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Literature summary week 3
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W3 Literature – OBReeves & Lewin (2004) Interprofessional collaboration in the
hospital: strategies and meaning
Enhancing collaboration between different health & social care professionals is a key aspect
of modernizing health and social care systems. The organization and delivery of care can be
improved when skills, knowledge and experience are well coordinated between professional
groups. Effective collaboration also requires:
- Explicit, appropriate tasks and goals
- Clear, meaningful roles for each individual
- Clear leadership
- Feedback on performance
However, the following factors can undermine attempts to work collaboratively:
- Insufficient time for teambuilding
- Confused team roles
- The effects of professional socialization
- Power and status differentials
- Vertical management of professionals
In hc, especially acute care, many interprofessional relationships are short-lived and
continually shifting between individuals and organisations. It’s a process of ‘knotworking’, in
which individuals constantly tie, untie and re-tie separate threads of activity during their
brief interactions.
Ward-based collaboration: interprofessional collab consisted largely of short, unstructured
and often opportunistic interactions. Wards are busy environments, and the number of
professionals attached to one ward were large. The professionals appeared to form loose,
transient ‘working groups’, both around particular patients and with other professionals
with whom they worked. Sustained and purposive collaboration in this setting is hard to
achieve then. Knotworking applies more. Nurse-doctor asymmetry. Doctors initiated
conversations to give orders, nurses to ask information.
The professional etiquette, which allows the stripping away of the normal social elements of
communication, appeared to reduce people to ‘representatives’ of their profession. This
could be seen as a mechanism to allow tasks to be carried out more ‘efficiently’ in a busy
environment (not interrupted by time-wasting banter). Teambuilding is seen as time-
wasting, and ways of work that value task orientation, clear outputs and a splitting of the
private and public are then privileged.
In practice, collaboration is fragmented and transient with little evidence of a coherent
approach to teamwork on the wards. These professionals (esp doctors) work separately
from one another, in loose groups. The concept of knotworking provides a more helpful
description of the collaborative work that occurs in this setting than the traditional notion
does. Formal and informal strategies (like the use of info mediators such as care
coordinators) could help overcome constraints to collaboration because it has the
advantage of not requiring large-scale reorganisations of care and doesn’t pose challenges
to professional ways of working. Doctors view collaboration as work with their medical
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, colleagues, whereas nurses etc see it as an interprofessional activity. Different professionals
construct collaboration in very different ways, and have competing notions of what
constitutes collaborative work. Policies need to recognize these differences.
West et al. (2013) Illusions of team working in health care
In practice, hc teams vary in their structures and effectiveness in ways that can damage
team processes and patient outcomes. Effective hc teamwork is associated with:
- Reduced medical errors (70% of medical errors are due to poor teamwork)
- Increased patient safety
- Improved worker outcomes such as:
o Reduced stress
o Intent to stay at work
o Job satisfaction
- Related to patient mortality
- More streamlined & cost-effective patient care
- Lower staff absenteeism and turnover
- More effective use of resources and greater patient satisfaction
Health care context is complex, with conflicting demands and objectives, multi-faceted and
often highly challenging daily tasks, demanding external environment, and highly diverse
body of professional clinical staff. Simply naming a team as a team does not help.
Hollenbeck’s typology for describing teams. Three (structural) dimensions:
- Skill differentiation – traditionally, hc team were unidisciplinary (members led
similar functional knowledge and conducted similar clinical tasks). Now increasingly
interdisciplinary (members with different functional and clinical backgrounds
working toward shared goals in order to fulfil complex and interdependent tasks that
require varying degrees of specialist skills and medical knowledge).
- Authority differentiation – the extent to which all team members are involved in
team decision-making processes. High differentiation means clear allocated
leadership roles, mostly occupied by senior status members. However usually quality
of care undermined due to hierarchies and conflict between professionals.
Unidisciplinary teams tend to have lower differentiation, more equal status by team
members.
- Temporal stability – some teams might work together for years, others might be
formed as a ‘one shot’ team for one time task. However, with high temporal stability
effective team processes will develop due to familiarity between team members.
Fundamental features of what defines a team: clear shared objectives, working closely and
interdependently, and reviewing the team’s effectiveness on a regular basis. Teams who
aren’t ‘real’, can potentially lead to bad outcomes like higher levels of errors,
harassment/bullying from staff and patients and lower levels of well-being and more stress.
Framework for conceptualizing teams: input-process-output (IPO) model of team
effectiveness. It proposes that team inputs (team task/resources/organizational support)
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