Health Care Teamwork: Interdisciplinary Practice and Teaching

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Teamwork in health is defined as two or more people who interact interdependently with a common purpose, working toward measurable goals that benefit from leadership that maintains stability while encouraging honest discussion and problem solving [1]. Researchers have found that integrating services among many health providers is a key component to better treat undeserved populations and communities with limited access to health care [2]. As the name implies, teamwork in health care employs the practices of collaboration and enhanced communication to expand the traditional roles of health workers and to make decisions as a unit that works toward a common goal [3].

The Canadian Health Services Research Foundation [4] found that teams function better when they have a clear purpose and implement protocols and procedures. Also important is the use of meetings and other communication methods to discuss patient results, share information, and debate suggestions to improve performance [5]. Teamwork and collaboration are especially essential to care of patients in a decentralized health system with many levels of health workers [2].

Health care, by definition, is a multidisciplinary profession in which doctors, nurses, health professionals from different specialties must work together, communicate often, and share resources [3]. Health teams are often made up of a variety of professionals — called cadres in health care — each with specialized knowledge and responsible for different tasks. These multidisciplinary teams are made up to solve health problems [4].

Teams can also work together to develop health promotion for diverse communities and instill disease prevention behaviors amongst patients [2]. Teamwork became an important health intervention for a number of reasons.

The Importance of Interprofessional Practice and Education in the Era of Accountable Care

First, clinical care is becoming more complex and specialized, forcing medical staffs to attempt complicated health services and quickly learn new methods. Aging populations, the increase of chronic diseases like diabetes, cancer, and heart disease have forced medical staffs to take a multidisciplinary approach to health care [ 6 , 7 ]. In countries like the United States, medical teams must manage patients suffering from multiple health problems [8]. Other countries are also concerned with increasing access to health care for diverse populations.

In Brazil, health teams train to intimately understand the needs of patients, but also of local communities and different cultures [2]. Secondly, researchers have found that working together reduces the number of medical errors and increases patient safety [ 9 , 10 ]. Of these, primary care is perceived to have the least likely level of success with interdisciplinary team work. Indeed, some commentators suggest that an interdisciplinary culture may only be possible as new generations of healthcare professionals enter the workforce [ 27 ]. Similarly, there is a lack of data identifying the processes of interdisciplinary team work and linking these with outcomes.

Studies tend to focus on processes or outcomes, but rarely both; or explore components of what defines an interdisciplinary team, without providing a clear guide on the attributes of good interdisciplinary team practice. This paper draws on a published systematic review of the literature [ 28 ], combined with empirical data derived from interdisciplinary teams involved in the delivery of community rehabilitation and intermediate care services CRAICs , to develop a set of competencies around effective interdisciplinary team practice.

CRAICs in England are community-based services frequently offering care for the elderly aimed at preventing admissions and facilitating earlier discharge from acute care. They exemplify the practice of interdisciplinary team work. Typically, CRAICs employ at least four different staff types, including nurses, physiotherapists and occupational therapists [ 29 ].

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They often exhibit high levels of joint working and role sharing, and employ a large proportion of support workers who, when used appropriately, have been shown to facilitate interdisciplinary practice in this setting [ 29 ]. However, previous research by our team found a great deal of variety in the way that teams work together, and their levels of effectiveness as teams [ 30 ].

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In response, we developed an Interdisciplinary Management Tool IMT which was implemented iteratively, using an action research approach with 11 teams to explore the impact of the tool on those teams and their patient outcomes [ 31 ]. This research formed part of a much larger project designed to develop, implement and evaluate an intervention to enhance interdisciplinary team work [ 28 ] through the development of an IMT [ 32 ].

The IMT is a structured change management approach which marries published research evidence relating to interdisciplinary team work with the tacit knowledge of the particular team to develop a tailored approach to optimize their interdisciplinary team work [ 33 ]. Development of the tool involved three systematic reviews, interactions with team members using an action research methodology, and capturing extensive, detailed qualitative and quantitative feedback from teams and service users.

The findings presented in this paper draw on a systematic review of the literature relating to the components of interdisciplinary team work and the qualitative data derived from the implementation of the IMT. Themes from these two perspectives were then examined for areas of agreement and dissonance to arrive at a set of competencies for good interdisciplinary team work. The systematic review, reported and published in full in the main study report [ 31 ], first considered quantitative studies; in particular randomised controlled trials RCTs published and unpublished between and , that evaluated the process and outcomes of different interprofessional staffing models.

Reference lists associated with the identified reports and articles were also searched for additional studies. Results were limited to English language articles in recognition of the importance of cultural factors in team work, and issues relating to differences in terminology for example, multi-, inter-, trans- and cross- disciplinary working. A total of studies, including 11 systematic reviews or meta-analysis, were reviewed and analysed; however, only were usable based on the supporting level of contextual detail.

Data on team effectiveness was extracted along with details on team processes, coordination, and leadership; all elements identified as important in the earlier concept analysis of the interdisciplinary team [ 18 ]. In the absence of mixed-method studies, suggested as a priority for future research by a recent review [ 34 ], the team designed a supplementary review strategy.

This strategy examined findings from qualitative research on interprofessional team processes, independent from the RCTs. Inclusion criteria for the supplementary review were studies between and involving an interprofessional team in CRAICs which included data focused on team processes. This complementary review identified 20 studies to supplement previous findings. The findings of the separate evidence bases from qualitative and quantitative studies were brought together and isolated to a data extraction table.

Themes were identified using a constant comparative method [ 35 ] and then each study was coded appropriately. The constant comparative method involves the incorporation, collation and comparison of newly collected data with existing or previous data collected from earlier studies. Thematic synthesis was used to look for common patterns across studies [ 36 ]. Eleven CRAICs, including staff were recruited to participate in an action research study, which examined the impact of implementing the IMT on service provision and outcomes for patients and staff.

All participating team members provided written consent for their involvement in this research. The IMT intervention was implemented through a series of semi-structured workshops with the support of a trained facilitator. The workshop outcomes were detailed in reports and action plans that guided the implementation of their proposed changes. These reports and plans provided the basis of the data for the team perspectives.

Background

The data were entered into NVivo version 8. Through the use of the constant comparative method, the thematic synthesis of the literature identified sixteen analytical themes with up to 12 descriptive characteristics in each theme. These themes highlight the defining characteristics of interdisciplinary team work. They recognize the important role that leadership plays for the complex communication and coordination necessary among different groups of professionals and non-professionals. They also demonstrate the need for both flexibility and clarity of roles when the bodies of knowledge of distinctive professional groups are shared, protected, and preserved.

These two thematic analyses were then combined with the themes identified from the systematic review to form a single theoretical framework to define the characteristics of a good interdisciplinary team. The high level of concordance across the three sources is illustrated. It is interesting to note that an audit of intermediate care, published after this study was completed, recognized weaknesses in strategic planning by commissioners [ 37 ], which was highlighted as a reason for the lack of clear vision by team members in this study. Triangulation of the data sources to identify the characteristics of a good interdisciplinary team.

Not surprisingly, the team participants did not raise any challenges or issues related to individual characteristics. This illustrates the value of combining data anonymously reported in the literature with primary data from the teams themselves.

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While the interaction of individual characteristics is fundamental to the way the team functions, it is unlikely to be directly affected by team actions, with the exception of changing recruitment criteria. However, one of the outcomes of the larger IMT intervention undertaken as the main part of the study was that some teams perceived that they were able to develop individual competencies which better prepared them to work as a member of an interdisciplinary team.

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These characteristics can be re-formulated as competency statements that an effective interdisciplinary team functioning at a high level might be expected to demonstrate. Identifies a leader who establishes a clear direction and vision for the team, while listening and providing support and supervision to the team members. Demonstrates a team culture and interdisciplinary atmosphere of trust where contributions are valued and consensus is fostered. Ensures appropriate processes and infrastructures are in place to uphold the vision of the service for example, referral criteria, communications infrastructure.

Provides quality patient-focused services with documented outcomes; utilizes feedback to improve the quality of care. Utilizes communication strategies that promote intra-team communication, collaborative decision-making and effective team processes.

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Climate Team culture of trust, valuing contributions, nurturing consensus; need to create an interprofessional atmosphere. Individual characteristics Knowledge, experience, initiative, knowing strengths and weaknesses, listening skills, reflexive practice; desire to work on the same goals. Why is Motivation Important in Health Care? View or change your orders in Your Account. This study has not examined the interaction between the characteristics of interdisciplinary teams and it is possible that there is some interdependence between some of the characteristics. Methods This research formed part of a much larger project designed to develop, implement and evaluate an intervention to enhance interdisciplinary team work [ 28 ] through the development of an IMT [ 32 ].

Provides sufficient team staffing to integrate an appropriate mix of skills, competencies, and personalities to meet the needs of patients and enhance smooth functioning. Facilitates recruitment of staff who demonstrate interdisciplinary competencies including team functioning, collaborative leadership, communication, and sufficient professional knowledge and experience.

Facilitates personal development through appropriate training, rewards, recognition, and opportunities for career development. In addition, our study identified the need for teams to regularly invest time in the processes of team development and maintenance of team functioning to ensure that these competencies are entrenched and enacted in their daily practice. Recognition of such time is frequently omitted from randomized controlled trial evidence of interprofessional working and is correspondingly overlooked when performing cost effectiveness evaluations.

The systematic review, which sought to identify quantitative studies detailing the outcomes of different staffing models, proved most amenable to conventional methods of systematic review and did not require significant amendment from its original protocol.

However given the acknowledged absence of such studies [ 34 ], the best available solution was to bring together the two evidence bases and then to triangulate them with rich primary qualitative research data. This study has not examined the interaction between the characteristics of interdisciplinary teams and it is possible that there is some interdependence between some of the characteristics.

For instance, previous research suggests that good leadership may be required for the team to have strong clarity of vision [ 39 ]. Further exploration and validation is required to examine whether any causal relationships exist between the different components of interdisciplinary team work. The facilitation process used in the workshops in this study was informed by the available literature, and therefore has the potential to bias the results from the teams. The risk of researcher bias was lessened by having the teams facilitated by six different facilitators.

It is notable that the views of the teams, and the issues they faced, were all similar. The high level of concordance between the published literature and the findings from the teams suggests strong face validity for the characteristics described and competencies proposed in this paper. The results presented in this paper are derived from interdisciplinary teams involved in the delivery of CRAICs. As such, they involve a specific, but broad, range of disciplines.

Previous literature has shown that these groups are typified by being non-medically led, non-hierarchical and fairly democratic in their approaches [ 24 ]. This research, and previous research [ 30 , 31 ], also found a great deal of heterogeneity in the structure and organization of these teams. It is therefore not possible to assume that these findings are relevant to all interdisciplinary teams.

Further research will be required to examine the generalizability of these characteristics and competencies beyond this paper. By establishing a broad set of competencies to guide interdisciplinary team work it moves towards the identification of a suite of processes to which teams can adhere, and sets up mechanisms and areas for improvement. As the published literature demonstrates, few existing interventions around interdisciplinary team work focus on these competencies and processes to implement them.

Why is Teamwork in Health Care Important?

Instead such studies tend to examine a single mechanism to support interdisciplinary team work. The characteristics and competencies identified in this study provide a framework for investigating good interdisciplinary team work, how it might be examined in different contexts, and how teams might identify interventions to improve or optimize their interdisciplinary team work. Interdisciplinary health care teams face a set of challenges that are not necessarily encountered by other types of teams such as unidisciplinary or non-health care teams.

These challenges include the contentious nature of sharing professional roles and expertise, planning and decision-making, while delivering quality patient care within complex contexts. This paper combines quantitative and qualitative insights from the published literature with empirical data derived from the experiences and insights of interdisciplinary teams working in CRAICs to identify the characteristics of a good interdisciplinary team. Our research has drawn together these sources of evidence to elicit a theoretical understanding and develop a framework to define the characteristics of interdisciplinary team work and presented these as competencies for effective interdisciplinary team work.

These outcomes now need to be validated with other types of interdisciplinary teams to determine their level of transferability to other teams and contexts. Community rehabilitation and intermediate care services; IMT: Interdisciplinary Management Tool; UK: SN, PE and AS conceived the original project and obtained the funding, were involved in the data collection, analysis, preparation of the final report and drafting and amending the final manuscript.

SA was involved in all stages of the project implementation, data collection and analysis, drafting the final report, and contributed to this manuscript. AR performed further analysis, drafting and compilation of the final report. All authors read and approved the final manuscript. Department of Health disclaimer: National Center for Biotechnology Information , U. Journal List Hum Resour Health v. Published online May Received Nov 19; Accepted Apr This article has been cited by other articles in PMC.

Abstract Background Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries.

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Method This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over staff from 11 community rehabilitation and intermediate care teams in the UK. Results Ten characteristics underpinning effective interdisciplinary team work were identified: Conclusions We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

Drinka , Phillip G. The Science and the Art of Interdisciplinary Practice.

Leadership and Power for Interdisciplinary Practice. Team Members as Learners and Teachers. Interdisciplinary Practice and Teaching Theresa J. Theory, Research, and Practice Gary M.