Department of Paediatrics, University of California San Francisco (UCSF), San Francisco, California, USA.
Med Educ. 2014 Jun;48(6):583-92. doi: 10.1111/medu.12424.
Working effectively in interprofessional teams is a core competency for all health care professionals, yet there is a paucity of instruments with which to assess the associated skills. Published medical teamwork skills assessment tools focus primarily on high-acuity situations, such as cardiopulmonary arrests and crisis events in operating rooms, and may not generalise to non-high-acuity environments, such as in-patient wards and out-patient clinics.
We undertook the current study to explore the constructs underlying interprofessional teamwork in non-high-acuity settings and team members' perspectives of essential teamwork attributes.
We used an ethnographic approach to study four interprofessional teams in two different low-acuity settings: women's HIV (human immunodeficiency virus) clinics and in-patient paediatric wards. Over a period of 17 months, we collected qualitative data through direct observations, focus groups and individual interviews. We analysed the data using qualitative thematic analysis, following an iterative process: data from our observations (20 hours in total) informed the focus group guide and focus group data informed the interview guide. To enhance the integrity of our analysis, we triangulated data sources and verified themes through member checking.
We conducted seven focus groups and 27 individual interviews with a total of 39 study participants representing eight professions. Participants emphasised shared leadership and collaborative decision making, mutual respect, recognition of one's own and others' limitations and strengths, and the need to nurture relationships. Team members also discussed tensions around hierarchy and questioned whether doctor leadership is appropriate for interprofessional teams. Our findings indicate that there are differences in teamwork between low-acuity and high-acuity settings, and also provide insights into potential barriers to effective interprofessional teamwork.
Our study delineates essential elements of teamwork in low-acuity settings, including desirable attributes of team members, thus laying the foundation for the development of an individual teamwork skills assessment tool.
有效协作是所有医疗保健专业人员的核心能力，但用于评估相关技能的工具却十分匮乏。已发表的医疗团队协作技能评估工具主要关注高风险情况，如心肺骤停和手术室危机事件，并且可能无法推广到非高风险环境，如住院病房和门诊诊所。
我们进行了当前的研究，以探讨非高风险环境下的跨专业团队协作的基本结构以及团队成员对基本团队协作属性的看法。
我们采用民族志方法研究了两个低风险环境中的四个跨专业团队：女性艾滋病（human immunodeficiency virus）诊所和住院儿科病房。在 17 个月的时间里，我们通过直接观察、焦点小组和个人访谈收集了定性数据。我们使用定性主题分析对数据进行分析，采用迭代过程：我们的观察数据（共 20 小时）为焦点小组指南提供了信息，而焦点小组数据则为访谈指南提供了信息。为了增强我们分析的完整性，我们通过三角测量数据来源并通过成员检查来验证主题。
我们进行了七次焦点小组讨论和 27 次个人访谈，共有 39 名代表八个专业的研究参与者参与。参与者强调了共享领导和协作决策、相互尊重、认识到自己和他人的局限性和优势，以及培养关系的必要性。团队成员还讨论了围绕等级制度的紧张关系，并质疑医生领导是否适合跨专业团队。我们的研究结果表明，低风险和高风险环境中的团队协作存在差异，并提供了有关跨专业团队协作的潜在障碍的见解。
我们的研究描绘了低风险环境中团队协作的基本要素，包括团队成员的理想属性，从而为开发个人团队协作技能评估工具奠定了基础。
