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Introduction
Modern healthcare is delivered by teams rather than individuals and requires the cooperation of healthcare professionals from multiple disciplines. However, the evidence suggests that these changes in healthcare delivery have not been supported by changes in the systems for communication between health professionals, especially across disciplines. Approaches that may have been effective in earlier, less complex and less distributed environments no longer reliably work. 1 We know that failures in interprofessional teamwork and communication lead directly to compromised patient care, staff distress, tension and inefficiency 2-7 ; make a substantial contribution to medical error 8-13 ; and are a contributory factor in 61% of sentinel events. 7
In this review, our focus will be on improving sharing of important clinical information between healthcare professionals. We will first describe the features of effective teams. We will then discuss the evidence on information sharing between different members of the team and categorise the challenges to interprofessional teamwork and communication in healthcare into three domains: educational, psychological and organisational. Finally, we will suggest a range of solutions to these challenges, synthesising these into a seven-point plan to promote effective healthcare teams. While our focus is predominantly on hospital-based teams, we believe lessons can be generalised to wider healthcare settings.
Features of effective teams
Following an extensive review of the factors associated with team performance across a range of industries, Salas 14 proposed a model for five key dimensions of effective teams: team leadership, mutual performance monitoring, backup behaviour, adaptability and a team orientation. These are coordinated by the underpinning mechanisms of mutual trust, closed-loop communication and shared mental models. Leadership involves not only task coordination and planning, but development of the team, motivation and establishing a positive atmosphere. Mutual performance monitoring requires sufficient understanding of the environment to enable monitoring of other team members to allow identification of lapses or task overload, while backup behaviour requires sufficient understanding of others' tasks to enable supportive actions to be taken by team members, such as redistribution of workload or support. Adaptability enables a team to respond to changes in the environment and change the plan for patient management. Team orientation is the willingness to take other's ideas and perspectives into account and a belief that the team's goals, which...