Teamwork in Healthcare: Promoting effective teamwork in healthcare in Canada

Executive Summary

Teamwork and collaboration in healthcare are “top of mind” issues for Canadians and their decision makers, with many reports calling for improved collaboration as a key strategy in healthcare renewal.

A healthcare system that supports effective teamwork can improve the quality of patient care, enhance patient safety, and reduce workload issues that cause burnout among healthcare professionals.

Yet, while many patients, caregivers, health professionals, and decision makers may be ready to embrace collaborative healthcare, current policies and systems issues are acting as barriers hampering the transformation to team-based healthcare. To support the movement to make teamwork a reality, this report was commissioned to answer three questions:

  • What are the characteristics of an effective team and how do we measure the effectiveness of a team (such as increased job satisfaction, shared workload, reduction of stress, etc.)?
  • What interventions have been successful in implementing and sustaining teamwork in healthcare? What can we learn from other settings and countries?
  • To what extent has teamwork been implemented in healthcare settings in Canada? What are the barriers to implementation?

To prepare this report, an interprofessional research team conducted in-depth interviews with key informants and undertook a wide-ranging survey of peer-reviewed and grey literature on the components of teamwork; effectiveness of teams; types of interventions; healthcare team dynamics; and the impact of government infrastructure, legislation, and policy on teamwork in the Canadian healthcare system. The development of the report was also guided by “Interprofessional Education for Collaborative Patient-Centred Practice: An Evolving Framework,” developed for a 2004 Health Canada initiative on Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). From these sources the team identified the challenges of building and maintaining effective teamwork. These include the lack of a common definition of teams and teamwork; the relationship between teamwork and collaboration; the spectrum of collaboration in healthcare; organizational factors affecting teamwork; and the implications of current policy, regulation, and legislation on teams.

What can be done? The fundamental change in the healthcare system required to support teamwork requires a collaborative effort. Leadership and commitment are needed at all levels of the healthcare system to implement and maintain teamwork over the long term.

A number of projects involving different health providers and patients are going on across the country and around the world that we can learn from. For instance, teams work most effectively when they have a clear purpose; good communication; co-ordination; protocols and procedures; and effective mechanisms to resolve conflict when it arises. Teams function better when they are working in an organizational culture that supports teamwork and they have strong leadership and effective administrative support.

Other studies underscore that the task defines the team, with the make-up and functioning of teams varying with the patient and the complexity of his or her needs. With this fluidity, health professionals need training to learn new ways of working together and to become aware of the roles and responsibilities of all members. However, despite this developing body of knowledge, transformation to teamwork is slow as professionals continue to protect their “turf” or limit scopes of practice to respond to their own needs. Further constraints come from the self-regulation of professionals; current malpractice laws; and funding and remuneration models that do not support teams. The education system has also been slow to adopt new approaches for professional training.

Some government policies support the development of collaborative and interprofessional models, but that alone cannot transform the system. Effective teamwork can only be achieved when all levels of the healthcare system work together. All sectors (including the courts, the professional regulatory bodies, education institutions, accreditation organizations, patients/clients, and providers themselves) must be ready to review current practices and embark on new initiatives that will improve support for collaboration and ultimately improve the health of the Canadian population.

This summary provides some background information and underscores that the practice, organizational, and policy levels must work together to move forward on the process of change required to support effective teamwork in healthcare based on what has been learned from the research and the experiences of other countries. Priorities and implications addressed in this report provide the premise to formally begin the process of establishing effective teamwork in Canada.