A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses (original) (raw)
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What do doctors mean when they talk about teamwork? Possible implications for interprofessional care
Journal of Interprofessional Care, 2018
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
Hierarchical medical teams and the science of teamwork
The virtual mentor : VM, 2013
The current view is that medical students, residents, fellows, and doctors alike are taught to think, feel, and behave in ways that hinder participation in care teams. Medical students internalize the hierarchy as early as their undergraduate classes . Rather than enhancing team performance, these internal power hierarchies diminish the effectiveness of these critical work teams.
“Teamwork in hospitals”: A quasi-experimental study protocol applying a Human Factors approach
http://isrctn.com/, 2017
Background: Effective teamwork and sufficient communication are critical components essential to patient safety in today's specialized and complex healthcare services. Team training is important for an improved efficiency in inter-professional teamwork within hospitals, however the scientific rigor of studies must be strengthen and more research is required to compare studies across samples, settings and countries. The aims of the study are to translate and validate teamwork questionnaires and investigate healthcare personnel's perception of teamwork in hospitals (Part 1). Further to explore the impact of an inter-professional teamwork intervention in a surgical ward on structure, process and outcome (Part 2). Methods: To address the aims, a descriptive, and explorative design (Part 1), and a quasi-experimental interventional design will be applied (Part 2). The study will be carried out in five different hospitals (A-E) in three hospital trusts in Norway. Frontline healthcare personnel in Hospitals A and B, from both acute and non-acute departments, will be invited to respond to three Norwegian translated teamwork questionnaires (Part 1). An inter-professional teamwork intervention in line with the TeamSTEPPS recommend Model of Change will be implemented in a surgical ward at Hospital C. All physicians, registered nurses and assistant nurses in the intervention ward and two control wards (Hospitals D and E) will be invited to to survey their perception of teamwork, team decision making, safety culture and attitude towards teamwork before intervention and after six and 12 months. Adult patients admitted to the intervention surgical unit will be invited to survey their perception of quality of care during their hospital stay before intervention and after six and 12 month. Moreover, anonymous patient registry data from local registers and data from patients' medical records will be collected (Part 2). Discussion: This study will help to understand the impact of an inter-professional teamwork intervention in a surgical ward and contribute to promote healthcare personnel's team competences with an opportunity to achieve changes in work processes and patient safety. Trial registration: Trial registration number (TRN) is ISRCTN13997367. The study was registered retrospectively with registration date 30.05.2017.
Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare
Modern healthcare is delivered by multidisciplinary, distributed healthcare teams who rely on effective teamwork and communication to ensure effective and safe patient care. However, we know that there is an unacceptable rate of unintended patient harm, and much of this is attributed to failures in communication between health professionals. The extensive literature on teams has identified shared mental models, mutual respect and trust and closed-loop communication as the underpinning conditions required for effective teams. However, a number of challenges exist in the healthcare environment. We explore these in a framework of educational, psychological and organisational challenges to the development of effective healthcare teams. Educational interventions can promote a better understanding of the principles of teamwork, help staff understand each other's roles and perspectives, and help develop specific communication strategies, but may not be sufficient on their own. Psychological barriers, such as professional silos and hierarchies, and organisational barriers such as geographically distributed teams, can increase the chance of communication failures with the potential for patient harm. We propose a seven-step plan to overcome the barriers to effective team communication that incorporates education, psychological and organisational strategies. Recent evidence suggests that improvement in teamwork in healthcare can lead to significant gains in patient safety, measured against efficiency of care, complication rate and mortality. Interventions to improve teamwork in healthcare may be the next major advance in patient outcomes.
Applied ergonomics, 2021
Shared perceptions of a task among those responsible for its completion are important for achieving successful outcomes. This study proposes a framework for eliciting various aspects of team members' "mental models" (TMMs) of complex medical tasks. The intention is to provide 'proof of concept' for a methodology to measure similarities and differences between team members' perceptions of selected attributes of the task. Applying our framework in a gynecology ward, we use cognitive interviewing and concept mapping to reveal differences between the TMMs of doctor and nurse teams. These group differences are found to reflect limited awareness of the other group's level of involvement, workload, responsibilities and contributions to quality of care. We argue that such differences may lead to frustration, conflict, poor teamwork and risks to patient safety; but once identified, and subject to certain limitations, the differences could be used to develop inte...
The effectiveness of health care teams
2001
Several research studies in England have highlighted interprofessional communication problems within primary health care teams. West and Field (1995) and Field and West (1995) interviewed 96 members of primary health care teams and described factors that impacted upon teamworking and communication in health care. Structured time for decision-making, team cohesiveness and team-building all influenced communication within teams. They highlighted the failure of health care teams to set aside time for regular meetings to define objectives, clarify roles, apportion tasks, encourage participation and handle change. Other reasons for poor communication included differences in status, power, educational background, assertiveness of members of the team, and the assumption that the doctors would be the leaders (see also West & Pillinger, 1995; West & Slater, 1996). Communication difficulties between different professional groups have been highlighted particularly. Bond, et. al., (1985) surveyed 161 pairs of General Practitioners (GPs) and health visitors, and 148 pairs of GPs and district nurses who had patients in common. They reported low levels of communication and collaboration between GPs and community nursing staff and suggested that GPs had a very poor understanding of the health visitor's role. Similarly, McClure (1984) describes low levels of communication in a survey of 48 health visitors and 45 district nurses attached to general practices. Community nurses reported that communication with practice staff was usually only about specific immediate patient issues rather than team objectives, strategies, processes and performance review. Health visitors were noted to be similarly unenthusiastic about progress in teamwork. Ross, Rink and Furne (2000) found that health visitors perceived teams as less effective. They suggested that health visitors were comparatively more defensive about the benefits of changing role boundaries and considered themselves less able to contribute to the teams as currently constituted. Cant and Killoran (1993) reached similar conclusions, based on their research study with 928 practice nurses, 682 health visitors and 679 district nurses. They argued that joint professional training and the instigation of regular team meetings were necessary to promote good communication. Cott (1997) used a social network analysis of 93 health care workers across 3 multidisciplinary long-term care teams to explore communication processes within teams. She concluded that higher status multi-professional members communicated most openly and worked fairly autonomously across loosely structured tasks, with low levels of authority. In contrast, hierarchical nursing sub-teams did not report high levels of information sharing. West and Slater (1996) reported that much of the potential benefit of teamwork was not being realised, with less than one in four health care teams building effective communication and teamworking practices (see also West & Poulton, 1997). In a similar vein, the Audit Commission report in 1992 drew attention to a major gap between the rhetoric and reality: "Separate lines of control, different payment systems leading to suspicion over motives, diverse objectives, professional barriers and perceived inequalities in status, all play a part in limiting the potential of multiprofessional, multi-agency teamwork.. . for those working under such • There were no significant differences in the composition of the teams between different types of locations (city, urban, urban/rural, rural). Nor were there differences in the composition of fundholding and non-fundholding practices. • There was a significant relationship between Jarman score and number of managers; teams with fewer managers had a higher Jarman score. • Teams with a higher Jarman index also had significantly more 'other' types of staff in the team. This may reflect the fact that the range of services required is much greater in socially deprived than socially enriched areas. • There was a higher proportion of Professions Allied to Medicine (PAMs) in teams with a larger list size. Jarman index / location 73 teams provided a Jarman index score of more than 0%. The mean score was 15.52 and the standard deviation 22.72. These were distributed across locations as follows: City-18 Urban-39 Urban / rural-5 Rural-6 Unclassified-5 • The Jarman index for city practices was significantly higher (mean = 32.6%) than for urban practices (mean = 11.9%) 4 Qualitative Research Methods Research in the second stage of the research programme explored in depth, and using a variety of consultation and qualitative research methods, all issues of team functioning and effectiveness. The methods used are shown in Fig 2.12. 4 The data collected as part of this research can be subjected to much further analysis and information extraction. The researchers are committed to working with others to ensure the maximum exploitation of this hard won data set. If there are analyses readers wish to conduct the researchers would urge them to contact the first author of this report.