First, we briefly revisit, summarise and reflect upon the contents of the preceding eight chapters in which we explored, discussed and critiqued a range of dimensions related to interprofessional teamwork.

In Chapter 1, we outlined some of the ‘basics’ of interprofessional teamwork to help understand how it is commonly understood as well as why teamwork is regarded as a central approach for helping to address a range of health and social care delivery problems. We also traced the emergence of a number of interprofessional teamwork initiatives which had occurred in a variety of countries. Finally, we offered some direct experiences of interprofessional teamwork from a number of different professionals based in different clinical settings.

In Chapter 2 we outlined a range of important political, social and economic developments which have emerged in the past decade that have, collectively, created a demand for interprofessional teamwork. Indeed, developments such as the patient safety initiative, the move towards collaborative patient-centred care as well as wider changes like the shift towards chronic illnesses can be regarded as key drivers which have contributed to the growing amount of teamwork activities that have been witnessed across the world.

We next explored, in Chapter 3, a range of key concepts and issues related to interprofessional teamwork to understand its conceptual foundations. We reviewed and critiqued a number of different team definitions, typologies and factors which affect team performance. We also introduced our notion of team tasks and discussed how predictability, urgency and complexity can affect interprofessional teamwork in important ways. In addition, we presented our typology of interprofessional work – teamwork, collaboration, coordination, networking – and discussed our contingency approach to reflect the different types of interprofessional work that can occur in different settings such as operating rooms, general medical wards and primary care clinics. We also introduced our notion of an adaptive interprofessional team – a team who can shift from one type of interprofessional work depending upon the needs of their patients. Finally, we problematised the use of teamwork approaches developed in the airline, quality and sports industries which have been gaining popularity in health and social care settings.

In Chapter 4 we presented our interprofessional framework in which we synthesised a range of teamwork factors into four domains: relational, processual, organisational and contextual. Through this discussion we explored how different factors such as professional power, hierarchy, gender, culture, team processes and organisational support affected interprofessional teamwork in different ways. We also discussed how these factors can affect teamwork individually and collectively.

In Chapter 5 we drew upon a range of social science theories to deepen our understanding of interprofessional teamwork and its potential role in the development and evaluation of teamwork interventions. We framed our discussion in this chapter by use of our four teamwork domains to show how different micro, mid-range and macro theories can yield different insights and understanding in the nature of interprofessional teamwork.

We explored, in Chapter 6, how different relational, processual, organisational and contextual interventions have been developed to improve interprofessional teamwork in a number of different ways. We also discussed the role of single and multifaceted interventions and how limitations in intervention design (e.g. a lack of critical analysis) can undermine the ability of interventions to achieve meaningful and lasting changes in the way interprofessional teams work together.

In Chapter 7 we argued that careful evaluation of interprofessional teamwork is needed in order to assist providers, policy makers and managers in their efforts to improve teamwork as well as advance our knowledge of the field. We also noted how most empirical accounts of interprofessional teamwork have been undertaken in an uncritical manner. We then went on to discuss why more thoughtful evaluation is needed to take into account the complexities of teamwork by use of qualitative, quantitative and mixed methods approaches.

In Chapter 8 we presented a synthesis of three studies based in Canada, South Africa and the UK to provide an account of our work designing and evaluating different interprofessional interventions. Our synthesis revealed that achieving improvement in teamwork and communication in acute settings in different contexts is a very complex process, involving a wide range of logistic, organisational and professional factors. We also outlined the need for theory in the design of interventions and how the use of ethnographic data can yield some important insights into why such interventions may succeed or fail.

Underpinning our exploration and discussion of the varying issues related to interprofessional teamwork were our various standpoints, which focused on being:

• Critical – to provide a text that could probe current assumptions, arguments and evidence related to interprofessional teamwork
  
• Pluralistic – to employ an approach which values contrasting views and understandings of teamwork
  
• Pragmatic – to keep thinking tied to the real world in order to provide a realistic account of the nature of teamwork and its impact
  
• Reflexive – to be thoughtful about our own work, views and experiences of teamwork when discussing it with others
  
• Optimistic – despite the multitude of challenges we have discussed in the book, to remain optimistic about the future of teamwork.

We incorporated these approaches to attempt to provide a different (missing) perspective on teamwork – one which problematised teamwork and also employed some new angles to think about an activity which, as we noted at the start of the book, has now become ingrained and largely accepted as a normal part of the health and social care landscape.

In Chapter 2, we provided the perspectives of teamwork leaders on the current gaps in our understanding of interprofessional teamwork. We now go back to the leaders for their ideas for the future of teamwork in terms of what work needs to be undertaken to advance our knowledge in this area.

A view from Canada:

In both the post-secondary education system and health care system, organised surveys need to assess the curricula across human health services programs. They need to know how much time, effort, energy and money is invested in teamwork. They need to look at their capacity and willingness to train students and workers as team members. They need to ask: do they have this capacity, what does the training look like? How is it funded? Where does the funding come from, and what are the policies that drive funds to be allocated to teamwork development? (Teamwork leader 1, Canada)

Practitioners need to be provided with the time to explore the dimensions of unidisciplinary learning and how this impacts on their ability to work collaboratively. They need to learn to articulate their own roles, knowledge and skills to their colleagues in other disciplines. All team members need to learn to value the knowledge and skills that each member brings to the team and where each has unique and shared areas. They need to develop the means to jointly assess patients and to be respectful in the data they collect from patients and their relatives. They need to develop guidelines on how to work together as a team and how to include the patient and relatives into the team. They need to learn to listen to the patient and value his/her input and use their requests for assistance to shape the care they provide. They also need to coordinate both social and health care interventions together to meet the total needs of patients and relatives. (Teamwork leader 2, Canada)

A view from the UK:

There is work to be done understanding diversity, discrimination, oppression, religion, stigma, gender, ethnicity and race. We need to educate professionals so that they understand the concepts of teamwork/interprofessional working. Patients also need to know how the staff are organised and are working to use their services effectively. Furthermore, work is needed to elicit a better understanding of the key concepts of teamwork and how factors such as professional tribalism can impede it. (Teamwork leader 3, UK)

A view from the US:

I think there needs to be more grant funding and support for research and evaluation. Within both the practice and educational contexts, this should support measuring the effectiveness and maintenance of educational programmes in teaching teamwork and assessing how to use teamwork most effectively in clinical or practice settings. Another related area for research is to assess how and why some interprofessional programmes last, while others do not. What are the factors related to continuation of programmes, and how can these be ‘built in’ to new programmes to increase their chances of success over the long term? This type of research is more historical or longitudinal in nature. (Teamwork leader 4, US)

We need to link good theory-driven research related to teamwork with the practical quality improvement approaches. We need to test just how much of business and aviation industry concepts and experiences apply in health care; we need to make sense of all the emerging competency-based taxonomies and we also need to differentiate between different types of teamwork models intended to produce different kinds of outcomes, access to care, filling worker shortages, comprehensive care, quality and safety. (Teamwork leader 5, US)

For the five teamwork leaders, future work centres on the need to develop better local interprofessional team relations, to develop the empirical, conceptual and theoretical base for interprofessional teamwork, as well as assess the contribution that professional education systems can make to preparing professionals for teamwork.

Drawing upon the work presented in previous chapters we now offer a range of ways forward for interprofessional teamwork in relation to future intervention and evaluation work.

Intervening to improve interprofessional teamwork

As previously discussed, we are committed to intervening to attempt to improve teamwork, interprofessional relations and the effects of teamwork on the delivery of care. Below are a number of future directions for developing and implementing interprofessional teamwork interventions:

• There is a need for more explicit awareness and understanding of existing structural factors such as professional power and hierarchical differences in the design and development of interventions. Future intervention designs should therefore take into account how wider professional and organisational factors may influence (most likely impede) teamworking activities. Over time, more explicit attention to these factors may also trigger contextual changes such as national policies and funding arrangements which promote interprofessional teamwork. However, such change may be slow due to the conservative nature of governments and professional bodies.
  
• Given the scope and complexity of contextual-level interventions, these largely depend on the support of national and regional governments and professional bodies. Such interventions will depend upon a range of individuals – policy makers, practitioners, educators, researchers and consumers – who will need to work closely together over extended timeframes to develop and implement this type of large-scale intervention. In contrast, due to the focused and smaller scale nature of relational, processual and organisational interventions, these are likely to be more achievable in the short term. Individuals interested in promoting teamwork at this level should therefore focus their attention on developing local interventions which aim at making change at relational (e.g. team training), processual (e.g. role shifting) and organisational (e.g. reorganising care delivery) levels. Attempting to intervene at these levels is more achievable, as there is more flexibility and scope for making change and implementing efforts to improve teamwork.
  
• Due to the complexities of interprofessional teamwork (see Chapters 3 and 4 in particular), there is a need for future interventions to adopt a multifaceted approach. As we discussed in Chapter 6, combining a relational intervention such as team training with an organisational change to reconfigure ward space to support interprofessional teamwork is likely to yield more gains than the use of a single intervention.
  
• A key step in the design of teamwork interventions is to define the nature of the interprofessional ‘problem’. The use of our typology of interprofessional work (see Figure 3.1) can help understand the nature of the problem, and whether it is related to teamwork, or another form of interprofessional work such as collaboration, coordination or networking. As well as helping to identify the nature of a problem, this typology can also be employed to inform the design of interprofessional interventions, which might focus on improving teamwork or coordination activities, depending upon the local context and local interprofessional needs – as outlined in our contingency approach and our notion of adaptive teamwork.
  
• Theory, as we discussed in Chapter 5, needs to be employed in the design and development of interprofessional teamwork interventions. The use of social science theory, in particular, can help to understand the nature of interprofessional relations, which in turn can inform activities which may be more likely to affect change. Also, the use of theory in intervention development helps its transferability from one setting to another.

Evaluating to extend our understanding of interprofessional teamwork

As well as having a shared commitment for intervening to improve interprofessional teamwork, as researchers we all share a desire to evaluate the things we do – to provide evidence for their (positive, neutral or negative) effects. Below are a number of future directions for evaluating interprofessional teamwork activities:

• There is a need for more high quality evaluations of the effects of teamwork interventions across care settings (e.g. primary, acute) and geographic locations (e.g. low- and middle-income countries). Preferably, these evaluations should adopt a mixed methods approach in the form of RCTs with complementary strands of qualitative and economic data.
  
• More thought needs to be given to generating a wider range of teamwork outcomes. Further outcome data are needed in the areas of staff absenteeism, staff morale, patient safety, patient care and costs-and-benefits. In addition, we need a firmer understanding of the impact of the introduction of new technologies (e.g. telemedicine, electronic patient records) on interprofessional teamwork.
  
• Greater exploration of interprofessional teams in action is needed by the use of qualitative observational approaches such as ethnography. This could include investigation of how tasks and roles are negotiated between professionals across different settings and locations, how different professionals understand what constitutes interprofessional teamwork and how informal mechanisms of interprofessional communication (such as corridor conversations) may support teamwork.
  
• Better evaluation of interprofessional teams is needed that includes a focus on a wider range of professions (e.g. therapists, pharmacists and social workers), as well as patients and their families.
  
• Further development of our typology of interprofessional work (see Figure 3.1) is needed to establish how our contingency approach and our notion of adaptive teamwork can and ought to be used in future. For example, if professionals only require low integration and infrequent contact in their interprofessional work, evaluation could explore how the use of a network approach might support their practice.
  
• There needs to be more sharing of knowledge across disciplinary areas (stroke unit teams, community mental health teams, operating room teams) to understand, with more certainty, how findings gathered from teams in one field may (or may not) translate to teams based in others.
  
• Lastly, but importantly, more longitudinal evaluation is needed to generate a better insight into the sustainability of teamwork interventions over time (e.g. six months, one year, five years).