BackgroundAlthough teamwork is known to optimise good health care, organisational arrangements and funding models can foster, discourage, or preclude functional teamworking. Despite a new, enhanced populationbased funding system for primary care in New Zealand, bringing new opportunities for more collaborative practice, fully implemented healthcare teamwork remains elusive.
AimTo explore perceptions of interprofessional relationships, teamwork, and collaborative patient care in New Zealand primary care practice.
Design of studyQualitative.
SettingEighteen nurses and doctors working in primary care, Wellington, New Zealand.
MethodData were collected using in-depth interviews with individual nurses and doctors working in primary care settings. Perceptions of, and attitudes about, interprofessional relationships, teamwork, and collaborative patient care were explored, using an interactive process of content analysis and principles of naturalistic enquiry.
ResultsNurses and doctors working in New Zealand primary care perceive funding models that include fee-forservice, task-based components as strongly discouraging collaborative patient care. In contrast, teamwork was seen to be promoted when health services, not individual practitioners, were bulk-funded for capitated healthcare provision. In well-organised practices, where priority was placed on uninterrupted time for meetings, open communication, and interprofessional respect, good teamwork was more often observed. Salaried practices, where doctors and nurses alike were employees, were considered by some interviewees to be particularly supportive of good teamwork. Few interviewees had received, or knew of, any training to work in teams.
ConclusionHealth system, funding, and organisational factors still act as significant barriers to the successful implementation of, and training for, effective teamwork in New Zealand primary care settings, despite new opportunities for more collaborative ways of working. 2 The resultant collaborative practice is an important principle of primary healthcare philosophy. This is when a range of different but complementary professional and personal skill sets are required to best meet multiple patient and community health needs. Despite these practical and theoretical advantages, effective teamwork is not necessarily easy and only occurs as universal practice when functional interprofessional relationships are actively fostered and supported. 3,4 A range of necessary precursors for effective teamwork in primary care settings has been repeatedly identified. This includes prior and/or concurrent interprofessional education, dedicated time for team development and reflection, appropriate leadership, and organisational and structural support. 5,6 However, teams working in primary health care are also heavily influenced by the funding and organisational arrangements within different health systems. Resource issues often act as significant barriers to open communication and interprofessional education.
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