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      Illusions of team working in health care

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          Abstract

          Purpose

          The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts.

          Designmethodologyapproach

          The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams.

          Findings

          Underpinned by the inputprocessoutput framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork.

          Originalityvalue

          The paper argues that the prevalence of the term team in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudolike groups, are accumulated.

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          Most cited references17

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          Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.

          T. Manser (2009)
          This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.
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            Physician, nurse, and social worker collaboration in primary care for chronically ill seniors.

            To examine the impact of an interdisciplinary, collaborative practice intervention involving a primary care physician, a nurse, and a social worker for community-dwelling seniors with chronic illnesses. A concurrent, controlled cohort study of 543 patients in 18 private office practices of primary care physicians was conducted. The intervention group received care from their primary care physician working with a registered nurse and a social worker, while the control group received care as usual from their primary care physician. The outcome measures included changes in number of hospital admissions, readmissions, office visits, emergency department visits, skilled nursing facility admissions, home care visits, and changes in patient self-rated physical, emotional, and social functioning. From 1992 (baseline year) to 1993, the two groups did not differ in service use or in self-reported health status. From 1993 to 1994, the hospitalization rate of the control group increased from 0.34 to 0.52, while the rate in the intervention group stayed at baseline (P= .03). The proportion of intervention patients with readmissions decreased from 6% to 4%, while the rate in the control group increased from 4% to 9% (P=.03). In the intervention group, mean office visits to all physicians fell by 1.5 visits compared with a 0.5-visit increase for the control group (P=.003). The patients in the intervention group reported an increase in social activities compared with the control group's decrease (P=.04). With fewer hospital admissions, average per-patient savings for 1994 were estimated at $90, inclusive of the intervention's cost but exclusive of savings from fewer office visits. This model of primary care collaborative practice shows potential for reducing utilization and maintaining health status for seniors with chronic illnesses. Future work should explore the specific benefit accruing from physician involvement in the collaborative practice team.
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              Leadership clarity and team innovation in health care

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                Author and article information

                Contributors
                Journal
                jhom
                10.1108/jhom
                Journal of Health Organization and Management
                Emerald Publishing
                1477-7266
                15 March 2013
                : 27
                : 1
                : 134-142
                Affiliations
                Lancaster Management School, Lancaster University, Lancaster, UK
                Aston Business School, Aston University, Birmingham, UK
                Article
                0250270108.pdf 0250270108
                10.1108/14777261311311843
                23734481
                adf030b0-5c8c-4af2-a1ed-3438a972fd88
                © Emerald Group Publishing Limited
                History
                Categories
                e-viewpoint, Viewpoint
                cat-HSC, Health & social care
                cat-HMAN, Healthcare management
                Custom metadata
                yes
                yes
                included

                Health & Social care
                Teamwork,Teams,Health care,Errors,Team working,Team effectiveness,Collaboration,Patient safety,Team processes

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