Effective teamwork within healthcare - Let's finally make it happen! A realist evaluation.

Introduction: Effective teamwork is essential for the successful functioning of healthcare. Breakdowns in teamwork are frequently flagged as contributing to major patient safety issues. Current research indicates a lack of knowledge regarding key factors that impact upon teamwork and how medical educators can best prepare students. This study explores how doctors work within healthcare teams; exploring barriers and enablers to effective teamworking.

Methods: A realist evaluation was used to understand the contextual influences and subsequent mechanisms that impact teamwork outcomes. Phase 1 included a realist literature review and scoping interviews with key stakeholders (n = 9). Phase 2 included 63 realist interviews representing a wide range of professional groups, roles and demographics across the UK healthcare.

Results: The initial program theory developed in Phase 1 was refined during Phase 2, integrating and extending the dispersed and patchy current evidence on the contexts, mechanisms, and outcomes of teamwork. Enablers included building a positive and supportive culture, effective communication, leaders who are understanding and approachable, clearly defined roles and respect, and continuity and experience of those in newer roles. Barriers included high service demands and work pressures, power imbalances and negative hierarchy, a lack of support for those new to teams and organisations, poor communication, poor leadership, a lack of appreciation and understanding of the needs of differing groups within teams, and finally EDI issues. There were particular difficulties for those in newer roles.

Discussion: We have identified that team dynamics are likely to be hindered by transient teams, lack of support, dysfunctional leadership and communication, and non-approachable colleagues. There are currently clear difficulties in how doctors interact with those in newer roles, and the ways in which team members are integrated into teams. This is the first research to develop a teamworking programme theory that can be used to support educators, institutions and regulators.[Box: see text].