Dimensions and intensity of inter-professional teamwork in primary care: evidence from five international jurisdictions

Abstract

BackgroundInter-professional teamwork in primary care settings offers potential benefits for responding to the increasing complexity of patients’ needs. While it is a central element in many reforms to primary care delivery, implementing inter-professional teamwork has proven to be more challenging than anticipated.ObjectiveThe objective of this study was to better understand the dimensions and intensity of teamwork and the developmental process involved in creating fully integrated teams.MethodsSecondary analyses of qualitative and quantitative data from completed studies conducted in Australia, Canada and USA. Case studies and matrices were used, along with face-to-face group retreats, using a Collaborative Reflexive Deliberative Approach.ResultsFour dimensions of teamwork were identified. The structural dimension relates to human resources and mechanisms implemented to create the foundations for teamwork. The operational dimension relates to the activities and programs conducted as part of the team’s production of services. The relational dimension relates to the relationships and interactions occurring in the team. Finally, the functional dimension relates to definitions of roles and responsibilities aimed at coordinating the team’s activities as well as to the shared vision, objectives and developmental activities aimed at ensuring the long-term cohesion of the team. There was a high degree of variation in the way the dimensions were addressed by reforms across the national contexts.ConclusionThe framework enables a clearer understanding of the incremental and iterative aspects that relate to higher achievement of teamwork. Future reforms of primary care need to address higher-level dimensions of teamwork to achieve its expected outcomes.

Uncovering the wisdom hidden between the lines: the Collaborative Reflexive Deliberative Approach

“…Three major findings emerged from our CRDA study. The first concerned the identification of four dimensions of collaboration within teams and that the fourth dimension, functional collaboration, was the most neglected, yet essential for long-term success ( 47 ). The functional dimension specifically involves the definitions of roles and responsibilities aimed at coordinating the team’s activities.…”

Transforming primary care: scoping review of research and practice

“…Peer groups were an invaluable forum for undertaking this reflection and in sharing learning about how to overcome common challenges. Team-based approaches help to provide additional capacity and more holistic care but can be particularly challenging for doctors ( Nutting et al , 2009 ; Cronholm et al , 2013 ; Levesque et al , 2017 ; McGough et al , 2017 ). This is connected with “deeply held beliefs that PC doctoring was based in a strong, trusting relationship between a patient and a physician” ( Russell et al , 2017 , p. 23).…”

“…Team working often requires doctors to develop new skills, and in particular new leadership skills ( Nutting et al , 2009 ; Levesque et al , 2017 ). Traditionally, they were able to adopt authoritarian approaches in which other professionals were instructed as to the required actions to be undertaken.…”

The Team Assessment of Self-Management Support (TASMS): A new approach to uncovering how teams support people with chronic conditions

“…15 To overcome existing problems, Canadian and other healthcare systems are implementing primary care models founded on multidisciplinary, 16 team-based care. 17 This includes chronic disease teams, primary care teams, and most recently, primary care networks. 18 The ability of teams to meet patient needs is dependent on complex and nuanced factors such as the disciplinary composition of the team, team roles, collaboration and function, and chosen models of care.…”