How Multidisciplinary Healthcare Teams Promote Optimal Clinical Outcomes

Concept Analysis: Team Work in Professional Nursing

1. Introduction

Although many nurses on the frontline in delivering high quality health care services may regard themselves as “an army of one,” they are still an integral part of an overall multidisciplinary team. Nevertheless, growing shortages of qualified nursing personnel have stretched existing resources to and beyond their limits in many health care organizations today, and the ongoing Covid-19 pandemic and its associated variants indicate the problem can be expected to worsen for the foreseeable future. Against this backdrop, it is clear that identifying opportunities to improve nurses’ understanding of the critical role they play as part of a multidisciplinary team represents a timely and important enterprise. The purpose of this paper is to provide a systematic review of the relevant literature to describe why and how teamwork in relevant to nursing in general and most especially with respect to staffing adequacy. In addition, a discussion concerning the specific uses of teamwork in the practice setting and a description of teamwork’s defining attributes, antecedents, and consequences are followed by an analysis of teamwork’s attributes, antecedents, and consequences to actual practice activities. Finally, a case example of teamwork in nursing and an assessment of its limitations are followed by a summary of the research and key findings concerning these issues in the conclusion.

2. Teamwork in nursing

One of the realities that nurses of all types must face in their professional practice is the need for teamwork in health care settings. In this regard, Anderson, Ross, Lim et al. (2019) emphasize, “Teamwork is essential to delivering high quality care and is central to nursing” (p. 119). Indeed, not only are the essentials of teamwork typically included as part of nurses’ curricular offerings, the need for effective teamwork is also consistently emphasized throughout their careers (Roper, Shulruf, Jorm et al., 2018).

Although effective teamwork is highly relevant to all types of nursing, the ability of nurses to participate fully in a team is constrained by the level of staffing adequacy that is available at any given point in time. For example, according to Bragadóttir, Kalisch and Bergthóra Tryggvadóttir (2019), “Teamwork and staffing adequacy are significant contributors to patient and staff safety in hospitals” (p. 4298). This constraint just makes sense given that the availability of fewer health care staff dictates the composition of any team, but the importance of effective teamwork is not diminished irrespective of staffing levels.

Under optimal circumstances, a multidisciplinary health care team can be comprised of nurses as well as members of all of the specialty areas that are involved. As staffing adequacy levels decline due to the unavailability of interdisciplinary practitioners, however, the ability of health care organizations to field appropriate multidisciplinary teams declines. The implications of inadequate staffing levels for the quality of patient care that is delivered are therefore significant. While such staffing adequacy concerns may only adversely affect certain practice areas depending on which disciplines are in short supply, it is reasonable to posit that the overall ability of health care organizations to provide optimal levels of patient care is directly affected by staffing levels. Some relevant examples of the specific uses of teamwork in the practice setting are described below.

3. Specific uses of teamwork in the practice setting

Effective teamwork has been identified time and again as an essential part of providing high quality health care services in virtually every type of practice setting. The impact of effective teamwork has also been studied in depth and the findings that have emerged from the research to date confirms that teamwork provides a wide array of benefits for patients as well as health care practitioners of every discipline. For example, the nursing professionals at Eastern Illinois University point out that, “When teams coordinate care, they decrease the level of stress patients may experience and positively affect outcomes. In addition, teamwork may reduce the number of issues related to burnout in nurses” (Why Teamwork and Communication are Critical in Nursing, 2019, para. 4).

Therefore, a lack of effective teamwork can not only detract from the quality of health care services that is provided patients, it can also negatively impact the wellbeing of nursing staff who are forced to make vital decisions and take action without the necessary consultation and support from other relevant medical disciplines. Furthermore, nurses must also work together as a team in order to achieve optimal clinical outcomes. As Goosen (2015) points out, “Nurses need to work together to realize the goals of patient care needs, improved outcomes and patient safety. The job of caring becomes more efficient and easier if teamwork is present in a nursing unit” (p. 37). Although every health care organization is unique in some fashion, teams share some defining attributes, antecedents and consequences as discussed below.

4. Teamwork’s defining attributes, antecedents, and consequences

One of the main defining attributes of any team is the composition and number of its constituent membership. For example, according to Babiker, Husseini, Al Nemri et al. (2019), “A team can be defined as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common and valued goal/objective/mission, who have been assigned specific roles or functions to perform and who have a limited lifespan of membership” (p. 10). Although teams can consist of as few as just two or three members, the types of multidisciplinary teams that are used in health care settings typically include several more members which represent the specialty areas that are most relevant to patients’ needs. For instance, the nursing professionals at Maryville University note that, “Today’s healthcare industry is built around a multidisciplinary approach to patient care. Nurses work closely alongside physicians and specialists to provide well-organized comprehensive care; therefore, teamwork is crucial to facilitating effective communication and promoting positive patient outcomes” (Top five benefits of teamwork in nursing, 2021, para. 2).

Consequently, the antecedents of multidisciplinary health care teams depend on what types of specialty care areas are involved as well as the adequacy of the staffing levels that is available. Just as effective teamwork has been demonstrated to have a positive impact on the quality of health care services that are provided patients, the consequences of inadequate or ineffective teamwork has also been shown to be severe and even life-threatening for some patients. As Roper, Shulruf, Jorm et al. (2018) emphasize, “Poor teamwork has been implicated in medical error” (p. 1072).

Conversely, there are a number of benefits to both patients and health care providers that have been identified for effective teamwork in health care settings, including the following:

· Improved patient satisfaction and clinical outcomes: Multidisciplinary health care teams improve patient safety as well as patient trust and satisfaction levels in ways that promote optimal clinical outcomes;

· Higher levels of job satisfaction on the part of health care providers: Studies have consistently shown that nurses who as part of a health care team experience higher levels of job satisfaction compared to those that do not;

· Increased professional accountability: Regular collaboration between the members of health care teams that is characterized by effective communication provides increased accountability for patient care;

· Lower rates of unplanned turnover: Improved teamwork among health care providers has been shown to improve job satisfaction among nurses and the corresponding rate of unplanned turnover in this profession;

· Improved engagement in the workplace: For instance, the nursing professionals at Maryland University emphasize that, “Nurses who are highly engaged in the workplace are usually more motivated to provide high levels of care” (Top five benefits of teamwork in nursing, 2021, para. 8).

In addition, some of the other antecedents of multidisciplinary health care teams include the increasing complexity of patient care that involves primary and comorbid conditions which require the close coordination of various types of specialized care. For example, the nursing professionals at Eastern Illinois University also point out that, “Multidisciplinary health care teams which are comprised of nurses, physicians and other specialty staff can reduce morbidity rates while increasing patient and healthcare worker satisfaction” (Why Teamwork and Communication are Critical in Nursing, 2019, para. 6). In sum, multidisciplinary health care teams can consistently achieve the following positive outcomes through close collaboration and effective communication:

· Enhance patient safety;

· Improve clinical performance;

· Reduce medical errors;

· Ease patient concerns about treatments and procedures; and,

· Raise efficiency and lower healthcare costs (Why Teamwork and Communication are Critical in Nursing, 2019, para. 6).

While the foregoing lists of benefits are not exhaustive, they do underscore the centrality of multidisciplinary teamwork in virtually all types of practice settings and these issues are discussed further below.

5. Teamwork’s attributes, antecedents, and consequences to actual practice activities

One of the most important attributes of multidisciplinary health care teams that are comprised of nurses, physicians and other specialty area staff members is the ability to reduce medical errors while concomitantly improving the levels of patient and health care practitioner satisfaction with the process and outcomes. In this regard, multidisciplinary health care teams that collaborate about patient care using effective communication strategies can achieve the following objectives:

· Enhance patient safety;

· Improve clinical performance;

· Cut down on medical errors;

· Ease patient concerns about treatments and procedures; and,

· Raise efficiency and lower healthcare costs (Why Teamwork and Communication are Critical in Nursing, 2019).

As noted above, however, any corresponding deficiencies in the composition of multidisciplinary health care teams can have severe consequences in actual practice activities. Taken together, it is clear that there is an overarching need for effective teamwork in health care settings in order to promote optimal clinical outcomes and minimize the adverse effects of suboptimal care and a relevant case example of this concept as it relates to nursing is provided below.

6. Case example of teamwork in nursing

Many if not most patients present with a number of comorbid conditions or other individual considerations that must be taken into account when formulating a treatment plan. On the one hand, these considerations may only require collaboration between nurses and other health care practitioners. On the other hand, though, some situations demand effective teamwork in order to achieve optimal clinical outcomes. For instance, the nursing professionals at Regis College note that, “If a pregnant patient shows signs of a heart issue, a cardiac surgery team will be called to work together with those in the maternity ward” (The importance of teamwork and collaboration in nursing, 2021, para. 3).

In this context, collaboration can be defined as “joint efforts between various independent teams or groups” while teamwork can be defined as “the efforts within one team to produce the highest quality and most efficient results” (The importance of teamwork and collaboration in nursing, 2021, para. 4). It is also important to note, though, that regardless of the specific practice setting, collaboration and teamwork are both essential elements needed to provide high quality patient care. Notwithstanding the importance of effective teamwork for the nursing profession, there are some limitations to effective teamwork that can detract from the quality of patient care as discussed below.

7. Limitations to effective teamwork in nursing practice

While gigantic strides have been made in recent years in recognizing nurses at all levels as highly trained health care professionals, the potential for physicians and other ancillary specialists to consider them as “equals” remains a salient limitation for close collaboration and effective teamwork. In addition, some team members may lack the requisite communication skills and demeanor that are essential for timely and effective teamwork (Carson, Laird, Reid et al., 2018). Likewise, some practitioners may have an inexplicable but visceral reaction to other team members which can derail close collaboration and effective teamwork.