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The U.S. Department of Defense (DoD) Patient Safety Program Office of the TRICARE Management Activity (TMA) provides training and support for the health-care facilities operated by military services to help strengthen their use of effective teamwork practices. In 2002, TMA funded a study aimed to assess the effects of teamwork training for labor and delivery teams on patient safety and other outcomes for mothers and newborns (Nielsen et al., 2007). The study presented in this report is a successor to the 2002 study, with the goal of addressing a number of the issues raised from the earlier study's findings. Using a case-study design, the study has focused on learning from the experiences of five labor and delivery units in implementing teamwork practices for the staff working in their units. Through a combination of process and outcome assessments, using site visits, interviews, staff surveys, and analysis of patient outcomes, the study sought to understand what is required for health-care organizations to achieve effective and sustainable teamwork practices. This study of teamwork-improvement initiatives in hospital labor and delivery (L&D) units was designed to document and learn from the experiences and outcomes of five L&D units as they implemented improvements in their teamwork practices over a one-year period. The study had the following objectives: (1) Better understand the conditions and actions required for hospital L&D units to achieve effective and sustainable teamwork practices, and (2) Assess the extent to which successful adoption of teamwork practices may influence the experiences of L&D staff and patient outcomes. Five hospitals participated in the study: two military and three civilian hospitals., Prepared in cooperation with the RAND Forces and Resources Policy Center, Santa Monica, CA.