Authors

1. Teles, Carine Sangaleti
2. Cabral, Mariana Schveitzer
3. Peduzzi, Marina
4. Lourdes, Elma Campos Pavone Zoboli
5. Baldini, Cassia Soares

Abstract

Review question/objective: What are the experiences and the meaning of teamwork in primary health care settings for health care professionals?

Background: Teamwork in primary health care settings is formed by workers from different professional groups, capable of answering to a greater array of health needs. The literature also indicates that teamwork is a possibility in the face of the increasing number of healthcare disciplines and shortage of human resources, mainly medical doctors, that may lead to health care fragmentation.1,2

During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: Interdependence of professional actions, focus on the user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups.3,4,5,6 Although teamwork and interprofessional collaboration have been pointed out as an adequate strategy for the organization of health care services, the literature shows that there has not been a consensus on these concepts among health care professionals.7,8,9,10

Recently a quantitative systematic review was developed to verify the effects of interprofessional collaboration on healthcare outcomes, selected in a period of five decades of searching, just five randomized controlled trials.11 The conclusion of the review stated the following:

"The review suggests that practice-based interprofessional care interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness."11,8

The authors also point out the terminology imprecision and problems with conceptualization of interprofessional collaboration as limitations to the study which compromises generalization and production of evidence of the usefulness of the collaborative practice in teams. The authors of the above mentioned study have concluded that it is necessary for a greater conceptual accuracy in the research and the development of qualitative studies focusing on teamwork and collaborative interprofessional practice. This review aims to fill that gap.

Other studies also highlight the lack of clarity or even a common understanding of the teamwork concept, hinders the assessment of the results linked to this form of work, and even impairs the validity of the research studies related to the theme.12,13,14

However, there are few studies that report a definition of health care teamwork.

Xyrics15 developed a concept analysis of health care teamwork and arrived at the following definition:

"A dynamic process involving two or more health professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision-making. This in turn generates value-added patient, organizational and staff outcomes.15,^p.238"

Pollard16 defines teamwork as a small group of professionals with a shared aim and common objectives, complementary skills, the same approach to health care and shared accountability in relation to results.

McCallin17 developed a review about interdisciplinary practice and adopted a definition of teamwork - coined earlier by Manion, Lorimer & Leander (1996) "A team is a small number of consistent people committed to a relevant shared purpose, with common performance goals, complementary and overlapping skills, and a common approach to their work. Team members hold themselves mutually accountable for the team's results or outcomes." ^17:421

In a later study McCallin18 based on findings of empirical research, defines teamwork as: collective contribution of professionals that share decision making, solve problems to achieve the best performance, share objectives and are held collectively accountable for the results.

According to D'Amour et al.5 and Martin-Rodrigues et al.4 the concepts of teamwork depends on the understanding of its determinants. These determinants include the interaction factors, which are related to the interpersonal relationship between the team members; the organizational factors referring to work conditions within the institutions, and the systemic factors that are the elements outside the work institutions such as the cultural, educational and professional systems. According to such determinants, the predisposition for interprofessional work may configure the teams with different integration levels on daily health care settings.5,12,19,20

Based on the above, the question of this review is: 'What is the experience and shared meaning of interprofessional collaboration and teamwork in primary health care to healthcare professionals?' The objective of this systematic review is to explore the experience and shared meaning of interprofessional collaboration and teamwork in primary health care to healthcare professionals. In searches done on Joanna Briggs Institute (JBI), Cochrane Library, The Campbell Collaboration Library, Ovid SP and Bandolier, no previous or ongoing systematic reviews were identified on the subject of interest of this review.

This review aims to determine the experience and meaning of teamwork and interdisciplinary collaboration, and to propose a teamwork definition for primary healthcare professionals; to contribute with the extension of strict accuracy on research of the theme; to advance the development of research, and to consolidate such modality of work in the primary healthcare services.