evaluation of
  2. competencies for 12-month clinical phase residents. Retrieved from
  3. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/380_SummativeEvalua
  4. tion_GPM_AA_04_10_2008.pdf.
  5. Agency for Healthcare Research and Quality (AHRQ). (2006).TeamSTEPPS curriculum tools
  6. and materials. Retrieved from http://teamstepps.ahrq.gov/abouttoolsmaterials.htm.
  7. Agrell, A., & Gustafson, R. (1994). The Team Climate Inventory (TCI) and Group Innovation – a
  8. Psychometric Test on a Swedish Sample of Work Groups. Journal of Occupational and
  9. Organizational Psychology, 67, 143–151. DOI: 10.1111/j.2044-8325.1994.tb00557.x
  10. American Board of Internal Medicine. (2017). Teamwork Effectiveness Assessment Module
  11. (TEAM). Retrieved from http://team.abim.org/.
  12. Anderson, N., & West MA. (1994). Team Climate Inventory: Manual and User's Guide. Windsor,
  13. UK: NFER-Nelson.
  14. Anderson, N., & West, M. (1996). The Team Climate Inventory: Development of the TCI and its
  15. applications in teambuilding for innovativeness. Eur J Work Organ Psychol , 5(1),53–66. DOI:
  16. 1080/13594329608414840
  17. Anderson, N., & West, M. (1998). Measuring Climate for Work Group Innovation: Development and
  18. Validation of the Team Climate Inventory. Journal of Organizational Behavior, 19(3), 235–258. DOI:
  19. 1002/(SICI)1099-1379(199805)19:3<235::AID-JOB837>3.0.CO;2-C.
  20. Babin, B. J., Svensson, G. (2012). Structural equation modeling in social science research: Issues of
  21. validity and reliability in the research process. European Business Review, 24, 320-330, DOI:
  22. 1108/09555341211242132
  23. Bain, P. G., Mann, L., & Pirola-Merlo, A. (2001). The innovation imperative: The relationships
  24. between team climate, innovation, and performance in research and development teams. Small
  25. Group Research, 32, 55–73. DOI: 10.1177/104649640103200103
  26. Baker, D.P., Gustafson, S., Beaubien, J, Salas, E., & Barach, P. (2005). Medical teamwork and
  27. patient safety: The evidence-based relation. AHRQ Publication No. 05–0053. Rockville: Agency for
  28. Healthcare Research and Quality.
  29. Beauducel, A. (2001). Problems with parallel analysis in data sets with oblique simple structure.
  30. Methods of Psychological Research, 6, 141-157.
  31. Beaulieu, M.D., Dragieva, N., Grande, C. D., Dawson, J., Haggerty, J.L., Barnsley, J.,…, West,
  32. M.A. (2014). The Team Climate Inventory as a Measure of Primary Care Teams' Processes:
  33. Validation of the French Version. Healthc Policy, 9, 40–54.
  34. Beaulieu, M. D., Haggerty, J., Tousignant, P., Barnsley, J., Hogg, W., Geneau, R.,…, Dragieva,
  35. N. (2013). Characteristics of Primary Care Practices Associated with High Quality of Care.
  36. Canadian Medical Association Journal, 185, E590–96. DOI: 10.1503/cmaj.121802
  37. Boada-Grau, J., de Diego-Vallejo, R., de Llanos-Serra, E., & Vigil-Colet, A. (2011). [Short Spanish
  38. version of Team Climate Inventory (TCI-14): development and psychometric properties]. 23, 308-
  39. [Abstract: Article in Spanish].
  40. Brodbeck, F.C. & Maier, G.W. (2001). The Team Climate Inventory (TCI) for innovation: A
  41. psychometric test on a German sample of work groups. Zeitschrift Fur Arbeits-Und
  42. Organisationspsychologie, 45,59–73. DOI: 10.1026//0932-4089.45.2.59.[Abstract: Article in
  43. German]
  44. Burningham, C. & West, M. A. (1995). Individual, climate, and group interaction processes as
  45. predictors of work team innovation. Small Group Research, 26, 106–117.
  46. DOI: 10.1177/1046496495261006
  47. Canadian Institute for Health Information (CIHI). (2012). Pan-Canadian Primary Health Care
  48. Indicator Update Report. Ottawa.
  49. Catell, R. B. (1978). The Scientific Use of Factor Analysis in Behavioral and Life Sciences (New
  50. York: Plenum).
  51. Clancy, C.M., Tornberg, D.N. (2007). Team STEPPS: assuring optimal teamwork in clinical settings.
  52. Am J Med Qual., 22, 214–217. DOI: 10.1177/1062860607300616
  53. Costello, A. B. & Osborne, J.W. (2005). Best Practices in Exploratory Factor Analysis: Four
  54. Recommendations for Getting the Most From Your Analysis. Practical Assessment, Research &
  55. Evaluation, 10 , 1-9.
  56. de Carvalho, J., & Chima, F.O. (2014). Applications of Structural Equation Modeling in Social
  57. Sciences Research. American International Journal of Contemporary Research, 4, 6-11. DOI:
  58. 1146/annurev.psych.51.1.201
  59. de Winter, J. C. F, Dodou, D., & Wieringa, P. A. (2009). Exploratory factor analysis with small
  60. sample sizes. Multivariate Behavioral Research, 44, 147–181. DOI:
  61. 1080/00273170902794206
  62. El-Kot, G. , & Leat, M. (2005). Research Note: Investigating team work in the Egyptian context.
  63. Personnel Review, 34, 246-261. DOI:10.1108/00483480510579457
  64. Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use
  65. of exploratory factor analysis in psychological research. Psychological Methods, 4, 272-299.
  66. DOI: 10.1037/1082-989X.4.3.272
  67. Goh, T. T., & Eccles, M. P. (2009). Team Climate and Quality of Care in Primary Health Care: A
  68. Review of Studies Using the Team Climate Inventory in the United Kingdom. BMC Research Notes,
  69. , 222. DOI: 10. 1186/1756-0500-2-222
  70. Goh, T. T., Eccles, M. P, & Steen, N. (2009). Factors predicting team climate, and its
  71. relationship with quality of care in general practice. BMC Health Serv Res., 9, 138.
  72. DOI: 10.1186/1472-6963-9-138
  73. Hatcher, L. (2005). A Step-By-Step Approach to Using SAS for Factor Analysis and Structural
  74. Equation Modeling. Cary, NC: SAS Institute Inc.
  75. Hellings, J., Schrooten, W., Klazinga, N., Vleugels, A. (2007). Challenging patient safety
  76. culture: survey results. Int J Health Care Qual Assur, 20, 620-32. DOI:
  77. 1108/09526860710822752
  78. Howard, M., Brazil, K., Akhtar-Danesh, N., & Agarwal, G. (2011). Self-Reported Teamwork in
  79. Family Health Team Practices in Ontario: Organizational and Cultural Predictors of Team
  80. Climate. Canadian Family Physician. 57, e185–191.
  81. Institute of Medicine. (2003). Health professions education: a bridge to quality. Retrieved from
  82. http://www.iom.edu/Reports/2003/health-professions-education-a-bridge-to-quality.aspx.
  83. Joint Commission. (2012). Improving patient and worker safety: opportunities for synergy,
  84. collaboration and innovation. Retrieved from http://www.jointcommission.org/assets/1/18/TJCImprovingPatientAndWorkerSafety-Monograph.pdf.
  85. Kenny, D. A. (2015). Measuring Model Fit. Retrieved from http://davidakenny.net/cm/fit.htm.
  86. Kivimäki, M., & Elovainio, M. (1999). A short version of the Team Climate Inventory:
  87. Development and psychometric properties. Journal of Occupational and Organizational
  88. Psychology,72,241–246. DOI: 10.1348/096317999166644
  89. Kivimäki, M., Kuk, G., Elovianio, M., Thomson, Kalliomäki-Levanto, T., & Heikkiä, A. (1997). The
  90. Team Climate Inventory (TCI) four or five factors? Testing the structure of TCI in samples of low
  91. and high complexity jobs. Journal of Occupational & Organizational Psychology, 70, 375–389.
  92. DOI:10.1111/j.2044-8325.1997.tb00655.x
  93. Kivimäki, M., Vanhala, A., Pentti, J., & Lansisalmi, H. (2007). Team climate, intention to leave
  94. and turnover among hospital employees: Prospective cohort study. BMC Health Services
  95. Research, 7: 170. DOI: 10.1186/1472-6963-7-170
  96. Kline, R. B. (2005). Principles and practice of structural equation modeling. 2nd ed. New York:
  97. Guilford Press.
  98. Knafl, G. (2006). Current Topics in Statistics for Applied Researchers: Factor Analysis. Oregon
  99. Health & Science University (OHSU). Retrieved from
  100. http://www.ohsu.edu/son/faculty/knafl/factoranalysis.html
  101. Körner, M., Wirtz, M., Bengel, J., & Göritz, A. (2015). Relationship of organizational culture,
  102. teamwork and job satisfaction in interprofessional teams. BMC Health Serv Res., 15, 243.
  103. DOI: 10.1186/s12913-015-0888-y.
  104. Lemieux-Charles, L., & McGuire, W.L. (2006). What do we know about health care team
  105. effectiveness? A review of the literature. Med Care Res Rev, 63, 263–300. DOI:
  106. 1177/1077558706287003
  107. LePine, J. A., Piccolo, R. F, Jackson, C.L., Mathieu, J. E., & Saul, J., R. (2008). A meta‐analysis
  108. of teamwork processes: tests of a multidimensional model and relationships with team
  109. effectiveness criteria. Personnel Psychology, 61, 273- 307. DOI: 10.1111/j.1744-
  110. 2008.00114.x
  111. Lipman-Blumen, J. ,& Leavitt H. J. (1999). Hot groups: Seeding them, feeding them, and using them
  112. to ignite your organization [M]. NY: Oxford University Press.
  113. Loo, R. & Loewen, P. (2002). A confirmatory factor-analytic and psychometric examination of the
  114. team climate inventory – Full and short versions. Small Group Research,33, 254–265. DOI:
  115. 1177/104649640203300205
  116. MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor
  117. analysis. Psychological Methods, 4, 84–89. DOI: 10.1037/1082-989X.4.1.84
  118. McCarthy W D. (2012). Causes of Correctional Officer Stress and its consequences. A Master’s
  119. Thesis Presented to The College of Graduate and Professional Studies Department of Criminology,
  120. Indiana State University Terre Haute, Indiana. In Partial Fulfillment of the Requirements for the
  121. Degree Master of Art Degree.
  122. Mathisen, G.E., Einarsen, S., Jørstad, K., & Bronnick, K.S. (2004). Climate for Work Group
  123. Creativity and Innovation: Norwegian Validation of the Team Climate Inventory (TCI).Scandinavian
  124. Journal of Psychology, 45, 383–392. DOI: 10.1111/j.1467-9450.2004.00420. x
  125. Meterko, M., Mohr, D.C., & Young, G.J. (2004). Teamwork culture and patient satisfaction in
  126. hospitals. Med Care, 42, 492-498. DOI: 10.1097/01.mlr.0000124389.58422.b2
  127. Mulaik, S. A. (1990). Blurring the Distinctions between Component Analysis and Common
  128. Factor-Analysis. Multivariate Behavioral Research, 25, 53-59. DOI:
  129. 1207/s15327906mbr2501_6
  130. Ouwens, M., Hulscher, M., Akkermans, R., Hermens, R., Grol, R., & Wollersheim, H. (2008). The
  131. Team Climate Inventory: Application in Hospital Teams and Methodological Considerations. Quality
  132. and Safety in Health Care, 17(4), 275–80. DOI: 10.1136/qshc.2006.021543
  133. Ouwens, M.M., Marres, H.A., Hermens, R.R., Hulscher, M.M., van den Hoogen, F.J., Grol RP, …,
  134. Wollersheim, H., (2007). Quality of integrated care for patients with head and neck cancer:
  135. development and measurement of clinical indicators. Head Neck, 29,378–86. DOI:
  136. 1002/hed.20532
  137. Patterson, M., Warr, P., & West, M. (2004). Organizational climate and company productivity:
  138. The role of employee affect and employee level. Journal of Occupational and Organizational
  139. Psychology, 77, 193-216. DOI: 10.1348/096317904774202144
  140. Proudfoot, J., Jayasinghe, U. W., Holton, C., Grimm, J., Bubner, T., Amoroso,…, Harris, M.F.
  141. (2007). Team Climate for Innovation: What Difference Does It Make in General Practice?
  142. International Journal for Quality in Health Care, 19, 164–169. DOI: 10.1093/intqhc/mzm005
  143. Queen’s School of Business & The Monieson Centre For Business Research in Healthcare. (2014).
  144. Change management in healthcare: Workshop Report.
  145. Ragazzoni, P., Baiardi, P., Zotti, A.M., & West, M.A. (2002). Research Note: Italian Validation of
  146. the Team Climate Inventory: A Measure of Team Climate for Innovation. Journal of Managerial
  147. Psychology, 17, 325–336. DOI: 10.1108/02683940210428128
  148. Reiss-Brennan, B., Brunisholz, K.D., Dredge, C., Briot, P., Grazier, K., Wilcox, A., …, James, B.
  149. (2016). Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost.
  150. JAMA, 316, 826-834. DOI: 10.1001/jama.2016.11232
  151. Revilla, M. A., Saris, W. E., & Krosnick, J.A. (2014). Choosing the Number of Categories in Agree–
  152. Disagree Scales. Sociological Methods & Research, 43, 73-97. DOI: 10.1177/0049124113509605
  153. Risser, D., Rice, M. D., Salisbury, M., Simon, R., Jay, G., & Berns, S. (1999). The Potential for
  154. Improved Teamwork to Reduce Medical Errors in the Emergency Department. Annals of Emergency
  155. Medicine, 34, 373-383. DOI: 10.1016/S0196-0644(99)70134-4
  156. Rummel, R. J. (1970). Applied factor analysis. Evanston, IL: Northwestern University Press.
  157. Sapnas, K.G., Zeller, R.A. (2002). Minimizing sample size when using exploratory factor
  158. analysis for measurement. Journal of Nursing Measurement, 10,135-53. DOI:
  159. 1891/Jnum.
  160. Shortell, S. M, Marsteller J. A., Lin M., Pearson M. L., Wu S. Y., Mendel P., ..., Rosen, M.
  161. (2004).The Role of Perceived Team Effectiveness in Improving Chronic Illness Care. Medical
  162. Care, 42, 1040–1048. DOI: 10.1097/00005650-200411000-00002
  163. Shortell, S.M., Schmittdiel, J., Wang, M.C., Li, R., Gillies, R.R., Casalino, …, Rundall, T.G.
  164. (2005). An empirical assessment of high-performing medical groups: results from a national
  165. study. Med Care Res Rev,62, 407–434. DOI: 10.1177/1077558705277389
  166. Silva, M. C., Peduzzi, M., Sangaleti, C. T., da Silva, D., Agreli, H.F., West, M. A., & Anderson,
  167. N. R. (2016). Cross-cultural adaptation and validation of the teamwork climate scale. Rev. Saúde
  168. Pública, 50, 1-11. DOI:10.1590/S1518-8787.2016050006484
  169. Strating, M., & Nieboer, A. (2009). Psychometric test of the Team Climate Inventory-short version
  170. investigated in Dutch quality improvement teams. BMC Health Serv Res., 9, 126.
  171. DOI: 10.1186/1472-6963-9-126
  172. Tseng, H., Liu, F., & West, M. A. (2009). The Team Climate Inventory (TCI) : A Psychometric
  173. Test on a Taiwanese Sample of Work Groups. Small Group Research, 40 (4), 465-482. DOI:
  174. 1177/1046496409334145
  175. Weijters, B., Cabooter, E., & Schillewaert, N. (2010). The effect of rating scale format on
  176. response styles: The number of response categories and response category labels. International
  177. Journal of Research in Marketing, 27(3), 236–247.
  178. Wensing, M., Wollersheim, H., & Grol, R. (2006). Organizational interventions to implement
  179. improvements in patient care: a structured review of reviews. Implement Sci ,1:2.
  180. DOI:10.1186/1748-5908-1-2
  181. West, M. (1990). The social psychology of innovation in groups. In: West MA, Farr JL, eds.
  182. Innovation and creativity at work: psychological and organizational strategies. Chichester, UK:
  183. Wiley.
  184. Widaman, K. F. (1993). Common Factor-Analysis Versus Principal Component Analysis –
  185. Differential Bias in Representing Model Parameters. Multivariate Behavioral Research, 28, 263-
  186. Williams, B., Brown, T., & Onsman, A. (2010). Exploratory factor analysis: A five-step guide for
  187. Novices. Australasian Journal of Paramedicine, 8,1- 13. DOI: 10.33151/ajp.8.3.93
  188. Yang, Y., & Xia, Y. (2015). On the number of factors to retain in exploratory factor analysis for
  189. ordered categorical data. Behav Res Methods, 47, 756-72. DOI: 10.3758/s13428-014-0499-2
  190. Yuan, L., Chaoying, T., & Peng, G. (2008). Chinese Validation of the Team Climate Inventory: A
  191. Measure of Team Climate for Innovation in R&D Teams. Proceedings of the 5th International
  192. Conference on Innovation & Management, Vols I & II, Pages: 1862-1867.
  193. Jung, S., & Lee, S. (2011). Exploratory factor analysis for small samples. Behav Res, 43,701–
  194. DOI: 10.3758/s13428-011-0077-9