The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment

Abstract

ObjectivesTo examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors.SettingControlled laboratory environment with well-appointed, quiet rooms and video and audio equipment.ParticipantsClinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions.InterventionsParticipants engaged in one of three team tasks, and their performance was video-recorded and assessed.Primary and secondary measuresPrimary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants’ individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted.ResultsAt baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).ConclusionsOnce clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals’ or professions’ characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.

The perspective of allied health staff on the role of nurses in subacute care

“…In some instances, a lack of respect for nurses was demonstrated and there was a limited understanding or recognition by some allied health staff for the complexity of the nursing role. This has been found in the previous research (Barreca & Wilkins, ; Kraft, Blomberg, & Hedman, ; Pryor et al., ; Seneviratne et al., ; Sinclair et al., ) and may be due to dissimilar professional culture or tribalism (Braithwaite et al., ; Hall, ), educational differences (White et al., ) or self‐perception (Pryor, ).…”

“…Teamwork between allied health staff and nurses is the cornerstone of successful inpatient rehabilitation; however, what this means in practice has not been well articulated (Sinclair et al., ). Effective teamwork is hindered by “tribalism” in which the clinical care is provided by health professionals independently of each other with low levels of interaction between the disciplines (Braithwaite et al., ). Pryor () argued that segregation of work practices which marginalise nurses add to the problems currently evident in rehabilitation.…”

Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration

“…Most of these use (informal) interview and observational data. Only four studies use either quantitative methods (social network analysis; Quinlan & Robertson, 2013) or multi-method designs, such as a mixed-method experiment design (Braithwaite et al, 2016).…”

Trabalho em equipe e prática colaborativa na Atenção Primária à Saúde

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