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You previously purchased this article through ReadCube. Institutional Login. Fransen et al. Dekker , p. While these views certainly constitute two of the possible extremes, what often seems to be overlooked in teamwork research is the need to consciously address the trade-offs required to apply and interpret any taxonomy:. A model that is cumbersome and costly to use will from the very start be at disadvantage, even if it from an academic point of view provides a better explanation.

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The trick is therefore to find a model that at the same time is so simple that it can be used without engendering problems or requiring too much specialised knowledge, yet powerful enough to go beneath the often deceptive surface descriptions […] The consequence is rather that we should acknowledge the simplifications that the model brings, and carefully weigh advantages against disadvantages so that a choice of model is made knowingly Hollnagel and Woods , p.

A predominant focus on individual behaviours, both in training and as the unit of analysis, is oftentimes observed, justified by the fact that teams are comprised of individuals and by their dynamic composition Flin et al. In a sense, the patient safety agenda is being hijacked to serve a more hidden, managerial one: organizational distancing, a defence against entanglement with accidents, and the illusion of control Cook and Nemeth It is worth noting that, in the current discourse on teamwork in healthcare, a substantial body of research is largely being ignored Finn et al.

Contributions from social sciences are rarely mentioned; instead, a more simplistic narrative seems to be accepted that provides more convenient but scientifically impoverished explanations Vincent In doing so, they deny themselves and their colleagues the opportunity to engage with and learn from the actual messiness that characterises their everyday work: divergent understandings, ongoing tensions and pervasive uncertainties. Iedema As far as teamwork is concerned, there is a tendency that normative, formal dimensions have been privileged over social and affective ones.

Research drawing on both organizational theory and the sociology of healthcare is scarce Finn ; Finn et al.

Its result, however, is a more diversified, critical, and maybe sombre view. In healthcare, teamwork as part of the professional identity superimposes the ideal of normative integration over individual interests, thereby overriding identities and aligning them with those of the team Findlay et al.

What mainstream teamwork literature rarely mentions, or glosses over, is what Finn et al. Ethnographic, descriptive research seems much more sensitive in capturing the intricate web of historically woven relations between different actors, professions and specialties and their ongoing conflicts and struggles than any quantitative approach. Obviously, power is an omnipresent force in daily organizational life. Formal authority, distribution of knowledge, control of rewards and resources and coercive power are all important notions that shape and influence organizations Antonsen In the teamwork literature, issues of power implicitly or explicitly permeate all levels of the discourse.

This not only applies to inter- and intraprofessional relations e. This coercive function, however, is oftentimes effectively masked with ideology and language. By framing problems as issues of teamwork, the focus is shifted from other, usually more profound organizational solutions, preventing robust and fundamental change. Within the teams, the egalitarian rhetoric rarely manages to break open encrusted structures and effect sustained change.

One has to be careful, however, not to see this as purely negative, but to acknowledge productive and enabling aspects of power. The potential to shape organizations through empowerment, regardless of its distribution, has to be recognized. Above, we illustrated from various angles how teamwork is described, understood, enacted and trained in healthcare, both practically and theoretically. Nevertheless, to conceptualize a way ahead for team training in healthcare, we must first try to gain a meta-perspective of the current state.

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At present, we can only speculate about reasons for why the existing, diverse body of safety knowledge is not readily harnessed in its entirety in medicine. However, based on our own experience, we would suggest far more trivial, if somewhat pragmatic, explanations that are rooted in traditions of academic medical discourse, rather than suspecting wider epistemological schemes. Traditionally, medical research is built on a strong Newtonian understanding of cause and effect.

Over centuries, complex issues have been broken down to the smallest accessible denominator, from macroscopic to microscopic to molecular levels, each adding small fragments to an expanding science that has progressively replaced ambiguities and guesswork of the past with new discoveries: from drugs and microorganisms, to signalling pathways, cellular receptors, and, increasingly, our very own DNA as building blocks of life itself. It is also important to consider how this discourse takes place in a society that is increasingly reluctant to accept gaps in knowledge, attribute circumstance to fate or higher religious powers, or accept physicians that simply cannot explain disease, suffering and death.

Challenges arise as patient safety issues that were of no concern in this data-driven world of medicine only decades ago now increasingly become visible Kohn et al. This represents one approach to explain the predominant, reductionist understanding of the concept of teamwork in medicine: it is based on how the associated complexities appear manageable amongst an onslaught of new challenges while appealing solutions in the form of normative rating and training instruments are readily available and confirm to the sought-after standards of measurability and comparability.

In addition, while expanding the discourse into the social sciences would be the primary responsibility of academic medical institutions, faculty there often not only lacks the time and liberty to do so while juggling the more traditional responsibilities of medical education, resident training, and patient care, but also lacks the necessary education and exposure to scientific fields other than medicine.


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In addition, this is likely influenced by whether the social sciences are perceived as mere critics or collaborative contributors Vincent In addition, while ongoing efforts of team training should continue, it might be wise to position these in a wider organizational context, rather than applying indiscriminate normative frameworks. Although an intimidating prospect at first, some of these points might be taken care of by emergent phenomena: presently, we can only speculate about the effects that allocation of resources, most notably time, might have on teamwork and team training. It has been repeatedly mentioned how time, or rather the lack thereof, shapes and constraints everyday work in healthcare and reinforces constant fluidity of personnel Allen ; Lewin and Reeves Organizational efforts concentrated on teamwork training underscore not only the prevailing desire to believe in a reductionist model, but also the illusion that local control is possible regardless of more macro system features and behaviour.

It reinforces the concept of institutional safety as the product of individual virtues despite organizational hysteresis, an approach that is consistent with the technical and pragmatic, problem-solving origins of safety science Dekker and Nyce However, this operationally convenient but conceptually simplistic approach is bound to continue the responsibilization of local, frontline staff in yet another exercise of power.

The way ahead might lie in efforts to increase awareness and strategically change power dynamics; this would represent a far more profound rethinking of organizational processes, but will require the allocation of resources and a willingness to fundamentally remodel parts of systems rather than mere teamwork strategies.

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Teamwork in healthcare remains a topic of great interest for both practitioners and researchers. It appears that currently, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept. This is not only confusing for practitioners, but in disregard of their needs and in stark contrast to the way their professional identities are otherwise constructed and understood.

Compared to the sophisticated professional standards set for practitioners, one has to challenge what it takes to teach, train, and evaluate teamwork in healthcare. It appears that healthcare would be well served to scrutinize questions of legislation, content, and accountability in team training. In addition, despite the need for measurements and evaluation, the continuous integration of social and cultural aspects in teamwork research will most likely enrich the current discourse for a more humanistic and complete understanding of what happens in healthcare teams.


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Recognizing power dynamics at the workplace in an effort to understand team processes and guide the serious allocation of resources will certainly address current challenges faced by frontline medical staff more thoroughly than the application of normative frameworks. This is a central idea of positivist views on safety, and a role responsibility of leadership in HRO theory Roberts or in the design of safety culture Westrum Skip to main content Skip to sections.

Advertisement Hide. Download PDF. Medical teamwork and the evolution of safety science: a critical review. Open Access. First Online: 12 February Table 1 Integrated teamwork skill dimensions Cannon-Bowers et al. Table 2 Overview of aspects of teamwork relevant to the quality and safety of patient care in dynamical domains of healthcare Manser Aspects of teamwork Examples of safety-relevant characteristics Quality of collaboration Mutual respect Trust Shared mental models Strength of shared goals Shared perception of a situation Shared understanding of team structure, team task, team roles, etc Co-ordination Adaptive co-ordination e.

A model for all other teams. BMJ Qual Saf 20 8 — Allen D Time and space on the hospital ward: shaping the scope of nursing practice Nursing and the Division of Labour in Healthcare. Antonsen S Safety culture and the issue of power. N Engl J Med 3 — A synthesis of the team process literature. Catchpole K, Alfred M Industrial conceptualization of health care versus the naturalistic decision-making paradigm: work as imagined versus work as done.

J Cogn Eng Decis Mak 12 3 — Surgery 1 — Accessed 31 Mar Deaton A, Cartwright N Understanding and misunderstanding randomized controlled trials. Soc Sci Med — Dekker S Drift into failure: from hunting broken components to understanding complex systems. Ashgate, Farnham Google Scholar. Saf Sci — Saf Sci 49 6 — Falzer PR Naturalistic decision making and the practice of health care. Finn R The language of teamwork: reproducing professional divisions in the operating theatre.

Hum Relat 61 1 — Soc Sci Med 70 8 — Flin R, Maran N Basic concepts for crew resource management and non-technical skills. Best Pract Res Clin Anaesthesiol 29 1 — Ashgate, Aldershot Google Scholar. Br J Anaesth 1 — Gaba DM Human error in anesthetic mishaps. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 5 — CrossRef Google Scholar.

Effective communication and teamwork promotes patient safety

Int J Aviat Psychol 9 1 — Hollnagel E, Woods D Epilogue: resilience engineering precept. Iedema R New approaches to researching patient safety. Soc Sci Med 69 12 — Ilgen DR Teams embedded in organizations: some implications. Six cognitive challenges of evidence-based approaches. A review of the literature. Levitt P Challenging the systems approach: why adverse event rates are not improving. BMJ Qual Saf 23 12 — Soc Sci Med 72 10 — Liberati EG, Gorli M, Scaratti G Invisible walls within multidisciplinary teams: disciplinary boundaries and their effects on integrated care.

Br J Anaesth 2 — BMJ i Manser T Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.