Despite a growing amount of research on interprofessional interventions to promote collaboration and teamwork, a systematic review that two of us undertook indicated a continuing problem with the conceptualisation of different types of interprofessional educational and practice interventions (Zwarenstein and Reeves, 2006). Clarity has been inhibited by the lack of a robust evidence base for the effects of these interventions, resulting in confusion between them, as can be seen in the variety of overlapping terms employed, such as ‘interprofessional learning’, ‘interdisciplinary teamwork’ and ‘transdisciplinary practice’. Leathard (1994, p. 5) originally termed this problem a ‘terminological quagmire’ – a situation which was relatively unchanged when she revisited the field nearly a decade later (Leathard, 2003a).

Funded by a recent Canadian Institutes of Health Research grant, and working with research, educational, clinical and policymaking colleagues, we conducted a scoping review to develop an empirically tested understanding of interprofessional interventions (including teamwork). This project has involved developing a model to help categorise interprofessional interventions. Findings from an analysis of over 100 papers revealed three main types of interprofessional intervention:

• Education-based interventions: Defined as those which included a curriculum with explicitly stated learning objectives/outcomes and learning activities (e.g. teamwork exercises, simulation, site visits and placements). Examples ranged from pre-qualification interprofessional education initiatives, which aimed to develop teamwork skills, to post-qualification interprofessional education activities, which focused on developing knowledge of different team members’ professional roles.
  
• Practice-based interventions: Defined as those which aimed to improve how professionals interact in practice. Examples included the use of interprofessional meetings as well as communication tools such as checklists.
  
• Organisation-based interventions: Defined as those which aimed to affect interprofessional collaboration or teamwork by the use of organisational means. This included the introduction of staffing policies or guidelines designed to enhance teamwork or the reconfiguration of workspace to promote the frequency and quality of interprofessional interactions.

While many of the studies included in our scoping review employed a single intervention (typically educational), some did use a multifaceted approach. These included, for example, an educational and a practice-based intervention. However, studies that employed two or more interventions often conflated them under the rubric of an ‘interprofessional intervention’. We were therefore unable to distinguish between the effects of the education- and practice-based approaches used. Conflation was compounded by a similar failure to tease out different outcomes, as studies typically employed interchangeable and poorly defined terms such as ‘teamwork’, ‘collaboration’, ‘communication’ and ‘coordination’.

The overall quality of the evaluations in these studies varied. While we found some of high quality, many of the interprofessional education-based studies were evaluated using only participant perceptions of the initiative in relation to changes in their knowledge and attitudes. In addition, studies that examined teamwork and collaboration used tools such as the Team Climate Inventory (see Appendix 4) or examined the content of team communication. However, neither the processes of teamwork nor their link to health and social care outcomes were investigated. More information on this scoping review can be found in Reeves et al. (2009b) and Goldman et al. (2009).

We go on to employ this typology to help frame our discussion of the different interprofessional teamwork interventions below.

In this section we present a selection of interventions designed to improve interprofessional teamwork. Building on the discussion of our framework in Chapter 4, we have organised the different interventions using the following four factors: relational, processual, organisational and contextual. As we go on to note, while a number of interventions, such as team training, are examples of ‘direct’ teamwork interventions (i.e. they aim to affect teamwork directly), others such as case management are more ‘indirect’ in nature. For such’indirect’ interventions, their effects on teamwork form only part of the intervention, which is aimed primarily at improving care delivery.

Relational interventions

These involve the use of education-based activities in the form of interprofessional learning interventions or practice-based activities in the form of team checklists and interprofessional team meetings. All of these approaches are examples of direct teamwork interventions.

Interprofessional learning activities

Working effectively as a member of a health or social care team is a complicated task (see Chapter 4). Despite this complexity, most practitioners continue to receive little or no formal training or education to work within an interprofessional team. A growing number of interprofessional learning activities have, however, been developed and implemented across care settings. We describe below three interprofessional learning activities: team training, simulation and team retreats.

Team training interventions: These consist of interactive workshops or educational sessions in which students and/or practitioners come together in teams to discuss their collaborative work and problem-solve. Such interventions usually involve a combination of practice-based and classroom-based experiences, focusing on preparing students for future teamwork interactions (see Box 6.1) or enhancing team members’ existing teamwork abilities (e.g. Reeves et al., 2006).

On occasion, such training can be delivered to students and practitioners jointly to encourage discussion and reflection among individuals at different stages in their development (e.g. Taylor et al., 2001; Boyce et al., 2009). Increasingly, such interventions involve patients and their families who interact with professionals and/or students to provide a patient perspective on the delivery of care (e.g. Weingart et al., 2009).

Simulation: A recent development in teamwork interventions is the use of simulated learning experiences. These range from low-fidelity (role-play exercises) to high-fidelity (computerised manikins, simulated clinical environments) activities. Simulated learning opportunities are regarded as advantageous as they allow students and qualified professionals to practice teamwork in ways that approximate actual clinical work as well as time to reflect upon their shared experiences. Typically, high-fidelity team simulation learning activities are offered in emergency, intensive care or operating room settings (e.g. Anderson and Leflore, 2008). There is growing evidence for the effects of such team-based simulated learning. For example, Wisborg et al. (2008) evaluated the impact of a trauma team training initiative designed to improve knowledge and skills in resuscitation. The study found that increases in knowledge and confidence were reported by team members from 26 hospitals, and these increases were maintained after 6 months. Other examples of simulated learning include the interprofessional management of emergencies, in which simulated disasters have been developed to help improve interprofessional team performance and increase the efficiency of care systems in an emergency or pandemic situation (Centennial College, 2009; Jeffs et al., in review).

Team retreats: At times teams are invited to retreats in which they reflect on and/or plan their collaborative work away from the distractions of clinical practice. While it is argued that such interventions help to ensure that members are ‘distanced’ from the pressures of everyday life, they may also generate a problem of dislocation. As members are apart from the real world, any learning that occurs at retreats may be left behind when they return to practice. Long (1996) provides a useful example in her study of a 2-day residential team building workshop held for primary health care teams in the UK. This intervention aimed to improve the understanding of different professional roles and how members could enhance their collaborative work. Interviews conducted before and after the workshops indicated that most participants felt there was more agreement over team goals. However, it was also felt that interprofessional friction between certain team members was unaltered, when they returned to clinical practice.

While evidence from systematic reviews has indicated that interprofessional learning can result in short-term gains regarding collaborative knowledge, skills and attitudes (e.g. Hammick et al., 2007), the long-term sustainability of these gains needs further exploration.

Communication interventions

In general, these direct teamwork interventions employ two main (practice-based) approaches: the use of meetings or rounds and the use of checklists or briefing sheets to help enhance interprofessional communication.

Team checklists: These can help team members focus on the often routine tasks they need to perform together. Checklists can also help trigger communication and dialogue between members, which can in turn improve their relationships. Box 6.2 provides an example of a communication intervention for surgical teams which uses a simple checklist to improve safety and relations.

The use of checklists has grown in recent years, mainly due to the emphasis on patient safety (see Chapter 2). Checklists can vary in nature, from simple tools such as that outlined in Box 6.2 to more comprehensive tools such as the SBAR (Situation- Background-Assessment-Recommendation), which aims to provide team members with a framework for communication around a patient’s condition (Leonard et al., 2004).