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Teamwork and Collaboration in Healthcare: Elements of Inter-Professional

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RESEARCH ARTICLE XXXXXXXXXXXXXXXXX

Copyright © XXXX American Scientific Publishers Advanced Science

Letters
All rights reserved Vol.
XXXXXXXXX
Printed in the United States of America

Teamwork and Collaboration in Healthcare:

Elements of Inter-Professional Teamwork
Sharifah Naziha Syed Kholed1 , Naffisah Mohd Hassan1* , Siti Noorsuriani Ma’on1 & Nur Zainie Abd Hamid1
1
Faculty of Business and Management, Universiti Teknologi MARA (UiTM) Selangor, 42300 Bandar Puncak Alam, Selangor
naffi885@puncakalam.uitm.edu.my

Teamwork is known as a significant factor that is important in other aspects of health care delivery. Inter-professional Teamwork (IT) is
necessary for all healthcare industries to support integrated delivery of healthcare service to focus on the health and social care needs of the
citizens. . However, limited research has been conducted to evaluate the strong elements of inter-professional teamwork that are promoting to
positive inter-professional collaboration practice. The purpose of this paper is to propose a framework that related to the issue. The framework
suggests two elements of inter-professional teamwork and its items that change inter-professional collaboration practice among healthcare
professionals. The framework focused on the elements of trust and respect to synthesize the best elements that affect IPC practice. A
comprehensive search was conducted of peer reviewed articles publish in English from 2000 to 2014 using several relevant databases including
Medline, Research Gate, Emerald, Pubmed, and Science Direct. There were 112 studies regarding of inter-professional collaboration (IPC)
practice and inter-professional teamwork (IT) were identified and only those 29 studies that related specifically to IPC and 23 studies of IT were
applicable for this review. This paper is highlights on the important elements of inter-professional teamwork in organization to influence the
positive results of the effective inter-professional collaboration practice among healthcare industry.

Keywords: Teamwork, inter-professional collaboration, trust, respect, healthcare professionals.

I. INTRODUCTION teamwork affect the IPC.

Today, the failure to collaborate among professionals
in healthcare industries is a critical issue especially in
Malaysia. Organizations viewed teams as one of the
important factors that can contribute to positive IPC
practice but there are only a few elements of inter-
professionals teamwork discussed and they are poorly
conceptualized among healthcare industries. Research
suggests that the inter-professional teamwork and
collaboration improve patient outcomes and access to
healthcare51. Moreover, a successful teamwork creates
positive environment to support the work that has the
potential to result in collaboration. Ohlinger et al., 2003;
Institute of Medicine, 2004 stated that high level of trust
and respect usually based on stable team memberships
that can allow team members to work together in a close
and integrated fashion. Thus, the purpose of this paper is
to identify which elements in inter-professional
II. RATIONALE OF STUDY
There are two elements of inter-professional
collaboration teamwork may influence the inter-
professional collaboration practice among healthcare
professionals, namely 1) trust and 2) respect. Teamwork
and collaboration between health professionals has been
shown to be key elements in the delivery of cost
effective health care, positive patient outcomes and
enhanced patient and professional satisfaction5,32,52.
According to Condon et al., 2000; Lockwook & Maguire
2000; Pullon, 2008; Akeroyd et al., 2009; Pulon et al.,
2011; Jarusevicience et al., 2013 respect and trust were
overwhelmingly represented as facilitating collaboration
in general practice. In addition, Pullon (2008) clarified
this representation by reporting that confidence in

*Email address: naffi885@puncakalam.uitm.edu.my

1
Adv. Sci. Lett. X, XXX–XXX, 201X
professional competence underpinned trust and respect.
According to Duchscher 2001; Casey et al., 2004;
Deppoliti, 2008; Anderson et al., 2009; Dyess &
Sherman, 2009; Martin & Wilson, 2011, the
disrespectful interactions were focused between new
graduate nurses and physicians. Other than that, much
international literature around collaboration practice has
focused on collaboration between general practitioners
and community pharmacists24, 34, nurses practitioners1, 15,
47
and allied health providers19, 29. However, most of the
studies focused on the physicians-nurses only and just a
few studies delved on overall healthcare professionals.
It is notable that most authors believed that trust and
respect are the important elements that can affect
teamwork in healthcare industries. A Canadian Inter-
professional Health Collaborative (2010) stated that the
elements of collaboration include respect, trust, shared
decision making, and partnerships. For instance, in
primary care setting in New Zealand, healthcare
professionals identified good and continuous
communication, trust and respect as the strongest
facilitators of interdisciplinary teamwork46. In another
study, Pullon (2008) stated that trust, respect, shared
values and goals were key elements in the relationship. It
can be a strong support in the literature for trust and
respect in teamwork as the elements that can improve
inter-professional teamwork in IPC. Kasperski (2010)
pointed out that the elements of collaborative practice
include trust, respect, responsibility, accountability,
coordination communication, cooperation, assertiveness,
and autonomy. Thus, it can be concluded that trust and
respect generally can be seen as the main elements in
inter-professional teamwork that affect the inter-
professional collaboration practice between healthcare
professionals.
As yet, limited studies have been focused on the
conceptual framework in inter-professional teamwork
and inter-professional collaboration practice in Malaysia.
We encourage other researchers to extend the scope of
study by looking at the elements under inter-professional
teamwork with more specific and focus on the overall
healthcare professionals such as physicians, hospital
administrators, nurses, therapists, and other allied health
staff. Therefore, this paper aims to propose a framework
of elements in inter-professional teamwork and inter-
professional collaboration practice.
III. CONCEPTUAL FRAMEWORK
The only few studies from several disciplines were
integrated in designing a framework. The framework is
RESEARCH ARTICLE
able to help envision how inter-professional teamwork
affect inter-professional collaboration practice, measure
the change, and identify the elements and items that
might contribute to indication of improvement in the
research study. This paper investigates the elements and
items of inter-professional teamwork that particularly
affect the inter-professional collaboration practice
among healthcare professionals. The proposed
framework is shown in Figure 1. A detail explanation of
the proposed framework using instructional design is
presented in the next section. There are four items of
trust under inter-professional teamwork (IT) which are
positive working relationship, job satisfaction, improve
team performances and openness in sharing information.
The meaning of trust can change the professionals in
healthcare working with positive relationship
environment and can contribute to job satisfaction at the
end of the result. Besides that, the studies also points
out that trust in teamwork can improve the performances
of team members and willing to share their information
with other professionals in healthcare industry.
Fig 1. The proposed conceptual framework
Inter-professional teamwork
Trust
 Positive working relationship
 Job satisfaction
 Improve team performances Inter-
 Openness in sharing information professional
Respect collaboration
 Understanding towards other practice
professional roles and equal
status (IPC)
 Gain self-confidence
 Allow team members to express
ideas and opinions
 Positive working
relationship/environment
A. Inter-professional collaboration practice
This paper will use the definition suggested by the
World Health Organization (2010) where they defined
IPC as “The multiple health workers from different
professional backgrounds work together with patients,
families, caregivers, and communities to deliver the
highest quality of care”. Governments, health-care
decision-makers and health professional associations
have identified inter-professional collaboration (IPC) as
an important policy approach for addressing patient
safety issues, health human resource shortages, and
2
RESEARCH ARTICLE
transforming the health-care system41, 51, 13. Chan &
Wood in their study has been prescribed IPC as a
strategy for health care system to improve health
outcome. In addition, it may increase the effectiveness
and efficiency of health care delivery and has proved to
ameliorate patient outcomes 39. Collaboration at this level
requires members to work together with open minds and
to value what each team member brings to the team.
B. Inter-professional teamwork
Working with teams is more effective than working
individually and it requires the cooperation of healthcare
professionals from multiple disciplines to work together
as a team to achieve positive outcomes. It is necessary
for the team from different professionals to support the
multiple facets of patient needs, disease complications
and treatment options10, 18. Patient diagnosis, treatment
planning and continuity of care are no longer dominated
by clinician focused approaches to service delivery. The
paradigm shift of patient centered care requires medical,
nursing and allied health professionals to collaborate in
managing a patients’ journey upon admittance, through
interventions, discharge and follow up30.
Teamwork has also been shown to provide benefits to
health care providers such as reducing extra work and
increasing job satisfaction20. Much of the literature
suggests inter-professional teamwork provides more
comprehensive and effective services for patients 50, 35, 11,
is advantageous for health professionals17, 8, and more
cost effective for healthcare organizations7, 37. The aim
of inter-professional collaboration in practice is to
provide an equal opportunity for each profession in the
inter-professional collaborative team to share
information and expertness in a respectful and trusting
environment38, 42. Based on the analysis, the healthcare
professionals’ barriers to IPC were clustered into two
elements; trust and respect. Despite this criticism, inter-
professional teamwork is claimed to affect the inter-
professional collaboration (IPC). The following sections
describe those elements and how trust and respect were
affecting the IPC.
B (i) Trust in inter-professional teamwork
Trust among team members is an important element
for teamwork6, 17, 47. It is related to the concept of time
where building positive inter-professional working
relationships within teams takes more time than
activities carried out within disciplines48 when
relationships may already be well established. Suter et
al. (2009), highlight mutual trust as one of the factors
involved in effective team building. The evaluation of
the introduction of teamwork into a health trust in the
3
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UK showed that their service provision has improved
and the health authority reported that cost per contact for
community services was significantly lowered37.
In addition, trust also affects the results of the team
and consequently the outputs of the organization, both
directly and indirectly. D’Amour et al. (2008) pointed
out that professionals place themselves in vulnerable
positions all the time and take risks in trusting each
other; however, when there is a high uncertainty or low
trust, professionals will avoid collaboration and hold
onto their own responsibilities for patient care. Overall,
it is important that individuals are comfortable with
themselves and their own competencies before relying
on others16.
B (ii) Respect in inter-professional teamwork
Mutual respect is defined as being open to the talents
and beliefs of all individuals, in addition to
understanding the value of your own contributions and it
is necessary for interdisciplinary team effectiveness 40, 28.
Mary et al., (2015) in their study stipulated that IPC
practice team must foster equal status between team
members. The collaboration also occurs when
individuals have mutual respect for one another and one
another’s professions and are willing participants in a
cooperative atmosphere9. This can be done through
understanding and respect for the other professions
within health and social care.
D’Amour et al. (2008) highlighted that one of the
important determinants for collaborative practice is
mutual respect, implying that healthcare professionals
within a team know one another and are aware of
contributions that each profession has to offer. Bradford
(2009) has pointed out that the lack of understanding,
respect or appreciation of the contribution of other
professionals thus constitutes a very real barrier to
collaboration between healthcare professionals. Studies
conducted among health professionals indeed
demonstrate that when working well in a collaborative
setting, professionals attach much importance to mutual
respect4, 23. Respect and trust were overwhelmingly
represented as facilitating collaboration in general
practice22, 36, 44, 3, 46, 33. Thus, respect and trust were linked
to each other as the key factors under the inter-
professional teamwork that can affect the inter-
professional collaboration practice between healthcare
professionals.
IV. CONLUSION
Inter-professional teamwork is an effective
factor that can contribute to positive inter-professional
collaboration (IPC) practice. There is a limited study of
Adv. Sci. Lett. X, XXX–XXX, 201X
inter-professional teamwork and inter-professional
collaboration practice in Malaysia. This issue has been
the focus of researchers in recent years but less focused
has been placed on it in Malaysia. Although this issue is
a global concern, findings have shown that many studies
are based on the Western environments and less attention
was given to Asian countries.
In addition, much of the findings are based on
the relationship between physicians-nurses or general
practitioners-community pharmacists. We also
encourage other researchers to widen the study scope by
looking at the elements under inter-professional
teamwork with more specific and focus on the overall
healthcare professionals such as physicians, hospital
administrators, nurses, therapists, and other allied health
staff.
However, there are limited studies that are focus
on quantitative methods and most of the studies are
focus on the qualitative methods. So, we are suggested
to focus on the quantitative method for this study.
Acknowledgment
We would like to express our sincere gratitude to the
Ministry of Education, Malaysia, Universiti Teknologi
MARA, (UiTM) Shah Alam and the Faculty of Business
and Management, Universiti Teknologi MARA (UiTM)
Selangor, Puncak Alam Campus, for their support and
contributions. This research work was supported by the
Fundamental Research Grant Scheme (FRGS) 600-
RMI/FRGS 5/3 (0030/2016).
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