In contemporary healthcare much greater attention is being paid to the importance of good teamwork in healthcare for a range of reasons (Baker et al 2006). Perhaps most importantly this is because evidence has emerged which shows that a significant number of adverse events in healthcare can be attributed to poor communication and poor teamwork among health professional teams (Manjolovich et al 2008). Quality and safety can be compromised where these issues exist with negative consequences for those on the receiving end of healthcare.

Research has also demonstrated that members of a multidisciplinary team may not be well informed about the nature and scope of practice of their colleagues (While & Barriball 1999). This has led to work designed to improve ways of better preparing health professionals in their undergraduate education for optimum healthcare teamwork on graduation. This includes, in particular, ensuring that graduates are aware of the role and function of the multidisciplinary healthcare team. Graduates (regardless of their specific health profession) need to understand the roles of all team members and the characteristics of effective teamwork, and have a strong appreciation of the importance of good communication in healthcare teams and implications for health outcomes of poor teamwork and communication. They need to be able to function effectively and optimally in a team context in healthcare (Baker et al 2006).

In Australia, work is underway to improve interprofessional learning (also referred to as multiprofessional learning) in healthcare to improve interprofessional teamwork and consequently patient care. For examples, see the Clinical Excellence Commission, New South Wales (www.cec.health.nsw.gov.au), and the National Health Workforce Taskforce (www.nhwt.gov.au). This has application to both students in the health professions and also currently practising health professionals.

The multidisciplinary team brings cross-discipline expertise to healthcare consumers in a collaborative and coordinated way. The aims of this model are to enhance the quality of care received, support a planned and holistic approach to care, and to optimise resources. Some authors who discuss this concept use the title ‘interprofessional teams’ in place of ‘multidisciplinary teams’. We have chosen to use ‘multidisciplinary team’ in this chapter. Our discussion of teamwork and team dynamics applies to a range of healthcare settings. These can include hospitals, and a range of other health agencies, including community care.

As a student of nursing who is being prepared to work in a contemporary healthcare system, whether it be in a hospital or within a community setting, it is imperative that you recognise the significance and responsibilities of being an active participant in multidisciplinary healthcare teams. To do this requires not only an awareness of the role of nurses, but also that of others within such teams. It is also useful to be aware of factors that impact upon the nature of teams, and how they form and function. Additionally, it is helpful to be aware of what affects their success.

In its simplest form, a team is a group of people. However, Gallagher (1995:276) draws an interesting distinction between ‘groups’ and ‘teams’. She asserts that while both are composed of a number of individuals with some unifying relationship, the two can be differentiated by virtue of the members of a team being ‘associated together in specific work or activity’. The key point to be made, then, is that while people participate in all sorts of groups, a team is characterised by common goals, interdependence, cooperation, coordination of activities, division of effort and shared language (Pfeffer & Schnack 1995).

A dictionary definition of a multidisciplinary (healthcare) team is a ‘team of professionals including representatives of different disciplines who coordinate the contributions of each profession, which are not considered to overlap, in order to improve care’ (O’Toole 2005:1737).

The ideals encompassed by a multidisciplinary approach to care require a culture conducive to collaborative working, as well as professional ideals that are complementary to the aim of improving client/customer experiences and outcomes. Effective communication and the ability to work in groups are important characteristics of team members, if the team is to function effectively.

Lenkman and Gribbins (1994) describe the values healthcare organisations must demonstrate for multidisciplinary care to become reality. These include being patient-focused and service-oriented, with attention to organisational, technical and professional issues. Staff who feel empowered to ‘make a difference’, who are also expert in systems thinking, who feel involved, and who are dedicated to the achievement of the goals of the organisation, form the basis of effective multidisciplinary teams.

To achieve such a culture, healthcare facilities need to move from individualistic or parochial group activity to multidisciplinary activity. This point is raised again later in this chapter, when factors impacting upon the effectiveness of multidisciplinary healthcare teams are discussed. The literature provides a number of examples of multidisciplinary healthcare teams working in a range of settings and populations, including: acute care (Scheuren et al 2006); aged care (Scherer et al 2002); the community (Inglis et al 2006); adolescents with diabetes (Strawhacker 2001); and inpatient rehabilitation (Ellis et al 2008). The reader is encouraged to explore these and other readings to build knowledge and understanding of multidisciplinary teams across contexts of healthcare.

Extending from the definition provided by O’Toole (2005) above, it could be said that the purpose of a multidisciplinary healthcare team is to involve professionals from various health-related disciplines, whose contributions do not overlap, in the planning and provision of ever-improving standards of healthcare.

This definition is simplistic and not truly reflective of clinical environments because it gives the impression that health professionals perform functions that are prescribed and confined by their discipline base. However, it does reinforce the fact that this multidisciplinary healthcare team has (or should have) as its focus, high-quality care. In practice, the demarcations that previously defined the functions and roles of each discipline are becoming blurred and increasingly complementary as collaborative models of care emerge. For example, shared care (Moser et al 2007) and managed care (Hillegass et al 2002) support collaborations between public and private healthcare providers.

Healthcare needs to be a team effort because no one person or any single discipline can provide the care and services required by the range of clients wishing to access health services, particularly in Western societies. This is indeed the case if one accepts the view that healthcare is wider than the services provided by hospitals and health centres (Hill & Becker 1995). The whole is (or should be) greater than the sum of the parts.

Yukl (2006:319) identifies that organisations usually comprise of ‘small subunits’ with defined tasks and that the types of teams that can be found in organisations can sometimes be very different. He identifies different types of teams and these can be readily identified in healthcare: functional operating teams (nursing); cross-functional teams (multidisciplinary); self-management operating teams (ancillary services); and top executive teams (healthcare executive teams).

Interestingly, Yukl (2006) also identifies another type of team—the virtual team. This type of team is emerging and it is suggested will be more commonplace in the future—a possibility enhanced by technological advances such as mobile telephones, email and teleconferencing. Whatever the description of the team, however, the success of a multidisciplinary team is identified not only by improved effectiveness, but also by the client’s experience of that team.

Borrill et al (2002) highlighted that the quality of team working is powerfully related to the effectiveness of healthcare teams, while according to Arthur et al (2003) teams are critical to person-centred care. The importance of this is very topical. Kitson and colleagues are currently exploring the impact of multidisciplinary teams and outcomes of care for the older person (Jordon 2008). The ideals of effective teams are identified by the Royal College of Nursing’s work (2007) on developing and sustaining effective teams. They summarise Borrill and West (2002) who:

In practice, few multidisciplinary healthcare teams fully meet these ideals, especially relating to clearly defined tasks (a point discussed later in this chapter). Nurses (and indeed other professionals within their own discipline) may therefore feel themselves to be more clearly a member of a unidisciplinary team (e.g. the nurses on a ward or unit, or in community settings) than a multidisciplinary one, though there are of course many specialties within the profession of nursing.

Multidisciplinary healthcare teams are like all teams, in that each member has expected roles and functions that are influenced partly by members of the team and partly by external factors. Health services have traditionally been organised around functional areas of professional expertise (e.g. nursing, medicine, nutrition) with a strong hierarchical structure. Individuals bring with them expectations associated with their discipline, which coalesce with the established social roles and rules (written and unwritten) associated with healthcare facilities. As a result, multidisciplinary healthcare teams tend to develop along traditional hierarchical lines, partly because of the varying skill levels of members, but also ‘because that’s the way it’s always been’ (reflecting organisational norms). The result is that relationships within multidisciplinary healthcare teams perpetuate the hierarchical approach to decision making (Cott 1997) and, as such, are dominated by those with legitimated power (e.g. managers) or historical/authority-based power (e.g. medical doctors).

From the discussion presented thus far, it would seem obvious that this situation is at odds with the concept of multidisciplinary teams, which implies seamless care, equal recognition of skills of members, and equal recognition of members’ contribution (Warelow 1996).

One association that has attracted attention in the literature is the nurse–doctor relationship. This association is not generally discussed within the context of multidisciplinary teams, but over the years this has been rather more commonly situated within the literature on power and how it is exercised over others (Farmer, 1993, Gjerberg and Kjolsrod, 2000, Matheson and Bobay, 2007, Porter, 1992, Roberts, 1983 and Warelow, 1996). The origins of ‘traditional’ nurse–doctor interactions and the nature of their association are both relevant to a discussion about multidisciplinary teams. It has been argued that, regardless of the expected roles of team members, the most powerful team members direct the contribution of others. In that scenario, the medical profession invariably dominates, and nurses (and to a lesser extent other allied health professionals) are generally submissive. This situation is maintained through an effective socialisation (societal and professional) based on gender and role differences.

Roberts (1983) in a now classic paper, presents a range of suggestions for nurses and nursing to free itself from domination by (particularly) the medical profession, within an excellent discussion of oppressed group behaviour and its implications for nursing. Included in her recommendations is that nurses and nursing should seek to have a public voice, clearly stating what is valuable about nursing’s contribution to healthcare teams and healthcare more generally. How this might be best achieved is discussed in the excellent text, From Silence to Voice: What Nurses Know and Must Communicate to the Public (Buresh & Gordon 2006). It is unfortunate that multidisciplinary teams in healthcare still tend to function in ways that perpetuate the power differences. At some time in the future, we may see increasing numbers of multidisciplinary teams in which the contribution of each member, regardless of professional background, will be recognised and the ideal of equality among members will be achieved. One way that this will be more readily achieved will be when nurses accept that they do play a vital role in healthcare, and are confident to assert that fact when working with colleagues from other health disciplines.

A multidisciplinary team brings together individuals from diverse disciplinary and functional backgrounds. The experience and skill that members bring to the team can be a significant asset when used in problem solving, decision making, conflict resolution and other activities that enable the team to achieve its goals. The outcomes will depend largely on how effectively the group of individuals is transformed into a team with common goals (Liberman et al 2001). To ensure these teams do function effectively, complex communication procedures must be established and maintained.

The literature on multidisciplinary teams indicates clearly that functional groups have elements in common (Hein, 1998, Ivancevich et al., 2008 and Kelly-Thomas, 1998). The most frequently identified attribute is the presence of effective communication. Other factors include clear roles (including leadership) and conflict resolution strategies. Inherent in these attributes is the importance of a sense of common purpose for the team, demonstrated by a mission statement and agreed goals (Kouzes and Posner, 2007, Marriner-Tomey, 2008, Wright, 2003 and Yukl, 2006).