A mixed methods study to evaluate the effects of a teamwork enhancement and quality improvement initiative on nurses' work environment.

To test the effect of a teamwork enhancement and quality improvement program named 'Nurturing Effective Teams and Continuous Quality Improvement' on nurses' work environments in the hospital setting.Mixed method study with quasi-experimental controlled trial and focus group interviews.Twelve units from two Philippine tertiary government hospitals will be matched and allocated to have 72 nurses receive the teamwork enhancement and quality improvement program, or no intervention. The program focuses on enhancing nurse autonomy, leadership and management support, teamwork and workload management, delivered in two phases: (1) teamwork enhancement training using Team Strategies and Tools to Enhance Performance and Patient Safety; and (2) implementation of quality improvement projects using the Model for Improvement to identify priority unit issues and change ideas and tested using the Plan-Do-Study-Act cycle. The 6-month implementation include two trainings and seven mentoring sessions with a quality improvement facilitator. Primary outcome is the nurses' work environment and secondary outcomes are job satisfaction, burnout risk, turnover intention and perceived quality of care provided measured at the nurse-level using self-administered survey and measured at 0, 3 and 6 months. Focus group interviews will be conducted among 14-16 nurse subjects to explore their experience during the program, while other stakeholders will be interviewed to reflect the program effects. Generalized equation modelling will be used to identify the program effects on the quantitative outcomes and content analysis will be used for qualitative data.Establishing measures to improve the nurses' work environments can be used to address poor nurse outcomes in high workload and low resource settings.A favorable nurse work environment is the cornerstone to sustainable nursing workforce and positive outcomes. This study will provide explicit evidence to inform the effect of a structured evidence-based protocol in improving nurse work environments given resource-limited context.