The Issue
Teamwork among hospital staff is important for improving quality of care, patient safety, and workers’ job satisfaction. In practice, however, health care decision-making is often hierarchical, rather than collaborative, with providers at the top wielding greater influence than those at the bottom. In this study, researchers examined elements of organizational structure that may make for more egalitarian decision-making on health care teams.
What the Study Found
Focusing on nine hospitals and seven health systems in upstate New York, the authors surveyed a total 1,527 hospital staff about team structure and collaboration. They found no significant variation among hospitals, only variation by unit and occupational group. Providers at the top of the hierarchy were more likely to experience their work as interdependent and collaborative and to report more positive interactions with other care providers.
The study found that "collaborative capacity"—the researchers' term for an organization's ability to foster teamwork even in the presence of rigid occupational hierarchy and the absence of formal teams—varied by patient care unit. In particular, it varied according to the presence or absence of a clear direction or mandate, a supportive organizational context, and leadership that promotes teamwork. Moreover, an emphasis on patient-centered care—which shifts the focus away from providers to put patients' needs and preferences first—was associated with collaborative teamwork .
Conclusions
The authors call for a shift from thinking about teams as stable bodies with rigid boundaries to the idea of collaborative capacity, which prioritizes respectful, helpful interaction and joint decision-making.