Improving teamwork in healthcare: current approaches and the path forward.

My grandfather was a general practitioner in a small town in the USA in the mid-20th century. His medical team consisted of himself and a nurse (who was also my grandmother). He even served as his own pharmacist. In stark contrast, the team in my primary care practice consists of my physician partners, several trainees, nurses, medical assistants, referral coordinators, pharmacists, the subspecialists and their teams, home health nurses and therapists, and more. Such large and disconnected teams can provide comprehensive care for complex and chronic illnesses, but when they malfunction, they can harm patients. Teams are larger and more dispersed in time and space, and there are now many more types of teams. They vary from teams whose members repeatedly work together over many years (eg, highly specialised cardiac surgery teams) to teams that are formed quickly and temporarily to resuscitate a patient. Teams are also formed for quality improvement (QI) projects, and they may work together for a few months or a few years. Unfortunately, education for healthcare professionals in most parts of the world still assumes that healthcare teams are like those during my grandfather’s time. Professional school and continuing education curricula have not been updated to teach the skills needed to work effectively in these varied teams. To fill this gap, team training programmes that address teamwork and communication for healthcare providers are increasing in number, becoming more heterogeneous and being evaluated more frequently. Here I propose three general approaches that have been developed to improve teamwork in healthcare, and I discuss their strengths, weaknesses and which of their aspects require further research (table 1). Finally, I suggest that these approaches complement one another, and by purposefully exposing care givers to them during their training and careers, we can eventually improve teamwork and patient outcomes.