A meta-ethnographic review of interprofessional teamwork in hospitals: what it is and why it doesn’t happen more often

Abstract

Objectives Although interprofessional teamwork has been shown to improve patient safety, it is not yet routine practice in most hospital settings. There is also a lack of clarity regarding what teamwork actually means, with terms such as collaboration, coordination, networking and knotworking often being used interchangeably. In this study, we analyse 20 years of qualitative research on interprofessional teamwork in hospital settings and examine what it looks like and the factors influencing it. Methods The literature search included articles published between 1996 and 2016, and articles were included if they examined interprofessional teamwork within a hospital using qualitative methodology. We used meta-ethnographic analysis of eligible primary studies applying reciprocal translation and line of argument synthesis. Results Nineteen articles were included. Interprofessional teamwork was largely absent in acute care and found to be influenced by systems perpetuating power imbalances, organizational practices that interfered with interprofessional interactions, representations of teamwork and leadership. Conclusions Future strategies to improve interprofessional practices should include policies and structural changes to develop healthcare systems that facilitate these practices.

'Team capital’ in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS

“…3 7-9 However, the definition of an 'effective team' or 'effective teamwork' remains contested by academics, policymakers and practitioners. 6 In a recent paper, Dixon and Wellsteed 22 evaluated a structured team-based learning approach to QI in two teams: one consisting of nurses and the other 8 Montgomery C, et al BMJ Open Quality 2020;9:e000948. doi:10.1136/bmjoq-2020-000948…”

“…Front-line staff charged with improving patient experience may have little experience or expertise in QI, and the kinds of teamwork practices required to achieve it. While there is substantial literature around effective teamwork in healthcare generally, [1][2][3][4][5][6][7][8][9][10] the specifics of QI teams are less well studied. Staff who may be well used to teamworking in the context of clinical care may find these patterns of working relationships do not transfer straightforwardly to QI, where the issues may be different.…”

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people

“…Currently, there is equivocal evidence about how to develop effective multidisciplinary working cultures 60. Some positively deviant teams purposively developed the characteristics over time, for example, by creating AHP workspaces and incorporating introductions at safety briefings.…”

Discussing teamwork in health care: from interprofessional collaboration to coordination and cooperation

“…In spite of the pervasiveness of the concept of IPC in the teamwork in health care literature, numerous scholars have observed that IPC was not implemented in daily clinical work (Michel, ; Petit Dit Dariel & Cristofalo, ; Rice et al, ). To explain these observations, some scholars argued that teams had failed to collaborate (Michel, ; Rice et al, ).…”

“…In contrast, however, these observations may indicate a problem with the concept of collaboration. To move away from a dichotomised view of IPC as either achieved or not, there is a need to adopt a more nuanced conceptualisation of interactions between health care professionals (Dow et al, ; Petit Dit Dariel & Cristofalo, ; Reeves et al, ). This could lead to policies and educational interventions that target more achievable forms of teamwork.…”