As noted in the Introduction, we view interprofessional teamwork as an activity which is based on a number of key dimensions. These include: clear team goals; a shared team identity; shared team commitment; role clarity; interdependence; and integration between team members. Our perspective on the important dimensions of teamworking is similar to those of our colleagues (e.g. Øvretveit, 1993; Meerabeau and Page, 1999; Onyett, 2003; Jelphs and Dickenson, 2008), which we introduce in later chapters.

Drawing on a study of primary care teams, West and Slater (1996) have usefully extended our thinking about the key dimensions of interprofessional teamwork. They found that team members viewed a number of additional elements of teamwork as being important, including:

• Democratic approaches
  
• Efforts to breakdown stereotypes and barriers
  
• Regular time to develop teamworking away from practice
  
• Good communication
  
• A single shared work location
  
• Mutual role understanding
  
• The development of joint protocols, training and work practices
  
• Agreed practice priorities across professional boundaries
  
• Regular and effective team meetings
  
• Team members valuing and respecting each other
  
• Good performance management.

Currently, however, we do not have a strong body of high quality, empirical evidence that confirms how these different elements – individually or collectively–affect interprofessional teamwork. Nevertheless, the dimensions listed above provide a useful reminder of the complex and multifaceted nature of this type of work. Accounts from the literature of the difficulties experienced in implementing interprofessional teamwork further highlight this complexity (e.g. Cott, 1998; Skjørshammer, 2001; Allen, 2002; Reeves et al., 2009c). Writing from a UK perspective, the Audit Commission (1992, p. 20) has pointed out that:

Separate lines of control, different payment systems leading to suspicion over motives, diverse objectives, professional barriers and perceived inequalities in status, all play a part in limiting the potential of multiprofessional, multi-agency teamwork […]. For those working under such circumstances efficient teamwork remains elusive.

In later chapters we investigate the complex nature of interprofessional teamwork, and explore why individuals can (and often do) experience difficulties when working as members of an interprofessional team.

There has been a growing support for the use of interprofessional teamwork across health and social care settings. This support can be seen in the numerous papers and documents which argue that interprofessional teamwork is an essential ingredient for reducing duplication of effort, improving coordination, enhancing safety and, therefore, delivering high quality care (e.g. Shaw, 1970; Gregson et al., 1991; Farrell et al., 2001; Schmitt, 2001; Onyett, 2003). Eichhorn (1974, p. 6) offers an early argument for why interprofessional teams are needed in the delivery of care:

Health [and social care] problems have become defined in complex and multi-faceted terms. Health organisations have discovered it is necessary to have the information and skills of many disciplines in order to develop valid solutions and deliver comprehensive care to individuals and families.

This view was reiterated more recently by Firth-Cozens (1998, p. 3) who has argued that:

Teamworking is seen as a way to tackle the potential fragmentation of care; a means to widen skills; an essential part of the need to consider the complexity of modern care; and a way to generally improve quality for the patient.

Similar sentiments can be found in a range of national government policies (e.g. Department of Health, 1997; Health Council of Canada, 2009), as well as in the documents and policies of professional regulatory bodies (e.g. General Medical Council, 2001; Association of American Medical Colleges, 2009) and international agencies (e.g. World Health Organization, 1988). As the National Health Service Management Executive (1993) in the UK stated:

The best and most cost-effective outcomes for patients and clients are achieved when professionals work together, learn together, engage in clinical audit of outcomes together, and generate innovation to ensure progress in practice and service. (Paragraph 4.3)

Repeated arguments for interprofessional teamwork as well as the policy level calls for its implementation have resulted in an expansion of teamwork activities across the globe. Indeed, the range of different countries reporting interprofessional teamwork activities has rapidly increased in recent years. In addition to countries with a long track record of teamwork initiatives, such as Australia, Canada, the UK and the US, a number of other countries, including Brazil (Peres et al., 2006), China (Lee, 2003), New Zealand (Pullon et al., 2009), Spain (Goñi, 1999), Sweden (Kvarnström, 2008) and The Gambia (Conn et al., 1996), are also reporting the use of interprofessional teamwork across a number of clinical contexts. We provide more detail on the nature of these different teamwork initiatives in the next section where we describe and discuss the emergence of interprofessional teamwork across a number of continents.

In this part of the chapter we offer a number of vignettes on the development of teamwork from different settings. Our aim is to illustrate how teamwork activities have evolved over time in different contexts and how it has come to the forefront of health and social care policymaking in the following six countries – Australia, Brazil, Canada, South Africa, the UK and the US.

Australia

National and state government policy directives in Australia have repeatedly noted that collaboration is a key element in improving service delivery (e.g. Australian Government, 2009). Policies such as the Enhanced Primary Care and Medication initiative aim to encourage the delivery of more effective care through interprofessional teamwork (McNair et al., 2001). The importance of interprofessional teams in providing primary care services is therefore increasingly recognised. However, it has been noted that progress has been restricted by traditional funding arrangements which emphasise parallel working and poor integration of professions. Efforts are currently focused on strengthening collaboration between GPs, nurses, midwives, therapists, pharmacists and dentists (Australian Government, 2008). One particular ongoing challenge is the provision of health and social care in rural areas which demands a very particular interprofessional team approach – see Box 1.1.

Brazil

Harzheim et al. (2006) note that the disease burden in Brazil results primarily from chronic diseases in adults, most notably hypertension and diabetes. In order to prevent and manage these diseases, the government has shifted its attention from acute to primary care. In 1995 it launched its Programa Saúde da Família (Family Health Programme) which aims to promote the use of an interprofessional team approach in primary care across Brazil. Since its inception, the number of teams has grown – collectively they cover 46% of the Brazilian population (Brazilian Government Ministry of Health, 2004). Box 1.2 provides an account of interprofessional relations in this type of team.

Canada

While Szasz (1969) outlined the need for interprofessional education, collaboration and teamwork in his paper published over 40 years ago, there was little response from the Canadian government until the early 1990s. A key initiative, Collaboration for Prevention, encouraged health care organisations to implement several projects demonstrating how health care teams could work together and involve patients in decision-making. Building upon this work, the federal government (Health Canada) announced in 2000 that $800m would be distributed through provincial and territorial agreements to support primary care providers develop collaborative approaches. Health Canada also recently launched a Pan-Canadian health human resources strategy to facilitate and support the implementation of an Interprofessional Education for Collaborative Patient-Centred Practice initiative across health and social care sectors (see Chapter 2). This followed recommendations in both the Romanow Report (2002) and the First Ministers’ Accord (Health Canada, 2003) on reforming the health and education systems to become more collaborative and responsive to patient needs. Box 1.3 outlines a recent initiative aimed at improving patient care through the development of interprofessional primary care teams in one of Canada’s largest provinces.

South Africa

The implementation of a district health system in South Africa in the 1990s resulted in a stronger emphasis on primary health care and an enhanced role for teamworking in primary care (South African Department of Health, 2001). Professionals are increasingly expected to collaborate in managing district health services and there is greater discussion of how professional and non-professional providers, such as lay health workers, can better work together in primary health centres. The demand placed on the health system by the HIV/AIDS epidemic has further emphasised the need to use the limited available human resources in the most effective way – a key issue for many low- and middle-income countries. The extent to which this rhetoric of teamworking is reflected in changes to policies and practice is unclear, although some novel interventions to promote teamworking in primary care have been implemented. One of these initiatives is discussed further in Box 1.4, which describes a programme to improve teamwork and the delivery of primary care to people living with HIV/AIDS.