title: Perceptions of interprofessional teamwork in low-acuity settings: a qualitative analysis.
abstract: BACKGROUND
  Working effectively in interprofessional teams is a core competency for all health care professionals, yet there is a paucity of instruments with which to assess the associated skills. Published medical teamwork skills assessment tools focus primarily on high-acuity situations, such as cardiopulmonary arrests and crisis events in operating rooms, and may not generalise to non-high-acuity environments, such as in-patient wards and out-patient clinics.
  
  
  OBJECTIVE
  We undertook the current study to explore the constructs underlying interprofessional teamwork in non-high-acuity settings and team members' perspectives of essential teamwork attributes.
  
  
  METHODS
  We used an ethnographic approach to study four interprofessional teams in two different low-acuity settings: women's HIV (human immunodeficiency virus) clinics and in-patient paediatric wards. Over a period of 17 months, we collected qualitative data through direct observations, focus groups and individual interviews. We analysed the data using qualitative thematic analysis, following an iterative process: data from our observations (20 hours in total) informed the focus group guide and focus group data informed the interview guide. To enhance the integrity of our analysis, we triangulated data sources and verified themes through member checking.
  
  
  RESULTS
  We conducted seven focus groups and 27 individual interviews with a total of 39 study participants representing eight professions. Participants emphasised shared leadership and collaborative decision making, mutual respect, recognition of one's own and others' limitations and strengths, and the need to nurture relationships. Team members also discussed tensions around hierarchy and questioned whether doctor leadership is appropriate for interprofessional teams. Our findings indicate that there are differences in teamwork between low-acuity and high-acuity settings, and also provide insights into potential barriers to effective interprofessional teamwork.
  
  
  CONCLUSIONS
  Our study delineates essential elements of teamwork in low-acuity settings, including desirable attributes of team members, thus laying the foundation for the development of an individual teamwork skills assessment tool.
authors.affiliation: Department of Paediatrics, University of California San Francisco (UCSF), San Francisco, California, USA.
authors.forename: Sandrijn M
authors.initials: SM
authors.lastname: van Schaik
authors.forename: Bridget C
authors.initials: BC
authors.lastname: O'Brien
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Almeida
authors.forename: Shelley R
authors.initials: SR
authors.lastname: Adler
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D011361:Professional Competence / Q000592:standards; D036301:Qualitative Research; D014481:United States