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Created By: Lorri Zipperer, Cybrarian, AHRQ PSNet Team
Date Created: October 14, 2024
Last Updated: December 17, 2024
Description
This curated library focuses on explicit discussions of multidisciplinary (interdisciplinary or interprofessional) teamwork in a variety of settings and its ability to improve the safety and reliability of care delivery.
Library Organization
Custom - This library is organized by custom section header names.
Foundations (6)
Neuhaus C, Lutnæs DE, Bergström J. Cogn Technol Work. 2020;22:13-27.
In this narrative review, the authors contrast approaches to teamwork in healthcare with current concepts in safety science. The authors encourage moving past a ‘reductionist’ ... Read More
Smith CD, Corbridge S, Dopp AL, et al. NAM Perspectives. Washington DC: National Academy of Medicine; 2018.
Teamwork can contribute to a healthy and respectful work environment. This discussion paper reviews evidence-based characteristics of high-functioning teams and barriers to their... Read More
Rosen MA, DiazGranados D, Dietz AS, et al. Am Psychol. 2018;73:433-450.
Teamwork in health care has been embraced as a key element of patient safety. This review summarizes the evidence regarding teamwork, including strategies to measure team... Read More
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Ambulatory (1)
Harper PG, Schafer KM, Van Riper K, et al. J Am Pharm Assoc (2003). 2021;61:e46-e52.
This article describes a systematic team-based care approach to medication reconciliation implemented in four family medicine residency clinics.... Read More
In-hospital, general (6)
Schilling S, Armaou M, Morrison Z, et al. PLoS ONE. 2022;17:e0272942.
Effective teamwork is critical in acute and intensive care settings. This systematic review of reviews and thematic... Read More
McHugh SK, Lawton R, O'Hara JK, et al. BMJ Qual Saf. 2020;29:672-683.
Team reflexivity represents the way individuals and team members collectively reflect on actions... Read More
Baxter R, Taylor N, Kellar I, et al. BMJ Qual Saf. 2019;28:618-626.
This qualitative study compared four high-performing geriatric inpatient units with four average-performance units in order to understand... Read More
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Specialty/Unit Focused (5)
Rose SC, Ashari NA, Davies JM, et al. CJEM. 2022;24:695-701.
Debriefing is used to enhance individual and team communication and to facilitate real-time... Read More
Romijn A, Teunissen PW, de Bruijne M, et al. BMJ Qual Saf. 2018;27:279-286.
This qualitative study assessed perceptions of teamwork and interprofessional collaboration between obstetricians, nurses, and hospital-based and... Read More
Kim MM, Barnato AE, Angus DC, et al. Arch Intern Med. 2010;170:369-76.
Efforts to improve the care of complex patients in intensive care units (ICUs) focus on many factors, including unit-based initiatives. This retrospective study evaluated the... Read More
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All Library Content (18)
Rose SC, Ashari NA, Davies JM, et al. CJEM. 2022;24(7):695-701.
Debriefing is used to enhance individual and team communication and to facilitate real-time learning opportunities after a critical event. This study evaluated a charge nurse-facilitated clinical debriefing program used in Emergency Departments (EDs) in Alberta, Canada. Qualitative analyses identified several themes underscoring the impact of the debriefing program – the impacts on clinical practice and patient care, impacts on psychological safety and teamwork, stress management, and the emotional acknowledgement after critical events – and barriers to debriefing.
Schilling S, Armaou M, Morrison Z, et al. PLoS ONE. 2022;17(8):e0272942.
Effective teamwork is critical in acute and intensive care settings. This systematic review of reviews and thematic analysis identified four key factors that frame the evidence on interprofessional teams in acute and intensive care settings – (1) team internal procedures and dynamics, such as cohesion, organizational culture, and leadership influence; (2) communicative processes; (3) organizational and team-extrinsic influences, such as team composition, hierarchy, and interprofessional dynamics, and; (4) team outcomes, including both patient and staff outcomes.
Harper PG, Schafer KM, Van Riper K, et al. J Am Pharm Assoc (2003). 2021;61(1):e46-e52.
This article describes a systematic team-based care approach to medication reconciliation implemented in four family medicine residency clinics. After implementation, there was a significant increase in the number of visits with physician-documented medication reconciliation and this increase was sustained one year later.
Neuhaus C, Lutnæs DE, Bergström J. Cogn Technol Work. 2020;22(1):13-27.
In this narrative review, the authors contrast approaches to teamwork in healthcare with current concepts in safety science. The authors encourage moving past a ‘reductionist’ (reducible through information) approach to teamwork training and discuss the potential benefit from a more interdisciplinary approach towards teamwork and safety science research by integrating medical and social science disciplines, moving towards a ‘macro’ view of health care delivery, and evaluating how socioeconomic factors influence both healthcare systems and individual practitioners.
McHugh SK, Lawton R, O'Hara JK, et al. BMJ Qual Saf. 2020;29(8):672-683.
Team reflexivity represents the way individuals and team members collectively reflect on actions and behaviors, and the context in which these actions occur. This systematic review identified 15 studies describing the use of team reflexivity within healthcare teams. Included interventions, most commonly simulation training and video-reflexive ethnography, focused on the use of reflexivity to improve teamwork and communication. However, methodological limitations of included studies precluded the authors from drawing conclusions around the impact of team reflexivity alone on teamwork and communication.
Baxter R, Taylor N, Kellar I, et al. BMJ Qual Saf. 2019;28(8):618-626.
This qualitative study compared four high-performing geriatric inpatient units with four average-performance units in order to understand factors that contribute to high performance. The authors conclude that the safety practices did not differ between the high versus average performers. Instead, optimal teamwork and positive safety culture led the high-performing wards to implement these safety practices in a more effective way.
Book/Report
Emerging Classic
Smith CD, Corbridge S, Dopp AL, et al. NAM Perspectives. Washington DC: National Academy of Medicine; 2018.
Teamwork can contribute to a healthy and respectful work environment. This discussion paper reviews evidence-based characteristics of high-functioning teams and barriers to their optimization in health care. Strategies to enhance teamwork and consequently clinician well-being include improvements in workflow, health information technologies, and financial models to train and sustain teams.
Rosen MA, DiazGranados D, Dietz AS, et al. Am Psychol. 2018;73(4):433-450.
Teamwork in health care has been embraced as a key element of patient safety. This review summarizes the evidence regarding teamwork, including strategies to measure team performance and the relationship between teamwork and outcomes.
Commentary
Graber ML, Rusz D, Jones ML, et al. Diagnosis (Berl). 2017;4(4):225-238.
Teamwork has been highlighted as a key component of patient safety that also applies to improving diagnosis. This commentary describes how the team approach to diagnosis is anchored in patient-centered care and suggests that the diagnostic team must expand beyond the focus on physicians and involve a wide range of professionals, including pathologists, allied health practitioners, and medical librarians.
Romijn A, Teunissen PW, de Bruijne M, et al. BMJ Qual Saf. 2018;27(4):279-286.
This qualitative study assessed perceptions of teamwork and interprofessional collaboration between obstetricians, nurses, and hospital-based and primary care midwives in the Netherlands. Overall, obstetricians perceived teamwork to be better than participants from other disciplines. The gap between physicians, nurses, and midwives was largest with regard to perceived openness to sharing opinions and discussing new ideas.
Commentary
Classic
Gandhi TK, Graydon-Baker E, Barnes JN, et al. Jt Comm J Qual Saf. 2003;29(8):383-90.
Drawing from their experiences at Brigham and Women’s Hospital in Boston, the authors discuss development of a patient safety team, including the key players and their roles, how to effectively integrate the team into preexisting committees, and how to establish clear goals and initiatives. They conclude by emphasizing the importance of a commitment from organizational leadership.
Pannick S, Davis R, Ashrafian H, et al. JAMA Intern Med. 2015;175(8):1288-98.
Interdisciplinary team care interventions are increasingly common on medical wards, based partly on a widespread belief that these practices will improve efficiency and patient safety. This systematic review sought to evaluate the performance of hospital-based interdisciplinary teams on patient outcomes. The majority of studies have chosen length of stay, complications, readmission, or mortality rates as their primary outcomes, but interdisciplinary teams rarely seem to affect these traditional quality measures, which may be insensitive to teamwork improvements in care delivery. The authors call for establishing more relevant outcomes to evaluate interdisciplinary team interventions. An accompanying commentary notes that this systematic review provides an opportunity to highlight the potential harms of choosing the wrong metrics to evaluate an intervention, which can undermine a program's mission.
Dietz AS, Pronovost P, Mendez-Tellez PA, et al. J Crit Care. 2014;29(6):908-14.
Improving teamwork and communication is a continued focus in the hospital setting. This systematic review revealed that although studies of teamwork in the intensive care unit abound, the field lacks common definitions and constructs. Teamwork usually entailed joint strategy and shared goals, and quality improvement approaches to enhance teamwork typically involve team training and development of structured protocols. Many interventions target rounds, during which interdisciplinary providers discuss each patient, or handoffs between clinicians. The authors suggest that communication is the most prominent aspect of teamwork and propose further study in conceptualizing teamwork to design effective interventions. The heterogeneity in defining and measuring teamwork may account for mixed results in improving safety outcomes. An AHRQ WebM&M perspective describes the Veterans Health Administration's medical team training program.
Commentary
Classic
Leape L, Berwick D, Clancy C, et al. Qual Saf Health Care. 2009;18(6):424-8.
Although significant progress has been made in improving patient safety over the past decade, most health care organizations still experience persistent safety problems. In this commentary, leaders of several leading safety organizations endorse five principles for transforming hospitals and clinics into high reliability organizations. These include transparency in disclosing errors and quality problems, integration of care across teams and disciplines, engaging patients in safety, developing a culture of safety, and reforming medical education to focus on quality and safety. The lead author, Dr. Lucian Leape, was interviewed about his remarkable career in patient safety by AHRQ WebM&M in 2006.
Kim MM, Barnato AE, Angus DC, et al. Arch Intern Med. 2010;170(4):369-76.
Efforts to improve the care of complex patients in intensive care units (ICUs) focus on many factors, including unit-based initiatives. This retrospective study evaluated the relationship between daily multidisciplinary rounds and 30-day mortality. Investigators discovered that the presence of daily rounds was associated with lower mortality among medical ICU patients. In addition, the survival benefits observed with intensivist staffing were in part explained by the presence of multidisciplinary care models. A related commentary [see link below] discusses this study's findings and the concept of health engineering as a systems science to study how we optimize staffing and patient outcomes in the ICU.
Edmondson AC, Schein EH. San Franscisco, CA: Jossey-Bass; 2012. ISBN: 9780787970932.
This book explores teamwork, including barriers to effective teamwork and tactics to enhance professional and organizational learning.
Connor M, Ponte PR, Conway JB. Crit Care Nurs Clin North Am. 2002;14(4):359-67, viii.
This article describes the multifaceted response of Dana-Farber Cancer Institute after a highly publicized medication error in 1995. The authors review a series of interventions designed through the multidisciplinary efforts of nursing, pharmacy, physician, administrative, and other clinical staff. Factors discussed include the role of the patient and family, the need for executive leadership, root cause analyses, a shift to nonpunitive environments, and development of better processes for care. The authors share how a single adverse event catalyzed 7 years of efforts to bring patient safety to the forefront and explain what future steps must occur in the area of patient safety.
Makowsky MJ, Schindel TJ, Rosenthal M, et al. J Interprof Care. 2009;23(2):169-84.
This qualitative study of the integration of pharmacists into inpatient care teams found that while pharmacists were greatly valued, successful integration required careful attention to team structure and workload.
