The Role of Teams in Shaping Quality of Obstetrical Care: A Cross-Sectional Study in Dire Dawa, Ethiopia


Gage, Anna, Bereket Yakob, Margaret McConnell, Tsinuel Girma, Brook Damtachew, Sebastian Bauhoff, and Margaret Kruk. 2022. “The Role of Teams in Shaping Quality of Obstetrical Care: A Cross-Sectional Study in Dire Dawa, Ethiopia.” BMJ Open 12. British Medical Journal Publishing Group: e066111. Copy at


Objectives To examine how characteristics of clinical colleagues influence quality of care.

Design We conducted a cross-sectional observational study examining the associations between quality of care and a provider’s coworkers, controlling for individual provider’s characteristics and contextual factors.Setting Nine health facilities in Dire Dawa Administration, Ethiopia, from December 2020 to February 2021.

Participants 824 clients and 95 unique providers were observed across the 9 health facilities.Outcome measures We examine the quality of processes of intrapartum and immediate postpartum care during five phases of the delivery (first examination, first stage of labour, third stage of labour, immediate newborn care and immediate maternal postpartum care).

Results For the average client, 50% of the recommended routine clinical actions were completed during the delivery overall, with immediate maternal postpartum care being the least well performed (17% of recommended actions). Multiple healthcare providers were involved in 55% of deliveries. The number of providers contributing to a delivery was unassociated with the quality of care, but a one standard deviation increase in the coworker’s performance was associated with a 2% point increase in quality of care (p<0.01); this association was largest among providers in the middle quartiles of performance.

Conclusions A provider’s typical performance had a modest positive association with quality of delivery care given by their coworker. As delivery care is often provided by multiple healthcare providers, examining the dynamics of how they influence one another can provide important insights for quality improvement.

Published paper (open access)

Last updated on 10/03/2022