285Cromb D, et al. Arch Dis Child Educ Pract Ed 2017;102:285–288. doi:10.1136/archdischild-2017-313825
Abstract
Objectives  To understand the effect of
attendance at departmental Christmas parties on
cohesion and teamwork within the healthcare
setting.
Method (design/setting/participants/
interventions/outcome measures)  We used the
‘Team Development Measure’ questionnaire to
assess team cohesiveness among healthcare
professionals before and after departmental
Christmas parties took place. A pooled mean
score (PMS) of responses was used to compare
between groups.
Results  There were no significant
differences in perceived measures of team
cohesion when comparing responses
before (PMSbefore
=1.86±0.20) and after
(PMSafter
=1.91±0.22) the departmental
Christmas party (p=0.37), nor was there
a significant difference when comparing
responses from attendees (PMSbefore
=1.83±0.23,
PMSafter
=1.89±0.24, p=0.52) or non-attendees
(PMSbefore
=1.84±1.47, PMSafter
=1.83±0.15,
p=0.91). No difference was observed between
professional groups (PMSdoctors
=1.85±0.23,
PMSnurses
=1.95±0.18, p=0.064).
Conclusion  Attendance at departmental
Christmas parties does not seem to result in
improved team cohesion.
Introduction
‘The family that plays together stays to-
gether.’
     A Scalpone, 19671
Anecdotal evidence suggests departmental
Christmas parties are commonplace
among medical institutions in the
UK. The expected benefits of Christmas
parties to improve staff morale and sense of
organisational value have been frequently
quoted but there is little in the way of
empirical evidence. Indeed, Christmas
parties in the non-health sector have
been declining in the past few years, with
up to 18% of employees reporting that
no Christmas celebration was offered.2
Appetite from employees to attend is also
waning, with 37% of employees deciding
not to attend their staff Christmas parties,
most commonly because of wanting to
keep home and work life separate, or due
to other family circumstances.3
There have been significant concerns
in recent years over the declining morale
of the healthcare workforce in the UK,
including issues with recruitment, contractual
disputes and financial remuneration
for medical and nursing staff in the UK
National Health Service.4 5
Paediatrics in
particular has seen reductions in workforce
among doctors and is recognised as
an area of staffing need.6
In the absence of an effective policy
lever to address these issues, we hypothesise
that the departmental Christmas party
What this study adds?
►► Departmental Christmas party attendance
does not appear to significantly affect
measures of team cohesion within the
healthcare setting.
►► A significant proportion of healthcare
workers were unable to attend a
departmental Christmas party because
they had to work themselves.
Review
The team that plays together stays
together: the effect of departmental
Christmas party attendance on team
cohesion within a healthcare setting
Daniel Cromb,1
Helen Thomas,1
Martin Garcia-Nicoletti,2
Ronny Cheung2
►► Additional material is
published online only.To view
please visit the journal online
(http://​dx.​doi.​org/​10.​1136/​
archdischild-​2017-​313825).
1
Department of General
Paediatrics, Croydon University
Hospital, Croydon, UK
2
Department of General
Paediatrics, Evelina London
Children’s Hospital, London, UK
Correspondence to
Dr Daniel Cromb, Department
of General Paediatrics, Croydon
University Hospital, Croydon,
CR7 7YE, UK; ​daniel.​cromb@​
nhs.​net
Received 28 July 2017
Accepted 15 September 2017
To cite: Cromb D,Thomas H,
Garcia-Nicoletti M, et al.
Arch Dis Child Educ Pract Ed
2017;102:285–288.
What is already known on this topic?
►► Workforce morale in hospitals in the UK is
declining, particularly within paediatrics,
and attempts to tackle this are required.
►► There are no studies investigating the
effect of Christmas parties on team
cohesion within the healthcare setting.
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Cromb D, et al. Arch Dis Child Educ Pract Ed 2017;102:285–288. doi:10.1136/archdischild-2017-313825286
Review
Table 1  Demographics of those participating in the study
Cohort Doctors Nurses Other
Preparty
questionnaires
completed
Postparty
questionnaires
completed Attendees Non-attendees
CUH 10 3 0 13 13 8 5
ELCH 12 12 2 21 17 15 11
Total 22 15 2* 34 30 23 16†
*Other: 1× healthcare assistant, 1×not stated.
†Reasons given for non-attendance included: working (n=9); prior plans (n=5); away on holiday (n=1); don’t feel like part of the team (n=1).
CUH, Croydon University Hospital; ELCH, Evelina London Children’s Hospital.
is an effective adjunct to financial reward systems and
may serve to improve clinical outcomes through better
team cohesion and morale. We report a prospective
multicentre observational study to investigate the
effect of a departmental Christmas party on self-reported
perception of team morale.
Methods
Study design
We used the ‘Team Development Measure’ questionnaire
(TDMQ) to assess team cohesiveness among
healthcare professionals in general paediatric wards at
two different London-based hospitals (Evelina London
Children’s Hospital (ELCH) and Croydon University
Hospital (CUH)) both before and after departmental
Christmas parties. The TDMQ was designed to
measure team functioning and how this might affect
clinical outcomes, and has been used previously to
measure team development in clinical care settings.7
For this study, the wording of some of the questions
was edited to ensure that a response of ‘strongly
disagree’ (resulting in a score of 0) was always associated
with a negative answer, and a response of
‘strongly agree’ (resulting in a score of 3) was always
associated with a positive answer. This allowed us to
average across responses on the questionnaire in order
to produce a ‘pooled mean score’ (PMS) which could
be used to compare between groups. Online supplementary
appendix 1 shows the full questionnaire sent
to participants.
Settings
ELCH is a tertiary children’s specialist hospital with
167 paediatric inpatient beds and several specialist
paediatric services. The study was conducted among
staff of the 42-bedded general paediatric ward. CUH
is a district general hospital with 20 general paediatric
inpatient beds and a 28-bedded level 2 special care
baby unit.
The intervention
The intervention in both settings was a seasonal paediatric
departmental social gathering—the ‘Christmas
Party’. Several key elements were prospectively identified
to ensure a degree of concordance between
the two sites, including the provision of food, drink,
music and dancing. It was not possible to mandate or
prespecify the precise dosage or delivery schedule for
each of these elements. The paediatric departmental
Christmas parties at both sites were organised by the
teams themselves and held in local establishments. We
were unable to obtain a grant to fund the ‘interventions’
at either site.
Study population and data collection
The TDMQ was administered to staff members
working on the general paediatric ward at ELCH and
the Special Care Baby Unit, a neoantal unit providing
level 2 care at CUH, approximately 2 weeks before and
1 week after the intervention. Data were also collected
about individual responders’ intentions regarding
Christmas party attendance (before) and whether or
not they actually went (after), along with information
about job title/role and reasons for non-attendance (if
applicable). Questionnaire responses were pseudonymised
using unique participant identifiers. Responses
were collated into groups according to attendance
or non-attendance. Before and after responses were
then linked for those subjects who had completed
both questionnaires, and the analysis repeated for this
subgroup.
Unfortunately, no participants gave consent for realtime,
in situ ethnographic analysis during the interventions
themselves. However, implied consent was
obtained through the completion and return of the
questionnaires.
Outcome measure
The primary outcome measure was the PMS on the
TDMQ before and after the intervention.
Patient and public involvement
Patients and public were not involved in the conception,
implementation or analysis of findings. The rationale
for this approach is available from the authors on
request, but should be self-evident.
Statistical analysis
Statistical analysis was performed using GraphPad
Prism software (V.6.0, GraphPad Software, La
Jolla, USA).
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Cromb D, et al. Arch Dis Child Educ Pract Ed 2017;102:285–288. doi:10.1136/archdischild-2017-313825 287
Review
Results
A total of 64 questionnaires were completed from
39 individual participants. Of these, 25 participants
completed both the before and after questionnaires.
Table 1 shows further demographics of the participants.
Changes in team cohesion before and after the
departmental Christmas party: all responders
The PMS (±SD) score for all responders (n=34) for
the questionnaire before the Christmas party was 1.86
(±0.20) (95% CI 1.79 to 1.93). The PMS (±SD) score
for all responders (n=30) for the questionnaire after
the Christmas party was 1.91 (±0.218) (95% CI 1.83
to 1.99). The difference between these two groups was
not significant (p=0.37).
Changes in team cohesion among responders who
completed both the before and after questionnaires
Twenty-five responders completed both the before
and after questionnaires. The PMS (±SD) for the
before questionnaire was 1.84 (±0.21) (95% CI 1.75
to 1.92). The PMS (±SD) for the after questionnaire
was 1.87 (±0.22) (95% CI 1.78 to 1.96). The difference
between these two groups was not significant
(p=0.57).
Changes in team cohesion for those who attended
The PMS (±SD) for those who completed both the
before and after questionnaires and did attend the
departmental Christmas party (n=18) was 1.83
(±0.23) (95% CI 1.72 to 1.95) before the party and
1.89 (±0.24) (95% CI 1.77 to 2.01) afterwards. While
the PMS was higher after the Christmas party for this
cohort than before, the difference between the two
scores was not significant (p=0.52).
Changes in team cohesion for those who did not attend
The PMS (±SD) for those who completed both the
before and after questionnaires and did not attend
the departmental Christmas party (n=7) was 1.84
(±1.47) (95% CI 1.71 to 1.98) before the party and
1.83 (±0.15) (95% CI 1.70 to 1.97) afterwards. While
the PMS was lower after the Christmas party for this
cohort, the difference between the before and after
scores was not significant (p=0.91).
Comparison of team cohesion as reported by doctors and
nurses
The PMS (±SD) for all completed questionnaires (ie,
both preparty and postparty) from doctors who participated
in the study (n=40) was 1.85 (±0.23) (95%
CI 1.78 to 1.92). The PMS (±SD) for all completed
questionnaires (ie, both preparty and postparty) from
nurses who participated in the study (n=21) was 1.95
(±0.18) (95% CI 1.87 to 2.04). While the PMS was
higher for nurses than for doctors, the difference
between the two groups was not significant (p=0.064).
Discussion
To our knowledge, this is the first study to investigate
the relationship between staff Christmas parties
and changes in team cohesion in the medical setting.
Although there was a trend towards an improvement
in team cohesion among paediatric clinical staff
following a Christmas party, this did not reach statistical
significance, either as a cohort or an individual
basis. No significant difference was observed between
professional groups.
There was a negative trend in the perception of team
cohesion after the party among those subjects who did
not attend. A lower average score on the TDMQ might
be expected among those with no interest in attending
a staff Christmas party; however, this result persisted
even when only looking at those who completed both
before and after questionnaires. It is possible that this
may be due to a feeling of being ‘left out’. This effect
may have been exaggerated among the high proportion
of staff unable to attend due to work commitments
(23%) who had the choice of not attending. Further
formal qualitative analysis is required to explore this
effect.
Strengths and limitations of study
The study population was relatively small. We encountered
significant difficulties with study recruitment due
to planned staff absence during the holiday season.
Contacting participants at the 1-week follow-up questionnaire
was also challenging, and future studies
should factor in the ability of Christmas party participants
to regain full cognitive function within the
follow-up period. Any similar effect on the study
authors themselves, while possible, was deemed by
internal review to be highly unlikely.
The pragmatic decision to deliver a naturalistic
rather than standardised intervention no doubt
impacted on our ability to interpret the results.
However, it was not possible to deliver identical interventions,
nor did we believe this was a realistic reflection
of their use in vivo. We mandated the inclusion
of standardised components (food, drink, music and
dancing) as a pragmatic means to increase uniformity
among the two interventions. However, it is likely
that any effect of any of these components would be
dose related, and the dose–effect relationship is likely
to be non-linear. Future studies should include the
analysis of potential interaction effects between each
component variable.
We did not account for all factors relating to the
nature of the participants. Without the use of functional
MRI, we were also unable to account for the
presence or otherwise of the ‘Christmas Spirit’ neuronal
network in individual participants.8
No time allowances
were made for how long respondents had been
a part of the team. The presence of senior staff during
the intervention itself may have reduced any positive
effect size, and follow-up studies might consider staff
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Cromb D, et al. Arch Dis Child Educ Pract Ed 2017;102:285–288. doi:10.1136/archdischild-2017-313825288
Review
seniority as an exclusion criterion (from participation
in the intervention, rather than its funding, naturally).
ELCH and CUH are located in demographically
distinct areas. Future studies might also attempt to
account for environmental factors such as area demography,
or multilevel random effects modelling for
dependent factors such as cost per person, or party
venue quality (eg, ‘Scores on the Doors’9
). Further
studies might consider a cluster randomised controlled
design—although we foresee significant challenges
with adherence to study protocol among those departments
randomised to the non-intervention arm.
Conclusion
We have been unable to find evidence from this
study that attending a staff Christmas party results in
an improved perception of team cohesion within a
healthcare setting. Findings should be interpreted with
caution, and future studies should take into account
methodological flaws outlined above in order to minimise
Heterogeneity versus Uniformity in Medical
Bayesian Unidirectional Geostatistical (‘HUMBUG’)
bias.
Contributors  DC designed the study, planned and performed the data
analyses, and wrote and revised the manuscript. HT collected data and wrote
and revised the manuscript. MG-N collected data and revised the manuscript.
RC initiated and designed the study, supervised data collection and analyses,
and wrote and revised the manuscript. RC is the guarantor.All authors have
full access to data (including statistical reports and tables) in the study and can
take responsibility for the integrity of the data and the accuracy of the data
analysis.
Disclaimer  The guarantor affirms that the manuscript is an honest, accurate
and transparent account of the study being reported; that no important aspects
of the study have been omitted; and that any discrepancies from the study as
planned (and, if relevant, registered) have been explained.
Competing interests  None declared.
Ethics approval  This study did not involve patient data or care, and was
deemed a service evaluation/improvement project with corresponding analysis;
therefore institutional ethics approval was not required.
Provenance and peer review  Not commissioned; internally peer reviewed.
Data sharing statement  Full data from the study are available from the
authors upon request.
© Article author(s) (or their employer(s) unless otherwise stated in the text of
the article) 2017.All rights reserved. No commercial use is permitted unless
otherwise expressly granted.
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healthcare setting
attendance on team cohesion within a
the effect of departmental Christmas party
The team that plays together stays together:
Daniel Cromb, Helen Thomas, Martin Garcia-Nicoletti and Ronny Cheung
doi: 10.1136/archdischild-2017-313825
2017 102: 285-288Arch Dis Child Educ Pract Ed
http://ep.bmj.com/content/102/6/285
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References
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