Importance of teamwork & role of HR
Importance of Teamwork in Hospitals
Hilaria N. Mtuleni
Department of Health Management, European University of Lefke, TRNC
According to Jones & George (2011), a team is formed when two or more people work together on a common project, service or goal. In organisations, employees can form a single professional team or a multi-professional team- in one place, one region or it can be geographically distributed (Kalish, 2007). Salas, Cooke & Rosen (2008), defined teamwork as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common goal, objective or mission. A definition of teamwork in healthcare by Xyrichis & Ream (2008), referred to teamwork as a dynamic process involving two or more healthcare professionals with complementary background and skills, sharing common health goals and exercising concerted physical and mental effort in planning, assessing and evaluating patient care. Basically, hospitals are broad with critical environments that requires good management and great effort from all individuals for proper functioning. Mickan (2005), stated that health care outcomes depends on optimal functioning of individuals in a team and how they are managed and involved in care provision.
According to Sexton et al. (2007), hospitals are made up of many disciples working in a complex network of health programs. Multi-professions in hospitals should all work towards a common goal of ensuring the provision of quality, safe and effective healthcare to patients with different conditions. There are different clinical and non-clinical human resources responsible for public and individual complex health intervention (Dit-Dariel & Cristofallo, 2018). As stated by Epstein (2014), common multi-professionals found in hospital settings are: Doctors, Nurses, Paramedics, Pharmacists, Radiographers, Physiotherapist, Physicians, Social Workers, Psychologists, Administration and Ancillary service providers. Healthcare professionals also fall in different categories according to their expertise like emergency teams, intensive care unit team, maternity team and other special areas, (Schmutz & Manser, 2013). Below is an example of a brief hospital hierarchy that shows different levels of hospital management. Each level is not detailed until the last category, and the hierarchy does not include all departments/professionals in a hospital.
Figure 1 adapted from hierarchystructure.com
Catchpole et al. (2007), stated that there are interrelated teams that support and deliver healthcare. According to Jain et al. (2008), teams in hospitals are categorise into interdisciplinary team, Trans-disciplinary team, multidisciplinary team, intra-professional team and rehabilitation team. Mitchell et al., (2012) indicated that an evidence based program implemented by Healthcare research and quality agency -TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), with the aim of optimising performance among different interrelated healthcare teams focusing on patient safety and health care quality formulated different team categories in health settings. “Core teams- involved in direct patient care, Contingency team- responsible for emergencies or specific events, Coordinating team- responsible for day to day operation and coordination, Support team- provide indirect service, Ancillary service- cleaning and domestic work, Administration- responsible for overall functioning of the hospital” Clancy et al. (2007).
According to Wisborg et al. (2008), teamwork is essential for provision of safe, effective and person-centred care in hospitals. Teamwork is increasingly becoming an essential need in hospitals due to large complex and specialised care, employee shortage, increase of chronic diseases, aging population and invention of safe working hours (Goh, Chan & Kuziemsky, 2013). Schmutz & Manser (2013), indicated that working as a team is essential for carrying out complex activities effectively. Research by Petiffer, Cooper & Munday (2007) found that different types of skills and expertise from healthcare providers is more effective through teamwork. The division of labour among medical, nursing and allied health practitioners indicated that no single professional can deliver a complete episode of healthcare (McKeon, Cunningham & Oswaks 2009), that is why teamwork is a necessity in all healthcare settings. As stated by Manser (2009), effective teams in hospital settings improves collaboration, communication and enhance understanding of traditional roles among health workers. Leonard & Graham & Bonacum (2004), stated that effective teamwork in conjunction with good processes of providing care, is essential for delivery of consistent high-quality care.
Polis et al. (2017), found that diversity in healthcare teams is being promoted due to decentralisation and more specialised areas with different managers. Toccafondi et al. (2012), argued that even though there are hospital teams, individuals focus more on their units/divisions and each profession is more focused on improving their section/department and not focusing on a hospital at large. Boult et al. (2009), also argued that the value of teamwork is not taught in Universities and most health workers focuses more on individual excellence and advancement rather than focusing on building a strong and effective teams when they start working. Research done by Lerner, Magrane & Friedman (2009), found that educating healthcare providers on the importance of teamwork while they are still in school or immediately before they start working results in better awareness among individuals who can then form effective teams.
A hospital without a team environment has a delayed success of developing, poor problem solving system and lack of safety for both patients and healthcare providers (Sexton et al. 2007). According to Hanscom (2008), poor teams in hospital setting fail to coordinate and manage clinical procedures, sometimes causing permanent harm or medical litigations. Mushta, Rush & Anderson (2018), found that hospital hierarchical structure of health workers also has an effect on teamwork as the conversation or planning is more done through one on one conversations and not through discussions. Bates et al. (2009), stated that all healthcare workers must be trained about teamwork so that each individual member will understand the importance of teamwork.
The aim of this project is to collect evidence on importance of teamwork by reviewing literature done on teamwork in hospital settings. Although there is a lot of literature on teamwork, this project will only review literature on the importance of teamwork to patients, to healthcare providers and to hospitals at large.
2. Literature Review
2.1 Importance of Teamwork to Patients
The whole healthcare system should be planned based on the interests of patients (Dit-Dariel & Cristofalo, 2018). A good teamwork ensure good communication with the patient, minimises misunderstanding of treatment and involves patients in their own care, Mitchell et al. (2012).
Research by Jain et al. (2006), in Northern Mississippi hospital whereby ICU care providers were trained on teamwork indicated a reduction of nosocomial infection related to ventilator associated pneumonia (VAP), bloodstream infection (BSI) and urinary tract infection (UTI) between fall year 2001 to 2003 after teamwork training. The graph below indicates the reduction in each year.
Figure 2 Reduction in adverse events in the ICU in relation to onset of specific quality improvement interventions with National Nosocomial Infection Surveillance (NNNIS) comparisons. VAP, ventilator associated infection; BSI, bloodstream infection; UTI, urinary tract infection.
Manser (2009), stated that good communication and mutual understanding brings out good input from different health professionals in all teams, which leads to proper planned treatment protocols. Effective healthcare teams are able to treat patients according to a well-established priorities, giving proper clear report and discussing treatment plans together (Behnia, HosseinPour & Zarea, 2016). According to Welp & Manser (2016), teamwork is important to provide enhanced quality patient care. Research done by Sexton et al. (2007), found that through good teamwork, specialists from different teams are able to manage complex problems in patients with no difficulties. Good health teams provides efficient and effective patient care.
When enhanced quality care is provided, complex problems are likely to be picked up on time and complications are reduced (Weller, Barrow & Gasquoine, 2011). Multiple professionals looking after one patient reduces chances of negligence, medico-legal hazards and other medical errors are avoided as staffs are motivating and correcting each other (Mushta, Rush & Anderson, 2017). Through good teamwork Patient progress is monitored accurately by both professionals, no task is left undone and the patients are considered safe from wrong treatments. Research done by Catchpole et al. (2007), in an operating theatre found that effective teams tend to have few minor problems and complete procedures within a short period of time. Manser (2009), stated that patient safety is improved by interventions based on a focused system, so effective teamwork improves patient safety.
Enhanced quality care and improved patient safety means that efficient and effective care is provided. When patients get the right treatment there is high chance of fast healing and unnecessary lengths of hospital stay are prevented (Kossaify, Hleihel & Lahoud, 2017). When right services are provided patients do not have to pay for unnecessary services, therefore reducing hospital costs. Jain et al. (2006), found that multidisciplinary ICU teams had a good systematic approach, health team collaboration, good communication and flow meetings that allowed rapid prioritisation of healthcare activities which led to a strong downward trend in hospital stay and costs per ICU episode. The graph below indicates the downward trend of hospital cost in research done by Jain et al. (2006).
Figure 3 Average cost per ICU episode over 2.5 years with fiscal year (FY) 2004 data to 1 March 2004.
According to Leonard, Graham & Bonacum (2004), organised methods of interventions leads to a more personalised level of care which impacts the patient’s satisfaction and good health outcome. Where enhanced quality care is provided and patient’s safety is ensured, patients feel more at ease as they are evaluated more thoroughly and they develop trust (Jain et al. 2006). As stated by Mckeon, Cunningham & Oswaks (2009), effective teamwork ensures patient’s satisfaction. Teamwork is not only an advantage for patients, it also important to team members involved.
2.2 Importance of Teamwork to Healthcare Providers
Every professional in the hospital setting carries with them experiences or skill sets that can be used when patient’s health or wellbeing are at stake. It is important for all the different professionals in the healthcare sector to work together.
Mithell et al. (2012), stated that individual health staff can rarely provide complete healthcare so a team is an essential need in care provision. According to Gupte et al. (2016), when an organisation of medicals has developed a high level of teamwork, it will experience greater staff fulfilment, lower levels of staff turnover and a standardised level of care. Research done by Siassakos et al. (2011), found that hospital staffs communicates more often either directly or through phones. The research also found that when staffs interact more often, they develop a bond, they also develop a good connection and high confidence knowing and trusting each other with specific jobs. Members of an effective teamwork respect the diversity of opinions from different professionals, therefore developing mutual respect (Pettifer, Cooper & Munday, 2007). Research carried out by Wisborg et al. (2008), in which 4200 healthcare providers from 50 Norway trauma hospitals were trained on teamwork, found reduction of stress after forming up effective teamwork.
According to Polis et al. (2017), mutual respect, brings out a great attitude as employees all have a common goal and they don’t feel much of overload. In a research contacted by Weller, Barrow & Gasquoine (2011), which evaluated relationships between a team of 25 nurses and doctors indicated mutual respect among staffs that interact more often. As stated by Behnia, HosseinPour & Zarea (2016), effective teams creates a less stressful environment as responsibilities are clearly defined and staffs feel less overwhelmed, creating a peaceful environment with less or no conflict. Research done by Pecorelli et al. (2018), showed that teamwork creates a good working environment, whereby staffs have a sense of belonging even if they are from a diverse religious and cultural backgrounds. According to Kalisch (2007), individuals tend to be more confident when they are working in groups then when they are working alone.
In a good working environment, roles and responsibilities are clearly defined for each professional. Individuals are also able to work according to their job description and therefore the workload is balanced (Mushta, Rush & Anderson, 2017), reducing overwork and staffs from multitasking (Jones & George, 2011). Welp & Manser (2016), stated that through well-defined roles and responsibilities, individuals in one team gets to know each other’s strengths and weaknesses, which can determine good delegation. Distributing different tasks evenly can increase engagement of each individual in the workplace, reducing burnout.
As stated by Mickan (2005), “teamwork is the fuel that allows common people to attain uncommon results.” Sharing ideas and correcting each other’s mistakes without judgements encourages each individual team member to put in effort to attain the common goal (Babiker, 2014). According to Williams et al. (2007), teamwork maximises strengths, bringing out the best in each team member. Each staff is more focused on what they know best, making them feel less overwhelmed and looking forward to going to work every day. Effective teamwork improves clinical output and staffs are more motivated when they know the positive outcome of job.
Mutual respect, good working environment and improved clinical outcome help individuals to be satisfied with their professional lives and find pride in their jobs. Health professionals are most likely to adapt to their job when there is teamwork (Kosaiffy, Hleihel & Lahoud, 2017). As indicated in a research by Pecorelli et al. (2018), health workers spent most of their time in hospitals, managing high-stressful situations together, so they get used to each other and some units even become as family. Overcoming certain challenges as a team also unites members, giving them a feeling of belonging and confidence. Gupte et al. (2016), stated that teamwork promotes job satisfaction in healthcare providers.
2.3 Importance of Teamwork to Hospitals
According to Fox et al. (2018), effective health teams provide the hospital with a diversity of thoughts, creativity, perspectives, opportunities and problem solving approaches which can help to upgrade the healthcare system. Research done by Polis et al. (2017) in five special units (ambulatory care unit, outpatient clinics, radiology unit, haemodialysis unit and oncology) at St George Hospital, Sydney, indicated that overall teamwork in different units of the hospital creates a good working environment, increases clinical expertise and creates a well-developed insight of patient needs.
Teamwork creates a common ground for all clinical teams in the hospital hence making the whole hospital management run smoothly increasing reliability and safety of the hospital at large, Tocaffondi et al. (2012). According to Tomasselo (2008), the whole hospital can have a good and cooperative communication model, mutual understanding among team members and ability to construct common cultural knowledge through effective teamwork. Effective teamwork help ongoing proper provision of care during tough economic times, when hospitals and health care providers stop recruiting to decrease the number of employees in order to save costs (Epstein, 2014). Through teamwork, healthcare providers are aware of the needs of other staff members, and they all can contribute to the overall morale.
Multidisciplinary teams from across the whole hospital can easily interact with no conflict and they are likely to come together and openly discuss issues, creating a good clinical learning platform (Leonard, Graham & Bonacum, 2004). According to Siassacos et al. (2011), efficient teams are most likely to create a good clinical environment, making it easier to handover or exchange patients among teams and to allocate tasks fairly among team members. A good teamwork develops a safety culture for the whole hospital whereby all individual members share a set of values, beliefs and behavioural norms (Mckeon, Cunning & Oswaks, 2009). As stated by Sexton et al. (2007), safety culture help to increase awareness amongst team members, making individuals understand each other’s differences without discrimination and adapt to a complex environment. Hanscom (2008), stated that effective teamwork makes it easier for the hospital management to set up, predict and monitor future direction.
According to Tomasselo (2008), effective teamwork skills rely on basic communication within departments and all personnel. Even though most hospitals are divided into different floors, units and many other departments, all healthcare workers have the same overall goal that can only be achieved through proper teamwork (Fox et al. 2018). Effective teamwork improves communication that enables good distribution of information. In the healthcare industry, teamwork equals efficiency. Time management is very important in hospital settings and previous researchers found that effective teamwork saves time. Horwitz et al. (2008), stated that effective teamwork is essential to control resources and saves time.
Babiker et al. (2014) found that teamwork help the hospital management to build a flat hierarchy, whereby all employees feel free to speak and participate in areas of care. The graph below shows an example of a flat hierarchy.
Figure 4 adapted from hierarchystructure.com
Hospitals being a complex entity with multiple talented individuals to provide care should be coordinated through proper teamwork. Clancy (2007) argued that optimal teamwork doesn’t automatically result from putting a group of professionals together in one place and that is why Human Resource Management needs to come in so that individuals from different professions can be trained and motivated to form comprehensive teams that support them fairly and accommodates them.
Study done by Dit-Dariel & Cristofalo (2018), whereby 20 years of qualitative research on inter-professional teamwork in hospital settings were analysed showed that organisational structure interferes with inter-professional interactions, therefore future strategies to improve teamwork among healthcare professionals should include structural changes to hospital settings. There is less information on what makes health professionals effective team members and also how to develop teamwork skills. Clancy (2007), stated that there is a science of teamwork from the past two decades of which the health sector slowly adopted because health professionals are rarely trained together and they are trained to function as individuals. Future research should concentrate on ways to promote teamwork in newly graduates.
Previous researchers found that healthcare providers from the lower level hierarchy, example ordinary nurses or pharmacists are not involved in patient care plan or decision making so they tend to concentrate more on orders or treatment plans given to them by the upper management and they are not free to advocate for the patients or suggest better care plans for individual patients. The patients are also not involved in their own care as treatment plans are made by people who are not in contact with them and likely to give patients generalised treatment. Future research needs to concentrate more on how to build flat hospital hierarchy that allows patients and all level healthcare providers to communicate effectively because though there is a wide range of healthcare providers with different expertise, these people often visit the patient at different times which makes them focus more on individual excellence, resulting in poor communication.
In hospital settings, human resource managers and health managers should be able to use wide variety of unique skill sets to build teams capable of achieving complex objectives. Hospitals should aid and put more effort on improving teamwork. Healthcare settings must also design a work system that supports effective team work.
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