INTERDISCIPLINARY TEAMS IN HEALTH CARE AND HUMAN SERVICES SETTINGS: Are They Effective?

Article excerpt

The interdisciplinary team is one of the most widely accepted innovations in the delivery of medical and mental health care and social services. With the advent of managed care, however, even widely accepted service delivery methods such as interdisciplinary teams are being scrutinized. Managed care is challenging organizations to demonstrate the effectiveness and efficiency of methods of health care delivery or eliminate them. In fact, in recent years, in inpatient and outpatient medical and mental health care services settings, staff members increasingly have been expected to work on their own. Rather than working in teams, where differences of opinion can be voiced and reconciled, members of various disciplines simply are expected to document their observations or interventions in the medical or case record as a way of informing the next professional involved. Thus, various disciplines may contribute to patient or client care, but the individual professionals involved may not have face-to-face contact with each other. Individual workers, supervisors, or case managers are left to take various viewpoints and develop a service plan. Although this trend currently may not be widespread, it is occurring in some major teaching hospitals and community mental health centers and thus may be growing. With these concerns in mind, we undertook a review of the literature on interdisciplinary teams. It seemed to us that health care and managed care organizations might place greater emphasis on the use of interdisciplinary teams, if such teams could be shown to aid in reducing costs or improving the quality of patient care and satisfaction.

We began with five central questions: What are the benefits and drawbacks of interdisciplinary teams? What is the relationship among interdisciplinary teams and treatment outcomes? What is the relationship among interdisciplinary teams and the costs associated with service delivery? What kind of institutional support (managerial, financial, or informational) is required to ensure the success of such teams? What role, if any, could interdisciplinary teams play in the redesign and restructure of health and human services agencies in an age of cost containment? To answer these questions, we examined four databases in eight health-related fields. We found that the literature repeatedly endorsed the team model, with little empirical evidence of efficacy. A small number of articles provided general critiques of the literature on interdisciplinary teams (Galvin & McCarthy, 1994; Schmitt, Farrell, & Heinemann, 1988), but the majority of articles reviewed simply assumed their value. Although we expected to find answers to our five questions, we found data that helped answer only the first two.

The purpose of this article is to describe the strengths and weaknesses of the existing literature and challenge social work practitioners and managers to document their experiences in using interdisciplinary teams. Such documentation will improve on the limited data now available and facilitate a re-examination of assumptions.

METHOD

Four databases - PsychLit (1974-1990), ERIC, MedLine (1990-1996), and Sociofile - were examined in eight health and human services fields known to use the interdisciplinary approach. The words we specified for the searches were "interdisciplinary" and one of the following terms: "rehabilitation," "gerontology," "health care," "AIDS," "allied health" "oncology" "mental health," and "substance abuse."

RESULTS

More than 25 articles were found in each of the areas of rehabilitation, geriatrics, and gerontology; health services or chronic illness; and mental health and psychiatry. Fewer than 25 articles were found in each of the areas of developmental disabilities, child abuse and neglect, training and practice, and organizational behavior.

Weaknesses in Terminology

Although the computerized search resulted in the identification of more than 2,200 abstracts, we found many of the abstracts were of limited value. …