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Objective To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies.Design Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial.Setting Six secondary and tertiary maternity units.Sample A total of 114 randomly selected healthcare professionals, in 19 teams of six members.Methods Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature.Main outcome measures Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated.Results More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient s b = )0.53, 95% CI from )0.74 to )0.32, P = 0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (s b = 0.46, 95% CI 0.17-0.74, P = 0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P = 0.03, Mann-Whitney U-test).Conclusions Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.

This collection of papers on disagreement adds new theoretical and methodological insights. It brings together interest in opposition in discourse with research on relational issues, traditionally discussed in work on identity construction and im/politeness research. We propose that the following observations in an attempt to systematically approach the understanding of disagreement: a) expressing opposing views is an everyday phenomenon; b) certain practices are prone to contain disagreement so that this speech act is expected rather than the exception; for example, they are in fact a sine qua non in decision making and problem solving talk in either ever day or professional contexts; other practices and contexts are less tolerant of the expression of disagreement; c) disagreeing cannot be seen as an a priori negative act; communities and groups of people have developed different norms over time which influence how disagreement is perceived and enacted; d) as in all language usage, the ways in which disagreement is expressed -and not only its occurrence per se -will have an impact on relational issues (face-aggravating, facemaintaining, face-enhancing); at the same time, expectations about how disagreement is valued in a particular practice will influence what forms participants choose. Against this backdrop, the aim of this special issue is to revisit the existing body of research on disagreement and to probe further in a variety of contexts in five papers and an epilogue to contribute to the debate of the impact of the context/medium on the interaction, the role of im/politeness in disagreements, the notion of 'appropriateness' in talk and the theorising of disagreement in general.

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We describe lessons for safety from a synthesis of seven studies of teamwork, leadership and team training across a healthcare region. Two studies identified successes and challenges in a unit with embedded team training: a staff survey demonstrated a positive culture but a perceived need for greater senior presence; training improved actual emergency care, but wide variation in team performance remained. Analysis of multicenter simulation records showed that variation in patient safety and team efficiency correlated with their teamwork but not individual knowledge, skills or attitudes. Safe teams tended to declare the emergency earlier, hand over in a more structured way, and use closed-loop communication. Focused and directed communication was also associated with better patient-actor perception of care. Focus groups corroborated these findings, proposed that the capability and experience of the leader is more important than seniority, and identified teamwork and leadership issues that require further research.

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