Multidisciplinary Teamwork and Interprofessional Partnerships in Healthcare Setting: The Critical Ingredients

Abstract

This chapter provides an overview of the components of successful teamworking and partnership working. It outlines the numerous benefits of effective teamwork and its promise for safe, efficient, and quality care for patients. The chapter describes the challenges to effective teamworking in health care, and delineates the stages involved in joint working efforts as they evolve, highlighting the need for specific teamwork enablers at each stage. The chapter then details selected teamwork enablers, namely communication; the requisite expertise and competencies required; leadership and its types that lend themselves to partnership and teamworking; and power issues within multidisciplinary care settings, and their influences on collaboration. The chapter also communicates other critical factors for successful joint working, including personnel factors, personnel barriers, organisational factors, organisational barriers, and power-related factors, highlighting the interplay of many interlacing factors in joint working. Finally, it illustrates important considerations when evaluating joint and teamworking efforts that require attention, whilst emphasizing some challenges frequently encountered when appraising such initiatives, in terms of process, outcome, and impact measures. The chapter concludes by bringing together these factors in a simple model as a useful take home message for practitioners, professionals, and administrators embarking on teamworking and partnership endeavours.

1. Introduction

Teamworking, partnerships, collaboration, cooperation, coordination, and interorganizational, interagency, or interprofessional working have all been used to describe the broad phenomenon of harmoniously working together in order to deliver outcomes that are usually beyond the reach of any single individual or organization alone. Collaboration and teamwork are commonly interchangeably used terms [1]. Teamwork represents interactions between members of the team who pool their combined resources to complete the required tasks [2]. Any team is a group but not very group is necessarily a team [3]; groups grow into teams when they acquire mutual commitment and synergism among the membership [4].

Patient care is increasingly dependent on the collaboration of healthcare teams of different professional backgrounds, for instance, physicians, nurses, and therapists, to provide quality and comprehensive care. Multi/interdisciplinary teams are standard practice in numerous aspects of the provision of healthcare [5], rendering teamworking critical as such provision is premised on the conduct and attainment of the team rather than that of the individual [6, 7]. Such sharing of labor among physicians, nurses, and allied health practitioners entails that no individual practitioner can dispense a complete experience of care [8]. Increasingly, the maintenance and enhancement of the health of the public in an economically viable manner necessitates team-based care [9, 10]. This is due to the multifold benefits of effective teamworking.

2. Benefits of effective teamwork

Research evidence supports a positive association linking teamworking and care outcomes [11]. Policymakers, practitioners, and academics alike have increasingly underscored teamwork to accomplish safe and patient-centered outcomes, incorporating care across institutional borders, professional groups, and organizational boundaries [12]. An evolving raft of evidence depicts the important significance of teamwork at various stages of the care process and is acknowledged to be a key feature in improving patient care [2, 13]. Given that most care is now delivered by teams of experts and specialists [14], teamwork is characterized as a significant element of health service reform, crucial for care that is safe and efficient [15].

Multidisciplinary teamworking for care that is coordinated has great promise to improve the outcomes of patients while decreasing the costs and is essential for healthcare professionals to enhance efficiency at the same time as to avoid unnecessary harm to the patient [9, 16]. The advantages of efficacious teamworking in healthcare comprise decreased medical mistakes, improved care quality for patients, higher satisfaction of patients, enhanced contentment and retaining of staff, and decreased burnout of the healthcare personnel [17, 18]. Teams who are involved in teamwork procedures and practices are 2.8 times more likely to attain high accomplishment than those who are not [19].

Recently, a systematic review and meta-analysis has observed that care establishments need to acknowledge the benefits and merit of teamworking and highlight strategies and policies that sustain and enhance teamworking for the advantage of their patients [19]. Today, professionals concur that effective teamwork is associated with care that is both safe and effective at many strata of the healthcare organization [20, 21, 22]. Moreover, effective teamwork improves control over the working ecosystem and hence results in efficient use of time, effectiveness, satisfied patients, and reduced patient and practitioner strain and worry [23, 24, 25, 26].

However, merely establishing a team structure does not necessarily guarantee that it is likely to function effectively [27]. Enhanced and more economically viable patient outcomes are accomplished when health practitioners practice and acquire skills together, audit their clinical outcomes jointly, and transform routines to progress and innovate practice and service delivery [28]. Despite the prospective advantages of teamwork, not everyone wishes to work in teams, because not all teams are effective [6]. Benefits are harvested when better functioning teams make decisions that are of better quality, manage complicated tasks more effectively, and better coordinate activities and expertise [29, 30]. Indeed, the challenges to successful and efficacious teamworking are numerous.

3. Challenges to effective teamwork

It is acknowledged that teamworking in the field of healthcare is complex. Members of the team with different professional backgrounds, education, preparation, understanding, skills, approaches, and outlooks may work in different areas and shifts [31]. The team members’ turnover is traditionally high, and members frequently are unfamiliar with each other and might not value the abilities and skills of the individuals they are working with [31]. Furthermore, the power hierarchies that might operate within and between professions could hamper novice staff, or whole practitioner clusters, from being incorporated effectively as full members of the team [7].

Certainly, in practice, interprofessional teamworking could be challenging to accomplish due to a range of causes. These include cultural and training disparities and distinctions between the different professions, seeming and real interprofessional hierarchical pyramids, attitudes of staff and their experiences of working in an interprofessional manner, and the sometimes temporary makeup and sporadic character of teams in care settings [7, 32, 33, 34]. Thus, despite the growing evidence on the paybacks and advantages of teamworking care in clinical settings, the healthcare environment might remain rather resilient to the wider application of such team-based care models. This is due to system-wide barriers in addition to difficulties at the level of individual agencies that deliver the healthcare [9].

Enhancing our grasp and knowledge of the ways interprofessional teamworking is navigated and implemented across care and clinical settings is hence critical to guide tailored quality improvement strategies design effective training programs premised on consideration and awareness of the limitations of clinical practice [35].

4. Stages of joint working efforts

It is critical that practitioners and members of any team are conversant with the stage of development of a joint working initiative [36]. The formation stage happens at the instigation of funding and establishment of committees. This then progresses to the implementation phase, as committees undertake needs assessment to explore and ascertain the concerns of populations they are dealing with and accordingly design and generate intervention policies and strategies. The maintenance stage includes the follow-up, scrutiny, and continuation of the committees and actions. Finally, while the outcome phase consists of the impacts that were foreseen for the given intervention/s, the implication is that each stage, with its unique tasks, would require unique focus on some of the factors or teamwork enablers more than others (Figure 1).

Figure 1.

Stages of development of joint working (adopted from [36]).

5. Teamwork enablers

Successes emanate from the successful implementation of teams, rather than merely having such teams in place. The formation and continuation of operational and successful teams require time and determination and usually necessitate investment [27]. Indeed, members of “pseudo teams” reported observing more errors, incidents, and near misses; underwent more annoyance, bullying, and mistreatment from both the staff and patients; and reported less well-being and more worry and tension than individuals working in real teams [37].

5.1 Communication

Communication is imperative among the entire membership of a clinical team [38]. Increased extents of the tightly linked communication and teamwork are vital to moderate stress and waiting times and enhance patient safety [24], and poor communication and organizational factors were the most common features impeding effective teamwork [6].

Communication among health care professionals (HCP) is influenced by human factors and interpersonal relations [39], where collegial relationships support effective teamwork that results in better outcomes for both the clients and providers (e.g., [40]). However, contrary to teams in other work environments, members of care teams do not automatically view themselves as equals, categorizing themselves in a hierarchical order of HCP that disadvantages both communication and joint working [41]. Such hierarchical differences, power, and conflicts contribute to shaping how communication is instituted in the context of healthcare, causing different professional groups to work in parallel, to the disadvantage of teamworking [42, 43]. Organizational silence and the difficulties some HCP might encounter in expressing themselves in the presence of their coworkers are an obstacle to communication and teamwork [44].

When individuals fail to articulate and voice their worries, the challenges and difficulties that they note remain unchanged, and the culture of silence is further boosted, rendering team members less dedicated and devoted [43]. Malfunctions and disappointments commonly happen when communication is overdue to be helpful; content is neither always complete nor precise; important members are excluded, and concerns remain unsettled until the point of necessity and stress [45]. Most conflict situations occur when one/more member of the team is not appropriately kept in the loop [16]. Collaboration can uncover diverging interests, and joint working can be spoilt and muddled by communication challenges [16]. Communication is a vital competency that is characteristic of many substantially successful teams that operate in many environments and across various disciplines [46]. For instance, for a highly effective endoscopy unit team, efficacious communication is critical between members of the team to avoid unproductive, unhelpful, or even damaging types of communication [47]. For instance, a pertinent example of successful communication for an endoscopy team is that of closed-loop communication which entails a three-step process to ensure effective and clear communication [48].

5.2 Skills, expertise, and competencies

The power of teamworking lies in the collaboration forged between different individuals who possess different skill sets and knowledge, in order to face and solve a joint and collective challenge. Hence, for teams to function successfully and effectively, all members must recognize and appreciate the abilities and capabilities of every individual and coworker in the team [49]. Effective interdisciplinary teams are characterized by having an appropriate and complementary skill and practitioner mix, sufficient competencies, and balance of personalities, together with the capacity to make the most of other team members’ experience and timely replacement or cover for empty or absent posts [50].

A systematic literature review on teams within the context of medical care categorized these capabilities into three groups, namely, knowledge (e.g., shared task models, understanding of the situation, acquaintance with team members’ characteristics, appreciation of the objectives of the team, and the particular duties attached to each undertaking), skills (e.g., monitoring, adaptability, behavior, leadership of the effort, resolving disagreements and differences, feedback, communication), and attitude (e.g., team alignment and focus, combined effectiveness, collective and mutual vision, team interconnection, mutual trust, value and significance of working in teams) skills [51].

Research has noted that effective healthcare teams require competencies that include familiarity with the organizational objectives, plans, and approaches and dedication of their agencies; mutual respect for other team members; and obligation to joint working in order to attain good value and superior results [52]. Similarly, others highlighted a range of capacity domains that are critical when jointly working in partnership. These included educational capabilities, partnership building and maintenance abilities, engagement skills, change expertise, talents in formulating strategy and managing groups, and that those working in such initiatives need to appreciate and value one other’s expertise and abilities [53].

For these reasons, it is critical to select the appropriate team composition [54]. For instance, across endoscopy teams, instigating successful teams required focus on the highly effective qualities and warranted the proper attention to the team’s configuration to distinguish the amount of members and responsibilities required to undertake the necessary tasks in order to ascertain that initiatives were run with the appropriate number and quality of individuals needed to be fruitful and productive [47]. If composition appraisal is poor, resulting in a team that has less than optimal number of partners or insufficient participants that have the required competencies, such an effort is not likely to accomplish and achieve [47]. HCP are expected to regularly and consistently have a good flow of information and synchronize and join forces with others both in and beyond their official team, frequently with colleagues from distinctive professions, specializations or teams. Hence, the ongoing processes of “teaming” are the norm, and some authors view that as practically every individual participating in providing healthcare need and hence have teamworking abilities, competencies, and experience above and on top of their clinical expertise [55].

5.3 Leadership

Understanding the influence of leadership as well as systematically appraising its relationships with the accomplishment of outcomes in partnership initiatives and team working is important [56]. Leadership comprises a vital part in teams that operate in difficult settings [57], and within partnership working efforts, the attributes of the leadership, as well as knowledge, dedication, competencies, communication, and interpersonal interactions, are vital in accomplishing the teams’ goals [58]. For instance, there is evidence to show that in joint working environments, more than 25% of the leaders’ skills were explained by their communication skills and their operational understanding, highlighting the value of these critical qualities for the leaders of collaborative efforts [59]. Indeed, effective leaders are linked to team success, sense of fulfillment, and achievements [60], and in settings where patients were also part of the collaborative effort, respondents who perceived their leadership positively expressed more favorable rankings among 30 other partnership features compared to those who viewed the leadership in a less positive light [61].

A particular type of leadership that resonates with teamworking is shared leadership, described as a sharing and allocation of leadership working relationships, in a way that every member has a distinctive function that is strongly placed in the setting of the group [62]. Healthcare teams face many of the challenges that propel them toward such shared leadership. These include the high complexity of the tasks, as well as a high level of interdependence in settings that are time-sensitive and changing. Generally, leadership of care teams is associated with high workloads [63]; hence, the sharing of leadership responsibilities, duties, and chores may contribute to diminish the cognitive load encountered by leaders [64]. Research indicates that shared leadership might offer a beneficial way forward to enhance the impacts of teams operating in acute care environments [65], and the successes of shared leadership have been recognized in settings characterized by tasks that have great complexity [57].

Certainly, several systematic reviews and meta-analyses across many and varied team and organizational environments have confirmed the positive interactions between shared leadership and team outcomes [66, 67, 68]. Shared leadership is recognized to increase the success of team efforts, as well as efficiency and fulfillment and gratification, leading to greater collaboration, coordination, unity, trust and agreement, which collectively decrease the probability of interpersonal disagreements, task tensions, and process clashes [69, 70, 71]. Notwithstanding, hierarchical norms that are firmly entrenched in healthcare may offer considerable impediment to the success of shared leadership [72].

Other leadership formats that have been noted to be useful in partnership and teamworking situations include the notion of functional leadership [73]. This notion suggests that successful leaders take on particular leadership activities (e.g., managing personnel/material resources) as necessitated by the team and that leadership is achieved by formally and informally selected leaders. Other types include collaborative leadership that builds upon the concept of involving members in collective problem-solving [74] and content-oriented leadership that focuses on appreciating the duty and on challenges, where such leaders facilitate and encourage the managing of information, presenting the foundation for sense-making to members of the team by information search and exchange [73]. In addition, structuring leadership encompasses channeling and configuring team processes through coordinating the actions of the team such as the allocation of roles and resource management [73].

5.4 Power in multidisciplinary healthcare team settings

Power is the capacity to achieve decisions, act autonomously, and possess control/influence over others [75]. Fundamental to the concept of collaborative working is the construct of shared power [76]. The inherent features of medical teams might generate many differences in opinions and are associated with thorny issues of the distribution of power within a team [75]. As in generally the case with teams in many contexts, teamworking in medical teams is affected by power differentials and conflict [77, 78].

Historically, healthcare settings have been hierarchical in nature, assigning status to individuals premised on their profession, discipline, and scope of practice [79]. A substantial feature in malfunctions in healthcare settings is unequal power interactions that occur between/among members of the team in an occupational hierarchical pyramid [39, 80]. Power is a function of inter-individual relationships, rather than an attribute of a person [81]. In interdisciplinary settings, teamwork can be impeded by such hierarchy as those team members with less authority are less comfortable sharing their skills and knowledge with others [79]. The key impacts that stem from power discrepancies and disparities include negative influences on team collaboration, decision-making, communication, and overall performance [82, 83]. Researchers have advocated that patient safety research needs to explore and appraise the complicated relationships between power and teamworking in healthcare settings [82].

What emerges is that conflict is inevitable in teamworking [84]. Conflict is a feeling by the parties involved of differences, discrepancies, and mismatched wishes [85]. It can be categorized as task-related conflicts, pertaining to the execution of tasks; relationship conflict, connected to the personality clashes that surface as a consequence of contradictions relating to personal matters; and process conflict that is related to logistical or delegational issues [86, 87]. Such conflict situations might be initiated or perpetuated by differences in the opinions of the members of the team, as there is evidence that different team members or “stakeholders” might perceive the outcomes of their joint working effort differently [88]. Collectively, these situations draw attention to the critical value of interpersonal skills within the team, as well as conflict resolution abilities, and talents in being able to critique and comment on team performance in nonthreatening ways [89]. Successful teamwork is premised on the interlacing connections of various work processes, exchanges of members, and shared and reciprocal recognitions of knowledge and objectives [90]. Hence, team members need to possess and nurture positive and constructive relationships that are critical [91] and to contribute to mediating and resolving any emerging conflicts [25].

5.5 Other factors

A variety of requisite foundations for successful teamworking in healthcare settings have been acknowledged, including organizational and structural support [92, 93]. Teams functioning in primary healthcare are also greatly affected by the funding and organizational provisions of the given health system [94]. An organizational structure is required that facilitates collaboration among players from diverse sectors and specialties [95], as the structure presents and offers a setting for planning, communicating, managing, and evaluating [96]. Good teamwork is a cultivation of these factors.

6. The interplay of factors in joint working efforts

Figure 2 depicts a comprehensive picture of the operational, technical, and conceptual interlacing dimensions that interplay in partnership and teamworking. These comprise personnel factors, for example, expertise: experience; personnel barriers, for example, priorities, availability, and interest; organizational factors, for example, interactions, decision-making, and flow of information; organizational barriers, for example, differences, lack of participation, and goal setting; power-related factors, for example, power disparities, tensions, and team dynamics; as well as other factors, for example, personal traits, motivation, negotiating skills, tolerance, and patience. Attention is required to the barriers that need to be considered by teams. These encompass barriers of organization, of attitude, of vision, and of ignorance [98, 99].

Figure 2.

The multiple dimensions of joint working. Adapted and modified from Rogers et al. [97], Gottlieb et al. [96], El Ansari & Phillips [76].

7. Evaluation of joint and teamworking efforts

The wide range of factors that interplay in joint working efforts suggests that evaluations of such initiatives are not going to be straightforward. Evidence on the bearing and outcomes of collaborative efforts is affected by the multiplicity of perspectives and viewpoints of the involved members and conceptual features, as well as challenges in the measurement of the many notions that are included [100]. Some of the factors to be considered include the choice of macro or micro evaluation, of proximal or distal indicators, of short- and long-term effects, or of individual-level or collective-level outcomes. Such assortment in turn suggests the need for mixed methods evaluations using quantitative and qualitative methodologies that capture both the process as well as the outcomes [101]. Whereas measuring the outcomes of team and partnership efforts is necessary to gauge effectiveness, it is usually not sufficient, as in cases where the outcomes are suboptimal; it is only the processes that might be able to explain and shed light on the deficiencies that are encountered. Hence, the variables involved in the process of joint working need to be measured; the analysis of collaborative teamworking as a “process” then becomes imperative. In summary, members value information on whether the team was effective or otherwise (outcomes) and why (process).

8. Conclusion

Due to the numerous features and aspects that blend together to generate an effective collaborative teamworking effort, this chapter outlined insights to the interlacing features necessary for understanding such initiatives. If such efforts are to move past the rhetoric, numerous skills and varied expertise, beyond and above the clinical knowledge and know-how, need to be cultivated in the many facets of these endeavors. For such initiatives to deliver impact, many critical ingredients are requisite for success. In many instances, practitioners, professionals, and administrators might not be fully aware of the raft of intricately interlacing aspects that intertwine to render such schemes effective.