Importance of Teamwork in Hospitals
Hilaria N. Mtuleni
Department of Health Management, European University of Lefke
According to George & Jones (2011), a team is formed when two or more people work together on a common project, service or goal. Salas & Dickinson (2004), defined teamwork as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common goal, objective or mission. A specific definition of teamwork in healthcare by Xyrichis & Ream (2008), refered to teamwork as a dynamic process involving two or more healthcare professionals with complementary background and skills, sharing common health goals and exercising concerted physical and mental effort in planning, assessing and evaluating patient care.
According to Theodre et al. (2014), health professions are made up of many disciplines working in a complex network of health facilities and programs. Kozlowski & Ilgen (2006), stated that healthcare is provided by teams consisting of different people interacting, with specialised roles and responsibilities, and have a shared goal of patient care.
As stated by Leonard & Frankel (2011), effective teamwork in conjunction with good processes of providing care, is essential for delivery of consistent high-quality care.
Working as a team is essential for carrying out complex activities effectively (Schmutz & Manser, 2013). Teams are also effective for work that requires different types of skills and expertise. Team In general is defined as any group of people involved or linked in the same activity or purpose. Team members have the same goal and it can be a single professional team or multiprofessional team- in one place, one region or it can be geographically distributed. According to Kalisch (2007), individuals tend to be more confident when they are working in groups then when they are working alone.
. This people are assigned different defined roles and functions, there is collaboration, enhanced communication and cooperative effort by each individual member of a good team (Kalisch 2007). According to Schyve (2005), teamwork is essential for provision of safe, effective and person-centred care in hospitals and it is increasingly becoming an essential need in hospitals due to large complex and specialised care, shortages, increase of chronic diseases, aging population and invention of safe working hours. The division of labour among medical, nursing and allied health practitioners means that no single professional can deliver a complete episode of healthcare (Leggat, 2007) that is why teamwork is a necessity in all healthcare settings.
As stated by Manser (2009), Teamwork in health care employs the practices of collaboration and enhanced communication to expand the traditional roles of health workers and to make decisions as a unit that works toward a common goal. Hospitals consists of multi-professions who should all work for the same goal of ensuring the provision of quality, safe and effective healthcare to patients with different conditions. In hospitals you find different kinds of human resources- clinical and non-clinical staffs, responsible for public and individual complex health intervention. Zurn, Stillwell & Adams (2004), acknowledged team work as essential in caring for patients with complex problems.
Basically, hospitals are broad with critical environments that requires good management and great effort from all individuals for proper functioning. Kabene et.al (2006) stated that health care outcomes depends on optimal functioning of individuals and how they are managed and involved in care provision. The different professionals may not have the same interest and unwilling to perform certain tasks, therefore there should be a common motivator through teamwork.
Hospitals being a complex entity with multiple talented individuals to provide care should be coordinated through proper teamwork. In hospital settings, human resource management should be able to use wide variety of
As stated earlier, hospitals consists of multi-professionals. Doctors, Nurses, Paramedics, Pharmacists, Radiographers, Physiotherapist, Physicians, Social Workers, Psychologists, Administration and Ancillary service providers are some of the common professions in hospital settings. This professionals are also falling in different categories according to their expertise like emergency teams, intensive care unit team, maternity team and other special areas. Clancy (2007) argued that optimal teamwork doesnt automatically result form putting a group of professionals together in one place.
According to Miller (2008), hospitals consists of different teams- interdisciplinary team, Trans disciplinary team, multidisciplinary team, intraprofessional team and rehabilitation team. All the professionals are essential for proper functioning of hospitals, else there will be incomplete healthcare provision. Due to different individual professional goals, staffs in hospitals are motivated and influenced by their own personal career aspirations (Seller & Frosdik, 2011) and that is why human resource management needs to come in so that individuals from different professions can be trained and motivated to form comprehensive teams that support them fairly and accommodates them.
Recently due to decentralisation and more specialised areas with different managers, healthcare workers tend to work more as a group then as a team. Toccandi (2015) stated that even though there are hospital teams, individual staffs focus more on their units/ divisions and each profession is more focused on improving their section/ department and not as a hospital at large. The hierarchical structure of health workers also has an effect on teamwork as the conversation or planning is more done through one on one conversations and not through discussions (Elern et. al, 2012). A hospital without a team environment has a delayed success of developing, poor problem solving system and lack of safety for both patients and healthcare providers Sexton et al. (2007). Research done by Lerner, Magrane & Friedman (2009), found that educating healthcare providers on the importance of teamwork while they are still in school or immediately before they start working results in better awareness among individuals who can then form effective teams.
The aim of this project is to review the evidence on importance of teamwork by analysing literature done about effective teamwork in hospital settings. Although there is a lot of literature on teamwork, this project will only review literature on the importance of teamwork to patients, to staffs and to hospitals at large.
2. Literature Review
According to Mickey (2010), there are interrelated teams that supports and deliver healthcare. Through TeamSTEPPS, a research by Healthcare research and quality agency, focusing on patient safety and health care quality came up with different interrelated teams of which includes- Core teams- involved in direct patient care, Contingency team- responsible for emergencies or specific events, Coordinating team- responsible for day to day operation and coordination, Support team- provide indirect service, Ancillary service- cleaning and domestic work, Administration- responsible for overall functioning of the hospital Clansy et al. (2007). Though, the hospital is full of different professionals with different expertise, these people often visit the patient at different times which makes them focus more on individual excellence, resulting in poor teams with no purposes, instead of strong and comprehensive teams. Lack of purposeful teamwork can lead to patient risks and unnecessary waste of resources and time (Horwitz et al., 2008), thats why effective teamwork is essential to avoid risks and control resources.
Boult et al. (2009), stated that the value of teamwork is not taught in Universities and most health workers focuses more on individual excellence and advancement rather than focusing on building a strong and effective teams when they start working. Teamwork is needed wherever multiple individuals with multiple skills are required to work interdependently towards a common goal. Werner (2012) found that, teamwork improves care at a level of organisation, patient, team as a whole and individual team members. Every individual in the hospital setting carries with them experiences or skill sets that can be used when patients health or wellbeing are at stake. One professional is never enough for health care provision thats why all the different professionals in the healthcare sector needs to work together.
The staffs from the lower level example ordinary nurses or pharmacists are not involved in patient care plan or decision making so they tend to concentrate more on orders or treatment plans given to them by the upper management and they are not free to advocate for the patients or suggest better care plans for individual patients. The patients are also not involved in their own care as treatment plans are made by people who are not in contact with them. Patients are also likely to get generalised treatment.
According to hanscom (2008), poor teamwork in hospital setting fail to coordinate and manage clinical procedures, sometimes causing permanent harm or medical litigations. Bates et al. (2009) stated that all healthcare workers must be trained about teamwork so that each individual member will understand the importance of teamwork. A good teamwork is not only good for patients, its also good for team members involved.
2.1 Importance of teamwork to patients
The whole healthcare system should be planned based on the interests of patients (Nemri & Faki, 2014). A good teamwork ensure good communication with the patient, minimises misunderstanding and miscommunication among team members and involves patients in their own care, Mitchell (2012).
Research contacted by Jain et al. (2006), in a hospital in Northern Mississipi, indicated a reduction of nosocomial infection related to ventilator associated pneumonia between fall year 2002 to fall year 2003 (from 7.5 to 3.2 per 1000 ventilator days). Reduction in adverse events in the ICU in relation to onset of specific quality improvement interventions with National Nosocomial Infection Surveillance (NNNIS) comparisons.17 VAP, ventilator associated infection; BSI, bloodstream infection; UTI, urinary tract infection.
Baker et al. (2005), stated that good communication and mutual understanding brings out good input from different health professionals in all teams, which leads to a proper planned treatment protocols. Well planned treatments forms a well-coordinated care, resulting in patients getting quality care. According to Rush & Anderson (2017), teamwork is important to provide enhanced quality patient care. Research done by Sexton (2007) found that through good teamwork, specialists from different teams are able to manage complex problems in patients with no difficulties, according to a well-established priorities, giving report to each other and discussing their treatment plans together. Ideas from different teams/professionals can be used to formulate new methods and improve ways of care provision. Good health teams provides efficient and effective patient care.
When enhanced quality care is provided, complex problems are likely to be picked up on time and complications are reduced. Multiple professionals looking after one patient reduces chances of negligence, medico-legal hazards and other medical errors are avoided as staffs are working together, motivating and correcting each other (Mushta, 2017). Through good teamwork Patient progress is monitored accurately by both professionals, no task is left undone and the patients are considered safe from wrong treatments. Manser (2009), stated that patient safety is improved by a focused system based interventions, so effective teamwork improves patient safety.
Enhanced quality care and improved patient safety means that Efficient and effective care is provided. When patients get the right treatment there is high chance of fast healing and unnecessary lengths of hospital stay are prevented (Kossaify, 2017). When right services are provided patients do not have to pay for unnecessary services, therefore reducing hospital costs. Jain et al (2006), found that through a systematic approach and health team collaboration, whereby multidisciplinary icu teams had a good communication and flow meetings that allowed rapid prioritisation of healthcare activities that led to a strong downward trend in hospital stay and costs per ICU episode that fell from $3406 in 2002 to $2704 in 2004.
Organised methods of interventions leads to a more personalised level of care which impacts the patients satisfaction and good health outcome (Leonard, 2004). Where enhanced quality care is provided and patients safety is ensured, patients will feel more at ease as they are evaluated more thoroughly and they develop trust. According to Mckeon (2009), effective teamwork ensures patients satisfaction.
2.2 Importance of teamwork to staffs
Mithell (2012), stated that individual health staff can rarely provide complete healthcare so a team is an essential need in care provision. According to Betsi (2010), when an organisation of medicals has developed a high level of teamwork, it will experience greater staff fulfilment, lower levels of staff turnover and a standardised level of care. Siassakos (2011), stated that hospital staffs communicates more often either directly or through phones. When staffs interact more often, they develop a bond, they also develop a good connection and high confidence knowing and trusting each other with specific jobs (Gore, 2013). Members of an effective teamwork respect the diversity of opinions from different professionals, therefore developing mutual respect (Angouri & Crofts, 2012).
According to Suen et al. (2016), mutual respect, brings out a great attitude as employees all have a common goal and they dont feel much of overload. There is also less stress as responsibilities are clearly defined and staffs feel less overwhelmed (Behnia et al. 2016), creating a peaceful environment with less or no conflict. Research done by Nicolo et al. (2018) found that teamwork creates a good working environment, whereby staffs have a sense of belonging even if they are from a diverse religious and cultural backgrounds.
In a good working environment, roles and responsibilities are clearly defined for each professional. Individuals will all be working according to their job description and therefore the workload is balanced (Mushta, 2017), reducing overwork and staffs from multitasking (Theodre & Varavikova, 2014). Through well-defined roles and responsibilities, individuals in one team gets to know each others strengths and weaknesses (Welp & Menser, 2016), which can determine good delegation. Distributing different tasks evenly can increase engagement of each individual in the workplace reducing burnout.
As stated by Andrew (2005), teamwork is the fuel that allows common people to attain uncommon results.” Sharing ideas and correcting each others mistakes without judgements encourages each individual team member to put in effort to attain the common goal (Tornberg, 2008). Teamwork maximises strengths, bringing out the best in each team member. Each staff is more focused on what they know best, making them feel less overwhelmed and looking forward to going to work every day. Effective teamwork improves clinical output and staffs are more motivated when they know the positive outcome of job.
Mutual respect, good working environment and improved clinical outcome help individuals to be satisfied with their professional lives and find pride in their jobs. Health professionals are most likely to adapt to their job when there is teamwork (Elern, 2015). Health workers spent most of their time in hospitals, managing high-stressful situations together, so they get used to each other and some units even become as family (Nicolo et al. 2018). Overcoming certain challenges as a team also unites members, giving them a feeling of belonging and confidence. Gupte et al. (2016) stated that teamwork promotes job satisfaction in healthcare providers.
2.3 Importance of teamwork to hospitals
According to Hambly, Winter & Fox (2017), effective health teams provide the hospital with a diversity of thoughts, creativity, perspectives, opportunities and problem solving approaches which can help to upgrade the healthcare system. Research done by Polis et al. (2017) in five special units (ambulatory care unit, outpatient clinics, radiology unit, haemodialysis unit and oncology) at st George hospital, Sydney, indicated that overall teamwork in different units of the hospital creates a good working environment, increase clinical expertise and a well developed insight of patient needs. Teamwork creates a common ground for all clinical teams in the hospital hence making the whole hospital management run smoothly increasing reliability and safety of the hospital at large, Tocaffondi (2012). The whole hospital can have a good and cooperative communication model through effective teamwork, Tomasello (2008), resulting in mutual understanding and ability to construct common cultural knowledge Tocaffondi (2012).
Multidisciplinary teams from across the whole hospital can easily interact with no conflict and they are likely to come together and openly discuss issues creating a good clinical learning platform (Leonard, Graham & Bonacum, 2004). According to siassacos (2011), efficient teams are most likely to create a good clinical environment, making it easier to handover/ exchange patients among teams and to allocate tasks fairly among team members. A good teamwork develops a safety culture for the whole hospital whereby all individual members share a set of values, beliefs and behavioral norms (Mckeon, Cunning & Oswaks, 2009). According to Sexton et al. (2009), safety culture help to increase awareness amongst team members, making individuals understand each others differences without discrimination and adapt to a complex environment. Hanscom (2008) stated that effective teamwork makes it easier for the hospital management to set up its future direction, predict and monitor future direction.
Barbiker et al. (2015) found that teamwork help the hospital management to build a flat hierarchy, whereby all employees feel free to speak and participate in areas of care.
Study done by Dit Dariel & Cristofalo (2018), whereby 20 years of qualitative research on interprofessional teamwork in hospital settings was analysed showed that organisational structure interfers with interprofessional interactions, therefore future strategies to improve teamwork among healthcare professionals should include structural changes to hospital settings. As shown in research done by Polis et al. (2017), experienced/ senior healthcare professionals tend to have a high interest in teamwork than newly graduates so importance of teamwork should be taught in universities. There is less information on what makes health proffesinals effective team members and also on how to develop teamwork skills. Clancy (2007) stated that there is a science of teamwork from the past 2 decades of which the health sector slowly adopted because health professionals are rarely trained together and they are trained to function as individuals.