Evaluating the Effectiveness of Health Care Teams

Article excerpt

Abstract

While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

Aust Health Rev 2005: 29(2): 211-217

THROUGHOUT THE HEALTH CARE LITERATURE there are regular assertions of the desirability, relevance and effectiveness of teams. While this trend has intensified from the early 1970's,1 only a small proportion of articles empirically validate the effectiveness of health care teams, as the complex and dynamic nature of teamwork has challenged objective description and measurement. Teams are often symbolised as complex three-stage open systems, which utilise resources, communicate within themselves and produce outcomes.2 A previous article summarised the characteristics of effective teams, in terms of antecedent conditions (input) and team processes (throughput).3 This article reviews the range of outcomes of effective health care teams.

Patients commonly present to health care practitioners with several problems that have multiple causes. The extensive medical, nursing and allied health divisions of labour reinforce the need for interdependent care because no one professional can deliver a complete episode of inpatient care.4 Quality patient care depends on a wide range of skilled professionals collaborating together in teams.5,6 Health care professionals need to understand the potential contributions of their colleagues and have the skills to work effectively with them.7

There are many different definitions of teams. There is general agreement that teams contain a small, manageable number of members, who have the right mix of skills and expertise, who are all committed to a meaningful purpose, with achievable performance goals for which they are collectively responsible. Team members regularly communicate, solve problems, make decisions and manage conflict, while adopting a common approach in economic, administrative and social functioning. Each team member must have a distinctive and necessary role within the team.3

Defining team effectiveness

Traditionally, team effectiveness has been strongly related to the productive outputs of teams.8,9,10 Additional social and personal criteria are also commonly measured in terms of team cohesion or viability and individual levels of mental health, satisfaction and well-being.8,11-14

However, team members and stakeholders commonly judge and prioritise effective team performance differently.15 Team effectiveness can therefore be considered both a political and an empirical concept.16,17 Team effectiveness is perceived differently by patients, team members and health care organisations.18-20 While patient satisfaction is often used to indicate team effectiveness, it is difficult for patients to separate the benefits of clinical intervention from the benefits of teamwork.21,22 Similarly job satisfaction and retention of team members may, but does not necessarily, reflect effective teamwork. …