Elsevier

Public Health

Volume 153, December 2017, Pages 91-98
Public Health

Review Paper
Team-based efforts to improve quality of care, the fundamental role of ethics, and the responsibility of health managers: monitoring and management strategies to enhance teamwork

https://doi.org/10.1016/j.puhe.2017.08.007Get rights and content

Highlights

  • Quality of care depends on individual profile, administrative planning, and teamwork.

  • Team monitoring and management are vital to achieve efficient teamwork.

  • Ethics constitutes the fundamentals of efficient and sustained teamwork.

Abstract

Objectives

Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature.

Study design

Review paper.

Methods

A MEDLINE/Pubmed search was performed starting from 1990, and the terms ‘team, teamwork, managers, healthcare, and cooperation’ were searched in titles, abstracts, keywords, and conclusions; other terms ‘patient safety, ethics, audits and quality of care’ were specifically searched in abstracts and were used as additional filters criteria to select relevant articles.

Results

Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere.

Conclusion

Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome.

Introduction

The word ‘teamwork’ (TW) in general denotes a method of working in collaboration with a group of people to achieve a goal, through interdependent actions and accountability to each other. The process is often framed within a system with institutional instructions and a leadership, the role of which is mainly to monitor and manage the whole process.1 TW is often more efficient and safer than individual work. Teams working together in high-risk and/or high-workload environments make fewer mistakes than individuals do, a fact proven in commercial aviation, military, and rapid-response police activities.1

In health care institutions (HCIs), the quality of care (QoC) depends on a complex system, including professionalism and individual awareness, institutional infrastructure (i.e. organizational issues, availability of equipment, etc.), and TW. Of note, medical errors are a leading cause of death worldwide, and many of these are the result of dysfunctional or nonexistent TW.2, 3 Moreover, it is more and more recognized that TW in HCIs is a crucial component of the health delivery system, given that it yields a better QoC, especially in complex clinical situations.1

In HCIs, people must cooperate, using their individual clinical, technical, and organizational skills to provide a better clinical outcome. Of note, a team does not consist only of physicians; it theoretically involves a group of people of different categories including paramedics, nurses, physicians, and managers.1 TW must be encouraged as a culture in all HCIs, and working environment is essential for appropriate implementation of TW. Many parameters are involved in this process to work properly, including working infrastructure, self-awareness, ethics, leadership, communication, cooperation, and competitiveness.4, 5 Of note, working environment plays a critical role in TW, also members of a team may need some time delay to adapt to each others and to the working environment to implement an efficient TW.

Efficient TW requires individual self-efficacy, appropriate communication among members, self-motivation and commitment, awareness of TW, acceptance of leadership, acceptance of advices and instructions, and adherence to protocols.6 However, in real practice, there is little data and experimental evidence regarding how to construct efficient TW, and how to assess TW skills using objective measures.6, 7

In view of this, constructing a safer health care system while targeting better TW has become a priority. In HCIs, the armamentarium to fight against medical conditions depends on a complex algorithm involving human and technical resources. In this algorithm, team-based effort is probably the most flexible and most available parameter for significant improvement of the QoC. Consequently, HCIs must focus increasingly on TW rather than on individual work, and such a policy may increase patient safety while yielding a better clinical outcome.4

In this article, we summarize key researches in the domain and discuss the personal, professional, and organizational elements for efficient TW, with a special focus on ethics, communication, and patient safety. Moreover, we highlight the importance of moving beyond simply including efficient and competent people in a team, to monitor and manage those people in order that they could effectively coordinate and collaborate.

Section snippets

Methods

We performed an extensive search of the literature starting from 1990, using MEDLINE/Pubmed. The Terms ‘team, teamwork, managers, healthcare, and cooperation’ were searched in titles, abstracts, keywords, and conclusions of the selected articles. Selected articles address mainly team-based effort with regard to clinical outcome, along with the managerial aspect rather than simply as a theoretical concept. Accordingly, the terms ‘patient safety, ethics, audits and quality of care’ were

Results

Thirty-three papers were reviewed and analyzed, and we present in the following sections the main results with regard to essential ingredients of an efficient TW: self-awareness and behavior, work environment and infrastructure, ethics, leadership, communication, cooperation and competitiveness. Table 1 represents a summary of the selected articles.

Discussion

The main points of a TW as presented in the Results section comprise: self-awareness, work environment, ethics, leadership, communication, cooperation, and competitiveness. Though all these points represent key features, we estimate that ethics and leadership are the most fundamental to enhance TW in HCIs. However, and for efficient TW, all of these key features should work together in a harmonized synchrony to yield optimal outcome; furthermore, health managers may utilize these key features

Ethical approval

None sought.

Funding

None declared.

Competing interests

None declared.

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    Present/permanent address: Cardiology division, University Hospital Notre Dame de Secours, Byblos, Jbeil, Lebanon.

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