Teamwork as Antidotes in Efficient Health Care Delivery: Challenges and Prospect of Its Implementation in Health Facilities

Abstract

A variety of actors, including both providers and recipients, are involved in the delivery of health care services. In particular, teams from many health and related fields work together to guarantee patient happiness and quality. Nonetheless, there is a dearth of research on teamwork and difficulties in healthcare settings, and most patients frequently lament about subpar service delivery and the difficulties they have receiving care from physicians in most medical facilities. Thus, using systematic reviews of relevant literature, this research evaluated teamwork as an antidote to efficient health care delivery: challenges as well as possibilities of its application in health facilities. According to the report, effective teamwork increases satisfaction, creativity, productivity, and engagement. Working as a team improves motivation, lowers stress, promotes learning, stimulates creativity, and encourages taking risks. Open communication and mutual support contribute to increased job satisfaction, enhancing retention rates. The paper suggests that training and retraining of employees, the provision of enabling policies and environments, funding, and leadership structure should be targeted towards quality care and stakeholder involvement in ensuring satisfactory service delivery.

1. Introduction

Health care service delivery is a multifaceted sector that necessitates a diverse group of health and allied health professionals, as well as representatives from other stakeholders and partner agencies, working as a team with the necessary knowledge and abilities to navigate holistically into the client, sick person, or group of sick people in order to ensure their health care needs satisfaction and the safety of humanity and the environment in general. In a health care setting, teamwork is a dynamic process involving two or more people, specifically health care professionals with diverse skill sets who collaborate with the sharing of objectives and physical and mental efforts in assessing, planning, and evaluating patient care.

In addition, the delivery of health care is unquestionably a team effort, and nobody can finish the health care supply chain by themselves. More than teams in other industries, medical and paramedical care teams, particularly in the dynamic domains of health care like health records outpatient units, operating rooms, intensive care, accident and emergency sections, or trauma and resuscitation teams, work under conditions that change frequently, may require leaders assembled on-the-fly, have a dynamically changing team membership, always collaborate for a brief period of time, consist of specialists or several specialist maintenance personnel, and have to integrate divergent perspectives.

Furthermore, delivering health care services involves a number of team types and formations and is intrinsically interrelated and multidimensional. To ensure high-quality patient care, teamwork in the health care industry entails a variety of professional positions arranged into various frameworks. Inter-professional practice-based approaches can enhance health care outcomes and procedures. It takes a diverse group of experts to work as a team in public health care institutions, including nurses, doctors, pharmacists, health information management specialists, and scientists and technicians from medical labs. Therefore, for the tenacity of enhancing quality health care services and delivering safe and effective care, health care providers and other employees of the health care facility must work effectively as a team.

2. Origin of teamwork

The Bible is where teamwork first appeared. The creator and implementer for teamwork is none other than God Almighty. God said to man, “Let us make man in our image, after our likeness,” according to Ref. ([1], p. 26) in the Bible. He also gave him dominion over cattle, animals, fish in the sea, and all creeping things that crawl on the ground. This suggests that without teamwork, an individual cannot accomplish much. Ref. [2] states that in a different realm, two people are preferable to one as they get a high return on their effort. One of them can assist the other in getting back up if they fall. However, feel sorry for anyone who trips and falls and cannot get aid. Moreover, two will remain warm if they lie down together. But how can one survive on their own? Two can hold their own even if one is overwhelmed. A cord with three strands also does not break easily. How good and pleasant it is when God’s people live together in unity, according to Ref. [3].

In addition, Ref. [4] says that as iron sharpens iron, so one person sharpens another. This implies that a team is often made up of more than one person or individual, and to work as a team, the people involved must work together and share ideas and relevant resources for the goals to be achieved. This is also exemplified in Ref. [5] which says, I appeal to you, brothers and sisters, in the name of our Lord Jesus Christ, that all of you agree with one another in what you say and that there be no divisions among you, but that you be perfectly united in mind and thought, according to Ref. [5]. Equally, in Ref. [6], the scripture says, let us consider how we may spur one another on towards love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another—and all the more as you see the day approaching.

In a healthcare setting, it might be believed that Florence Nightingale and her team of nurses, dispatched by the British government in 1854 to assist in providing health care services for the soldiers, are the forerunners of teamwork. Nightingale, 1863, cited in Ref. [7], says that in 1854, Russians were forced to evacuate the Turkish provinces of Moldavia and Wallachia by British forces fighting in Crimea and the surrounding area. The British government dispatched a team of nurses to accompany Florence Nightingale to Turkey in order to assist in providing medical care for the soldiers, as cholera and diarrhoea were the main causes of death for the British soldiers. After Florence Nightingale arrived, the disease-related death rate decreased from 42 to 2.2%.

3. Definition of team and teamwork

Teams, according to Ref. [8], are made up of two or more people that collaborate to accomplish particular, shared goals, have specialised roles and task-specific competences, use resources that are available to all team members, and communicate to plan activities and adjust to change. Ref. [9] established that a team is a distinguishable group of two or more individuals who interact dynamically, dependably, and adaptively in order to achieve a shared and valued goal, who have been given specific roles or functions to carry out, and who have a finite amount of time to be a part of the team. Teamwork is the activity of amicably working well together as a team. The sixth edition of the Ref. [10] defines “teamwork” as the act of cooperating effectively as a group. Working as a team is known as teamwork, and it is defined by shared decision-making, open communication, and interdependent collaboration.

Teamwork, according to Ref. [11], entails the formation of team members, team members’ relationships, team leadership, team problem solving, and organisational environment in ensuring the delivery of quality health care service to beneficiaries, either from a particular healthcare facility, level of healthcare system, or from a global collaborative perspective, with the main objective of ensuring the safety of mankind, his healthiness, and his environment. Ref. [12] averred that the variety of professional and non-professional providers involved in the delivery and organisation of health care services is becoming increasingly indicative of these services, with each team having its own area of expertise, set of responsibilities, and hierarchy within medicine and other disciplines.

As a result, ideas of “teams” in the health care industry and “teamwork” are frequently mentioned in discourses about modernising and improving the system. Teams have the potential to improve clinical care, according to Ref. [13], because they can pool, modify, combine, and apply a wider range of knowledge to make decisions, find solutions to issues, come up with new ideas, and carry out tasks more quickly and effectively than an individual working alone. Because of this potential, a diverse team of healthcare experts might ideally collaborate to make diagnoses, create care plans, carry out treatments, offer suitable follow-up, and overall serve patients with high-quality care.

4. Conceptual review of teamwork

Teamwork is crucial for delivering high-quality healthcare services. In health care delivery settings, teamwork involves collaboration among a multidisciplinary group of allied and health care providers, administrative staff, patients, and other stakeholders. Team members have a significant impact on the effectiveness of teamwork in the delivery of quality health care in hospitals. A strong health care team relationship facilitates cooperation and provides greater opportunities to share ideas, innovate, and also learn about a patient’s unique health needs. More so, team relationships impact the effectiveness of teamwork in health care delivery by positively influencing patient satisfaction, employee performance, job satisfaction, and reducing costs. Team relationships also impact the effectiveness of teamwork in health care delivery, with proximity between healthcare workers facilitating trust-building and communication. According to Ref. [14], team relationships are essential for effective teamwork in delivering quality health care in hospitals. Equally, team relationships impact the effectiveness of teamwork in the delivery of quality health care by influencing the care provided and job satisfaction among health care workers.

Another development was the finding by Ref. [15] that 15% of the causes of adverse events directly relate to communication issues between health care professionals and patients or within the teams of health care professionals. In more than 50% of the cases, the incident was caused by a lack of effective teamwork. Communication failures are the leading causes of inadvertent patient harm. According to the Joint Commission for Hospital Accreditation report of analysis of 2455 sentinel events, the primary root cause in over 70% of them was communication failure. Reflecting the seriousness of these occurrences, approximately 75% of these patients died, and all too often, clinicians providing care had very different ideas about what should happen [16]. Effective communication and teamwork are aimed at creating a common mental model or getting everyone in the same picture. Equally important is creating an environment that feels safe for team members, so they will speak up when they have safety concerns. The mantra of everyone in the same picture, no surprises, is an effective one that is easy to communicate.

Although healthcare services are delivered by multiple team members, healthcare service quality and safety have historically been structured on the performance of professionals, individual practitioners, and allied health personnel. Consequently, effective communication encourages collaboration, patient safety, and a better result. Coordination, efficiency, and quality of service are critical in the operating room as a whole. These factors aid leaders in navigating effectively and efficiently to ensure team members cooperate, brainstorm, innovate, share responsibilities, and work dependently and interdependently to achieve organisational goals. In every healthcare facility, successful leadership and teamwork are lubricated by excellent communication. This allows for the delivery of high-quality healthcare services. In addition, a unified mental model, a safe atmosphere, and team members cooperating, brainstorming, innovating, and sharing duties, as well as working together and cooperatively to achieve organisational goals, are the aims of effective communication in a team relationship. This enables the provision of top-notch health care services through good team leadership.

Leadership is crucial in making it obvious that the culture demands that everyone be treated with respect on a daily basis. There is a tonne of information showing that rude, aggressive behaviour is exceedingly dangerous in the healthcare industry [17]. Universally, in an organisation, operational teamwork emerges naturally when the leaders are motivating, respectful of others’ perspectives and rights, and demonstrating a lifestyle that is admirable. It is the responsibility of the leaders to convey how important it is for their teammates’ efforts to contribute to the organisation’s success. Higher levels of interest and dedication result when an employee’s work is seen as meaningful and significant.

According to Ref. [18], leaders are crucial in encouraging team members’ dedication to achieving corporate goals. Leaders who score highly in the job and support behaviour are particularly helpful at encouraging good teamwork performance. Leaders are people who develop standards and values inside an organisation while also distributing resources to colleagues to increase their availability. In addition, delegation or giving them difficult jobs that provide them some autonomy, control, performance feedback, and the chance to participate in decision-making processes also helps them develop commitment. Also, the team leader can raise team motivation by restructuring tasks to add more crucial job resources. Work resources are the social, physical, and organisational facets of the workplace that support the achievement of corporate objectives and promote individual development through delegation of functions.

According to Ref. [19], effective leadership in the field of health care has attracted research attention over the last few years, and one of the key areas of focus by the Cameroon government, which is believed to improve the country’s health care sector, has been the quality of leadership. In addition, claims have been made that the most effective way of achieving high-quality service delivery would be through strong leadership. Warri further stated that the strength of the leadership within an organisation is often linked to the type of leadership style adopted by the organisation. In addition, Ref. [20] argues that team leaders can also increase team motivation by delegating work and reorganising priorities to include more essential job resources. Delegation is the act of providing someone else with work or obligations that would otherwise be yours. It is frequently required when a team leader needs additional work completed quickly and by individuals with the required technical knowledge. It is a three-way process that involves the delegation of authority by the leader, the delegation of responsibility, and the creation of accountability for subordinate acceptance or compliance [21].

5. Importance of teamwork in health care service delivery

Teamwork lowers medical errors, boosts patient safety, lessens burnout, and boosts patient happiness [22, 23]. Additionally, it decreases workloads, improves job satisfaction and retention, lowers morbidity, lowers care costs and wastages, develops spaces for professional and technical knowledge acquisition and sharing, prevents work redoing, and promotes sustainability of care consistency. Understanding teamwork helps a multifaceted health care professional’s ability to debate with stakeholders. The following are some crucial grounds for implementing cooperation in health care organisations and other institutions:

Teamwork enables teams to self-monitor, evaluate, and rely on one another’s work, create an avenue for efficient work, learn from each other’s strengths and failures, innovate more quickly, and reduce stress. It is one of the 14 crucial elements of management principles identified by Henry Fayol and can lead to better productivity, reduced costs, greater profitability, and many other benefits [24]. Collaboration can result in more effective issue solving, faster work completion, and thorough creativity. Teamwork encourages healthy competition because employees may learn from one another and develop an environment that supports delivering high-quality health care services. Successful cooperation depends on having good working relationships and rapport, since these things can result in friendships, dependability, and attractiveness. To guarantee patient safety and high-quality health care service delivery, health care and allied health care providers must collaborate, support, and communicate effectively with one another [25].

For the purpose of providing high-quality health care, communication and teamwork skills are crucial because they can improve patient outcomes, prevent medical errors, increase efficiency, and increase patient satisfaction. A culture of learning and continuous improvement will be fostered, staff wellness will increase, patient safety will be improved, and better teamwork and communication will ensure that everyone feels empowered to voice their concerns and ask questions. Moreover, Ref. [26] assert that when co-morbidities and complexity rise and the need for high-quality patient care rises, cooperation is crucial for providing high-quality health care services.

The following are some examples of the importance of teamwork implementation in a health care setting:

1. Effective communication is fostered by teamwork.

2. Collaborating enhances idea generation.

3. A shared objective is fostered through teamwork.

4. Problem-solving abilities are enhanced in the workplace by teamwork.

5. Trust is developed through teamwork.

6. Company culture is enhanced through teamwork.

7. Efficiency is produced through teamwork.

More so, good teamwork boosts engagement, productivity, creativity, and satisfaction. Teamwork increases motivation, reduces stress, encourages learning, fosters creativity, encourages risk-taking, builds problem-solving skills, improves job satisfaction, and ensures team members feel valued. Open communication and mutual support contribute to increased job satisfaction, enhancing retention rates.

6. Challenges in effective teamwork implementation

How easily normal and non-routine day services are provided varies depending on the initiatives, interests, and personalities of different individuals in any organisation, but especially at a federal tertiary healthcare facility. In general, team members should master soft skills, including effective communication and relationship building, to enhance both individual and team performance as well as patient safety. Ref. [27] assert that the following issues prevent teamwork among health and allied healthcare providers:

In the health care sector, culture and ethnicity can be obstacles to collaboration, particularly in poor and emerging countries. This may result in difficulties with language, comprehension, and communication, as well as ineffective team leaders and bad leadership techniques. Inadequate team members or bad team formation can result from changing roles, and changing circumstances can cause teams to be formed or modified, as well as new teams to be formed or existing ones to be changed. These abilities are necessary for a team leader to successfully manage or lead a team and create a productive workplace.

Globally, diverse scholars, including Ref. [27], have established that health care service delivery is a multidisciplinary and multitasking setting involving different professionals, allied health workers, and other relevant stakeholders. Equally, Refs. [28, 29] averred that health care services require multitasking and employing diverse employees with expertise in diversity, public relations, and patient care management, as a formidable team is paramount and teams with diverse personnel and skill mixes can provide high-quality care services and ensure patient safety. A supportive work atmosphere, culture, and structure, strong relationships, problem-solving abilities, good team leadership, task-focused, honest communication, and optimism are essential for these teams to succeed. Furthermore, this diverse set of employees or workforces has different traits that can be aligned with the attributes of Douglas McGregor’s Theory X and Y [24, 30]. Theory X (i.e., those people who do not like working but only have an interest in getting remuneration and could only work when forced or threatened with sanctions) and Theory Y (those who like work, see it as part and parcel of their endeavour, and can contribute positively more to the growth of the organisation even if a little motivation is given to them).

Therefore, when leaders, managers, and directors of health facilities are forming a team that will ensure quality health care services to the target audience and the larger society, measures must be put in place to integrate these employees or people with these characters or traits for effective and efficient management of patient care and related service provision. This is because if only a team of Theory Y traits is formed to manage health facilities, in the event of a sudden death or a case of terminal ill health of some cardinal team members, the organisation can be cut short or go to extinction since those with innovative ideas are gone.

On the other hand, when people or employees who possess both traits are engaged, they will learn and share valuable ideas and skill sets in such a way that if one is no longer in the system, her or his absence may not have many negative effects on the organisation and the entire health care service delivery. Due to the high level of hierarchy among medical practitioners in Nigeria, teamwork is severely hindered. In 1985, Decree 10 came into effect, shifting management and administrative skills in Nigerian health care to doctors, who may or may not have significant experience in the area [31].

Health care hierarchies can be detrimental to teamwork as well as to individualised aspects of health care, suboptimal inter- and intra-clinical workflow optimisation, unstable teams, and a lack of inclusion of various health professions. The three main causes of teamwork failure are unclear role definitions, a lack of explicit coordination, and miscommunications. The most significant factors that prevent effective teamwork in health care settings and other organisations include a lack of organisational support, poor communication, a lack of goal orientation, a lack of task prioritisation, a lack of motivation, a lack of delegation, a lack of accountability, a lack of responsibility, a lack of trust, a lack of individual development, a lack of directional unity, a lack of discipline and order, a lack of realistic organisational goals, brain drain, and a high turnover rate.

Equally, the follow serves as hinderance to effective implementation of teamwork in a typical health care facility. Thus:

Communication/Language Barrier: Ref. [32] averred that medical errors and adverse effects are brought on by ineffective teamwork and communication among healthcare professionals and relevant stakeholders. It is worthy of note that, when it comes to resolving the issues pertaining to poor quality service delivery and enhancing patient safety as well as boosting patient satisfaction with healthcare service provision, teamwork is seen as an imperative variable. Also, where team members are well coordinated, improvements in patient care, including quality enhancements and decreases in patient length of stay, are always achieved. Thus, effective teamwork is a pivotal way to solve communication gaps between healthcare providers and patients and among the various health teammates and health partner agencies.

The communication aspect of teamwork is crucial for effective collaboration, proper management of health resources, and decision-making in problem-solving. For a team’s work to result in the delivery of high-quality healthcare services in any healthcare facility, communication between teammates, between providers (patients or carers), and other relevant stakeholders is one of the essential components. Communication is the process of transmitting and sharing accurate, reliable, and high-quality data, information, ideas, and knowledge using a suitable language and format that the recipient or teammates can understand, as well as giving feedback to the sender in order to encourage innovation, foster a sense of shared understanding in problem-solving, and gain an advantage over rivals. It is noteworthy that language plays a crucial role in good teamwork and communication. The Babylonians, for instance, built a massive city and tower with its pinnacle in the skies, according to the Holy Bible, in an effort to gain fame.

However, God interfered with the work by making the languages of the expert and non-expert employees, as well as those of the supporting workers, so confusing that they were no longer able to communicate effectively or understand one another well enough to work as a team to accomplish their primary goal. As a result, the city and tower were never finished, and they were scattered across the surface of Earth [32]. In order for a team to properly collaborate and utilise its collective knowledge, good communication is optimal when the appropriate language is used in the exchange of ideas and information between team members. Positive communication contributes to team identification and group cohesion. On the other hand, a lack of communication might cause team members to work too independently and lose sight of how their work affects others. Hence, effective cooperation is made possible by strong communication, which empowers the leader to organise and motivate subordinates to offer high-quality services and dependable goods.

7. Empirical review of teamwork

Arora et al. [30] examined the effectiveness of teamwork in the workplace and found that effective teamwork is crucial for human progress and survival. Results establish that teamwork provides better results for organisations than individual work, but many management personnel still lack the necessary skills to build teams. The study surveyed 225 participants aged 18–80, primarily Hispanic or Latino (56%), white or non-Hispanic (40%), and 4% of other races. Results showed a significant difference between ethnicity and teamwork preference, but no significant difference was found between gender and perceived self-awareness. The findings further indicated that organisations that are open and supportive of cultural diversity in the workplace are more likely to have effective work teams. Some of these findings were supported by the recent findings of Ref. [33], who studied the relationship between team characteristics and job team effectiveness in IT organisations. A survey of 110 information technology professionals revealed that team purpose, goals, roles, processes, and relationships are interdependent. Positive relationships were found between team roles and processes. The study emphasises the importance of investing in various team effectiveness dimensions to develop effective teams. Findings revealed that workplace resilience is crucial for enhancing performance and well-being in challenging circumstances, and other factors like work culture, leadership, and management support are also essential for developing effective teams.

In another development, Ref. [31] conducted an empirical study on perceived organisational support in healthcare, focusing on the importance of teamwork and training for employee wellbeing and patient satisfaction through a serial mediation involving employee well-being and intention to remain. Findings showed that data from both surveys was managed by the Care Quality Commission in partnership with Picker Institute Europe and other regulators of health and social care services in Britain. The findings indicate that teamwork has a positive indirect association with patient satisfaction (r = 0.43, p < 0.01) through employee well-being (job satisfaction and work engagement) and intention to remain (r = 0.03, p < 0.01). The strength of this indirect relationship is also enhanced by the training provided by the organisation. The study found that the quality of social relationships and support generated by teamwork activities play a vital role in reducing employees’ withdrawal tendencies towards the organisation. Although there was no significant direct relationship between employees’ teamwork perceptions and patient satisfaction, the study showed that perceptions of teamwork have a positive indirect influence on patient satisfaction, explained by job satisfaction and intention to remain. These results lend additional support to previous findings by Ref. [34], suggesting that employees’ exposure to collaborative team processes is crucial for both employees’ and patients’ satisfaction.

According to Ref. [34] investigation on health care professional development: working as a team to improve patient care, effective teamwork in health care is crucial for patient safety and outcomes. The need for effective teams is increasing due to co-morbidities and complex specialisations. Findings indicated that the evolution in health care and a global demand for quality patient care necessitate parallel health care professional development with a great focus on patient-centred teamwork. A patient-centred approach is essential for professional development, focusing on values and principles that place the patient at the centre of care. The results further state that motivation and practical skills are essential for team members to achieve goals and overcome challenges, thereby emphasising the importance of teamwork and providing practical approaches to delivering quality patient care.

Consequently, in Iran, Ref. [35] studied the impact of teamwork on an organisation’s performance using a cooperative game framework. They compared individual and collective performance indexes and used a cooperative game model to improve organisational performance. The model evaluated employee activities and implemented fair payments, such as overtime pay and rewards, to increase performance and satisfaction. The cooperative approach created effective communication between employees and authorities, enhancing motivation for teamwork. The results could be used for employee decisions, training requirement analysis, employee development, research, and plan valuation. The cooperative coefficient is a key factor in increasing productivity and organisational efficiency. The study found that the cooperative approach directly positively affects teamwork and organisational performance, increasing motivation and satisfaction among employees. These findings connote that when there is effective teamwork among diverse employees in any organisation, seemingly high-quality health care output and patient safety are guaranteed.

8. Summary

Teamwork is crucial for human progress and survival in the workplace. However, many management personnel lack the necessary skills to build teams. It has been established that teamwork has a positive indirect association with patient satisfaction through employee well-being and intention to remain. More so, a cooperative approach directly positively affects teamwork and organisational performance, increasing motivation and satisfaction among employees. Through effective teamwork among diverse employees, seemingly high-quality health care output and patient safety are guaranteed. Importance of teamwork in patient safety, as well-functioning teams commit fewer mistakes, and with high patient acuity, a collaborative approach is crucial for both patients and health care providers’ safety. Effective teamwork development has a strong positive correlation with the quality of health care service provision. This suggests that organisational success depends on understanding roles and interdependence within teams.

Teamwork is a vital part of clinical work and patient care but is poorly understood in certain instances. More so, team satisfaction, trust, and strong coordination are crucial for success in the workplace. Despite the importance of teamwork in a health care setting, there are many factors hindering teamwork effectiveness, including the working environment, leadership, government policies, employees’ attitudes, and peer support, which significantly impact employee engagement. In a nutshell, an effective team not only protects patients from risks but also creates a more positive, engaging, and resilient workplace. Similarly, effective teamwork leads to positive patient outcomes but is hindered by factors such as doctors’ dominance, allied professionals’ attitudes, salary disparity, poor communication, and a defective leadership style. Teamwork suffers when healthcare providers are unable to communicate effectively.

9. Suggestion

The provision of health care services is a multifaceted, multitasking activity that calls for a broad workforce, including unskilled, semi-skilled, and skilled workers. As a result, cooperation is essential to patient-centered care and a counterbalance to the provision of high-quality healthcare services. For effective teamwork to be adopted for quality patient care achievement and related issue addressing, the following suggestions are provided, viz.

1. Adequate manpower and other resources should be employed in health care settings.

2. Leadership should be restructured to align with the organisation’s goals and objectives.

3. Building trust and providing an enabling environment and policies

4. All stakeholders must be responsible and accountable.

5. There should be training and retraining of team members.

6. There should be policies that do not hinder individual contributions or stakes in decision-making.

7. There should be monitoring and evaluation of the delivery of health care services and mechanisms of feedback.

Conflict of interest

There is no conflict of interest in this study.