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TCAM Theory
TCAM Theory
This document presents detailed information about the TCAM method and questionnaire, as
well as references and further reading sources. This will help with understanding the goals and
aims of TCAM. The material is technical in nature and so is not required reading for the Coordinator of the TCAM programme. It is not recommended that the material is passed to the
team members unless they specifically ask for more detailed information on TCAM.
Concepts and Definitions
The Team Climate Assessment Measure (TCAM) measures Dimensions of a work group’s climate that
are associated with:

effective team functioning in general

the specific area of patient safety and effective adverse incident management in
clinical settings.
Team
A team is defined as a group of people who share common objectives and who need to work together to
achieve them.
For example: a breast cancer team has the shared objective to accurately diagnose breast cancer, and a
primary health care team has the shared objective to improve the health of the practice population.
The more Team Members have to work together to achieve their common objectives, the more they
need to function effectively as a team.
Climate
Theoretical and empirical work about climate in organisations has been published during the last three
decades within Organisational Psychology and Sociology (cf. reviews from Campbell, Dunnette, Lawler
and Weick, 1970; Joyce and Slocum, 1984; Rentsch, 1990; Rousseau, 1988; Schein, 1985; Schneider,
1990; Schneider and Reichers, 1983). Two concepts of climate emerged through this work: climate as
cognitive representations and climate as socially shared perceptions.
The cognitive representations approach
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This approach views climate as the result of individuals’ perceptions about characteristics within their
work environment. Thus climate is measured by analysing the meanings individuals derive and construct
on the basis of the characteristics of their work environment and how this is approached (cf. Ashforth,
1985; James and Sells, 1981; Schneider and Reichers, 1983).
The socially shared perceptions approach
In addition to the cognitive representations approach, the socially shared perceptions approach requires
some consensus among individual cognitions of the members that make up a group about the
characteristics of their work environment (Levitt and March, 1988). The TCAM follows this approach.
Why examine climate at team level?
The concept of climate is commonly employed in relation to organisations and seldom in relation to
work groups or teams. However, organisations are large social systems comprising many subunits and
groups of employees, so that one socially shared climate per organisation is difficult to obtain (Danserau
and Alluto, 1990; Jackofsky and Slocum, 1988).
The various subunits within organisations differ in the characteristics of work environments they
provide for members of an organisation. In addition to this, the various groups of employees differ in
their perspectives and their selective focus on organisational characteristics. Thus an organisation
comprises not just one climate, but a variety of different climate zones and concepts, depending on the
subunits (e.g. work groups) and perspectives (e.g. by job category) of the organisational members.
Therefore, consensus among individual perceptions of a particular organisation’s climate is expected to
be low (Patterson, Payne and West, 1996).
Team climate differs from organisational climate, as it focuses on the proximate work environment of
individuals who relate to each other as part of socially meaningful subsystems within an organisation.
Such ‘socially meaningful’ work environments are provided by work groups or teams, in which
members identify (more or less) with a (more or less) common vision or task objectives, and interact
(more or less) with each other in order to perform tasks that are (more or less) interdependent.
Work groups or teams are the primary medium within which a socially shared climate is likely to
develop and sustain through active social co-construction of work-related meanings (Anderson and
West, 1998; Hosking and Anderson, 1992; West, 1994, 1997).
The evaluation of a socially shared team climate (as compared to organisational climate) receives validity
through the higher likelihood that (according to Hosking & Anderson, 1992) socially shared cognitions
develop when individuals:

have the possibility to interact directly (face-to-face) and regularly
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
pursue common and mutual goals

perform tasks that are evidently interdependent forcing them to collaboratively
develop a mutual understanding about their work environment.
The more a collective of individuals satisfies these criteria, the more likely it is that a climate measure
captures socially and meaningfully shared cognitions about the work environment. A work group or
team, as defined further above, is more likely to satisfy the above three criteria than a whole
organisation or a class of employees.
The TCAM is particularly applicable to work units that meet these criteria (at least to some extent) or
that aspire towards meeting them.
Team Climate
Team climate is the shared perception of behaviours, practices and procedures, both formal and
informal, within a team; it is ‘the way things are done around here’ as perceived by Team Members.
Therefore, all TCAM items comprise descriptions of how work group members or the group as a whole
perform various aspects of their team tasks.
For example: the members of an acute care unit commonly report that they engage in weekly team
meetings in order to reflect the quality of their communication and collaboration. This is one indicator
for the TCAM Dimension ‘Team Reflexivity’ (i.e. the degree to which Team Members review their
objectives, their ways of achieving them and their methods of working).
Facet-specific Climate
Facet-specific climate is the application of the concept of climate to a particular referent, such as climate
for effectiveness, climate for innovation, climate for learning, climate for safety.
For example: members of an operating theatre team report insufficient coverage of risk and safety
issues in their weekly team meetings (or there is noteworthy disagreement in their respective
responses, as measured by the rwg - statistic). This is an indicator of low team reflexivity with respect to
safety issues (or, in other words, reservations on the part of some Team Members).
The use of a general construct of climate, which does not refer to a specified criterion (e.g.
performance or outcome variables such as effectiveness or safety indicators), is meaningless according
to Schneider and Reichers (1983). Some of the conceptual problems within climate research addressed
by these authors’ notion can be reduced when a facet-specific construct of climate is used (Rousseau,
1988).
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From a test-theoretical perspective, a facet-specific construct is more valuable than a general construct
of climate. Validity (i.e. the degree to which the target object of measurement is indeed represented by
a test) refers to the strength of empirical evidence in support of the conclusions derived from the test
scores a measurement tool delivers. In other words, it is not the measurement tool itself that is
validated by empirical studies, it is the conclusions drawn from (and for) a particular application of a
measurement tool that are validated (Häcker, Leutner and Amelang, 1998, p. 10). Thus, the validity of a
test also depends on what you actually do with the measurement tool in relation to its intended use.
The TCAM addresses two specific criteria, as follows.
1. It contains team climate Dimensions derived from theories of effective group functioning, for
example, Task Reflexivity, Participative Trust and Safety, Inter-professional Learning , which
relate to team effectiveness in a variety of domains, including quality of patient care.
2. The Dimensions also relate to issues of safety/adverse incident management.
TCAM Scales, Items and Adaptations
Unit of Measurement
The unit of measurement targeted by the TCAM is the work group as a whole. This unit of
measurement has been chosen because team climate is a group-level construct, in the above described
sense, and so measuring at either individual group member (or classes of employees) level or the
organisation level would not give a meaningful result.
The variance of individual perceptions within work groups (e.g. due to individual idiosyncrasies in
perceptions of the work environment or response tendencies) is controlled for by aggregating the
individual group members’ TCAM scores onto the group level of analysis. For this, the rwg - statistic
(James, deMaree and Wolf, 1984, 1991) is used. This establishes the degree of consensus among group
members for each TCAM item and scale within a work group. The resulting statistic allows us to test
whether the degree of commonality among individual perceptions about the various team climate
characteristics is sufficient for aggregation onto the group level.
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Evaluation and Research Design for TCAM
Development
The TCAM’s Internal and External Validity
Internal and external validity has and continues to be established in several ways, as follows.
1. The current set of TCAM scales was selected on the basis of a review of conceptual links
between a comprehensive list of team climate scales and components of the OACM (see
items in the TCAM questionnaire developed by Brodbeck, Inceoglu & Guillaume for the
NPSA, below)
2. Patient safety-relevant items were integrated into the selected TCAM scales
3. Validation of the questionnaire continues as part of the collaboration with NPSA.
The TCAM Items by Dimension
Task Reflexivity
1. The team often reviews its objectives.
2. The methods used by the team to get the job done are often discussed.
3. We regularly discuss whether the team is working effectively together.
4. In this team we modify our objectives in light of changing circumstances.
5. Team strategies are rarely changed.
6. How well we communicate information is often discussed.
7. This team often reviews its approach to getting the job done.
8. The way decisions are made in this team is often reviewed.
Safety / Adverse Incident Management items specific to this dimension
9. The methods used by the team to ensure patient safety and effective adverse incident
management are often discussed.
10. We regularly discuss whether we effectively manage issues of patient safety together.
11. The team supports me in reviewing my individual beliefs and behaviours relevant to patient
safety.
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Participative Trust and Safety
1. If you make a mistake on this team, it is often held against you.
2. Members of this team are able to bring up problems and tough issues.
3. People on this team sometimes reject others for being different.
4. It is difficult to ask other members of this team for help.
5. No one on this team would deliberately act in a way that undermines my efforts.
6. Working with members of this team, my unique skills and talents are valued and utilised.
Safety / Adverse Incident Management items specific to this dimension
7. In this team, it is difficult to discuss concerns about patient safety.
8. I am encouraged by other team members to report any patient safety concerns I might have.
9. In this team it is difficult to speak up if I perceive a problem with patient care.
Team Learning Behaviour
1. We regularly take time to consider ways of improving our team’s work processes.
2. This team tends to handle differences of opinion privately or off-line, rather than addressing
them directly as a group.
3. This team frequently seeks new information that leads us to make important changes.
4. In this team, someone always makes sure that we stop to reflect on the team’s work
process.
5. People in this team often speak up to test assumptions about issues under discussion.
6. We invite people from outside the team to present information or have discussions with us.
Safety / Adverse Incident Management items specific to this dimension
7. Information obtained through incidents reports is used by our team to make patient care
safer.
8. We invite patient safety managers to present information or have discussions with us.
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Individual Development
1. The team supports my professional development.
2. The team supports my individual learning activities.
3. My team provides me with useful ideas and practical support.
4. My team helps me to optimise my professional development.
5. We pay attention to each other's work so that the work done remains at a
high standard.
Safety / Adverse Incident Management items specific to this dimension
6. My team helps me to optimise patient safety.
7. We pay attention to each other's behaviour relevant to patient safety.
Inter-professional Credibility (Lewis, 2003)
1. I am comfortable accepting procedural suggestions from other team members.
2. I trust that other members’ knowledge about the project is credible.
3. I am confident about relying on the information that other team members bring to the
discussion.
4. When other team members give information, I want to double-check it for myself.
5. I do not have much faith in the other team members’ ‘expertise’.
Safety / Adverse Incident Management items specific to this dimension
6. Input from junior members of the team about patient care and safety is listened to in the
team.
7. I do not have much faith in the other team members’ expertise about patient safety.
8. I am comfortable accepting suggestions about patient care and safety from other Team
Members.
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Inter-professional Learning
1. There is often conflict between professional groups about how best to achieve our
objectives.
2. There is a feeling of trust and safety between colleagues with different professional
backgrounds.
3. There is a climate of constructive debate between professional groups within the group.
4. All professional groups work closely together to achieve the task.
5. There is a high level of co-operation and trust between different professional groups.
Safety / Adverse Incident Management items specific to this dimension
6. Between professional groups, there is a climate of constructive debate about patient safety
issues.
7. There is often conflict between professional groups about how best to achieve patient safety.
8. All professional groups work closely together to ensure patient safety.
Regular Contact
1. There is regular contact among group members.
2. We hold group meetings regularly.
3. We are regularly in touch with each other.
4. We have frequent and mutual exchanges.
5. The group members meet frequently to discuss topics informally.
Safety / Adverse Inci dent Management items specific to this dimension
6. We have frequent and mutual exchanges about patient safety issues.
7. We regularly hold group meetings about patient safety and adverse incident
management issues.
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Mutual Trust
1. There is trust and friendliness among group members.
2. We support each other.
3. Among group members there is a strong sense of helpfulness.
4. Among group members there is understanding and empathy.
5. There is lack of teamwork.
Safety / Adverse Incident Management items specific to this dimension
6. With patient safety issues in particular there is a strong sense
of helpfulness among group members.
7. With issues of adverse incident management in particular there
is trust and friendliness among group members.
Team Efficacy
1. Achieving this team’s goal is well within our reach.
2. This team can achieve its task without requiring us to put in unreasonable time or effort.
3. Certain individuals in this team lack the special skills needed for good team work.
Safety / Adverse Incident Management items speci fic to this dimension
4. This team can achieve high standards in patient safety without requiring us to put in
unreasonable time or effort.
5. Certain individuals in this team lack the skills needed for good team work in service of
patient safety.
6. Members of this work group have more than enough talent and experience to ensure patient
safety.
7. Everyone in this work group has the special skills that are needed to ensure patient safety.
Team Stability
1. There is a high turnover of staff in this team.
2. I have the impression that many people have left the team over the last 6 months.
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Shared Leadership and Leadership Clarity
1. A number of people lead/coordinate the team.
2. We all have leadership/co-ordinator roles in one way or another.
3. There is a very clear leader/co-ordinator.
4. There is no clear leader/co-ordinator.
5. There is conflict over who leads/co-ordinates the team.
6. Team members take initiatives to promote high shared motivation and commitment.
7. Team members take initiatives to make sure the team develops and uses the best possible
approach to work.
8. Team members take initiatives to help the work group build and use members’ knowledge
and skills.
9. Team members take initiatives to constructively resolve problems or conflicts that develop
among members.
10. Team members tell other members what to do and how they should do it.
References
Anderson, N.R. and West, M.A. (1998) Measuring climate for work group innovation: development and
validation of the team climate inventory. Journal of Organizational Behavior, 19, 235–58.
Ashforth, B E. (1985) Climate formation: issues and extensions. Academy of Management Review, 4, 837–
47.
Campbell, J.P., Dunnette, M.D., Lawler, E.F. and Weick, K.E. (1970) Managerial Behavior, Performance and
Effectiveness. New York: McGraw-Hill.
Danserau, F. and Alluto, J.A. (1990) Level-of-analysis issues in climate and culture research. In B.
Schneider (ed.), Organizational Climate and Culture. San Francisco: Jossey Bass, 193–236.
Edmondson, A.C. (1996) Learning from mistakes is easier said than done: group and organizational
influences on the detection and correction of human error. Journal of Applied Behavioural Science, 32,
15–28.
Häcker, H., Leutner, D. and Amelang, M. (1998) Standards für pädagogisches und psychologisches
Testen. Diagnostica und Zeitschrift für Differentielle und Diagnostische Psychologie (Supplementum
1/1998).
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Hosking, D.M. and Anderson, N.R. (1992) Organizational Change and Innovation: Psychological Perspectives
and Practices in Europe. London: Routledge.
Jackofsky, E.F. and Slocum Jr, J.W. (1988) A longitudinal study of climate. Journal of Organizational
Behavior, 8, 319–34.
James, L.R. and Sells, S.B. (1981) Psychological climate: theoretical perspectives and empirical research.
In D. Magnusson (ed.), Toward a Psychology of Situations: An International Perspective. Hillsdale, NJ:
Erlbaum, 275–95.
James, L.R., deMaree, R.G. and Wolf, G. (1984) Estimating within-group interrater reliability with and
without response bias. Journal of Applied Psychology, 69, 85–98.
James, L.R., deMaree, R.G. and Wolf, G. (1991) rwg: an assessment of within-group interrater
agreement. Journal of Applied Psychology, 78, 306–9.
Joyce, W.F. and Slocum, D. (1984) Collective climate: agreement as a basis for defining aggregate
climates in organizations. Academy of Management Journal, 27, 721–42.
Levitt, B. and March, J.G. (1988) Organizational learning. Annual Review of Sociology, 14, 319–40.
Patterson, M., Payne, R.L. and West, M. (1996) Collective climates: a test of their socio-psychological
significance. Academy of Management Journal, 39, 1675–91.
Rentsch, J. (1990) Climate and culture: interaction and qualitative differences in organizational meanings.
Journal of Applied Psychology, 75, 668–81.
Rousseau, D.M. (1988) The construct of climate in organization research. In C.L. Cooper and I.T.
Robertson (eds), International Review of Industrial and Organizational Psychology (Vol. 3). Chichester:
Wiley, 139–59.
Schein, E.H. (1985) Organizational Culture and Leadership. San Francisco: Jossey Bass.
Schneider, B. (1990) Organizational Climate and Culture. San Francisco: Jossey Bass.
Schneider, B. and Reichers, A.E. (1983) On the etiology of climates. Personnel Psychology, 36, 19–39.
West, M.A. (1994) Effective Teamwork. Leicester: British Psychological Society.
West M.A. (1996) Reflexivity and work group effectiveness: a conceptual integration. In M.A. West
(ed.), The Handbook of Work Group Psychology. Chichester: John Wiley, 555–79.
West, M.A. (1997) Developing Creativity in Organizations. Leicester: BPS Books.
West, M.A. and Markiewicz, L. (2004) Building Team Based Organisations. Oxford: BPS Blackwell.
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Further Reading about Patient Safety Incident
Management
Edmondson, A.C. (1996) Learning from mistakes is easier said than done: group and organizational
influences on the detection and correction of human error. Journal of Applied Behavioural Science, 32,
15–28.
Helmreich, R.L. (2000) On error management: lessons from aviation. British Medical Journal, 320, 781–5.
Institute of Medicine (2000) To Err Is Human: Building a Safer Health System, at
http://books.nap.edu/books/0309068371/html/index.html.
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