What fosters or prevents interprofessional teamworking in primary and community care? A literature review

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Abstract

Background

The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved.

Objectives

This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century.

Design

A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods.

Findings

Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed.

Conclusions

These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.

Section snippets

What is already known about the topic?

  • The increase in prevalence of long-term conditions requires an integrated approach to promoting and maintaining population health, whilst improving service effectiveness.

  • Interprofessional working is not always achieved in delivery of healthcare services; this may be due to a variety of reasons.

What this paper adds

  • Two main factors, team structure and team processes, continue to have an impact on interprofessional teamworking in primary and community care in the 21st century.

  • Within team structure, team premises, team size and composition and the availability of organisational support are important indicators of successful teamworking. Within team processes, setting clear goals and objectives for the team, ensuring regular team meetings and audit appear to foster effective teamworking.

Methods

For the purpose of this literature review and considering time and cost limitations, we included an electronic search of three bibliographic databases, a web-based search, a hand search of relevant journals, and an ancestry approach (Cooper, 1998).

Many different terms are used to describe the collaborative work between professionals such as ‘interprofessional collaboration’ and ‘teamwork’. Indeed, the terms ‘multiprofessional’, ‘interdisciplinary’ and ‘multidisciplinary’, are often used

Findings

The search yielded a final total of 43 articles. After a preliminary reading of the full papers, ten articles were identified and included in the review. Reasons for excluding 31 articles were: review papers (5); discussion papers (5); not focused on primary or community care (4); not identifying barriers or facilitators to teamwork (17). In addition, the two papers identified through informal channels were not considered in the research synthesis since their findings did not add anything new

Discussion

The analysis of studies included in this review revealed that the structure of the team, including the geographical proximity of team members, its size and composition, and the support an organisation provides, is vital for successful teamworking. Using thematic analysis, the findings were separated into themes and categories to allow in-depth consideration of issues; however it should be noted that these categories are not mutually exclusive, and the functioning of a team will also depend on

Implications for primary and community care team members

Some barriers identified in this review, such as team size and base, may be out of nurses’ control, but others may be more amenable to change. The Department of Health, 2004c, Department of Health, 2004d recent policies Agenda for Change and NHS Knowledge and Skills Framework have provided opportunities for nurse development. Both policies advocate nurses’ role in supporting reward systems, innovation, and implementation of change. In addition, nurses could facilitate the development of team

Conclusion

We conclude that the functions of interprofessional healthcare teams working in the 21st century are complex, being influenced by many interrelating factors. Governmental support for teamwork in healthcare is ongoing, although further work needs to be conducted at both a team and organisation level to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision over the coming decades. Taking this review's suggestions into consideration may facilitate

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