Understanding what makes team interventions work: Learning from healthcare professionals

Introduction: Research on multi-disciplinary team-working in acute hospitals tends to focus on whether or not specific team interventions are effective in improving quality and safety of patient care. By contrast, there is a dearth of research on how or why particular types of interventions work, or why some interventions work well in one setting but fail to successfully translate into other settings. Using healthcare professionals as “key informants”, this research develops a programme theory to inform multi-disciplinary team intervention success. Theory/Methods: 15 healthcare professionals working on multi-disciplinary teams were recruited from 4 hospitals for interview. The critical incident interview technique was used to elicit specific instances where they recalled either positive or negative experiences of team interventions. Drawing on realist methodology, data were synthesised to build an initial programme theory of what works for whom within the team; in what conditions; why; and how. Results: A motivating driver; leadership support; alignment of “smart” team goals with organisational goals; an evidence base for the intervention; effective communication within the team; consultant engagement; informal relationships and appropriate team composition are considered key enablers for multi-disciplinary team interventions. These conditions helped to enact a shared sense of responsibility, developed a sense of common purpose, created mutual understanding, and motivated the team towards successful outcomes including more integrated care. Competing workload demands were perceived as a barrier to intervention success. Discussion: Team interventions are dependent on effective inter-disciplinary teamwork for successful outcomes.  In busy acute hospital contexts, there is little expendable energy for learning amongst healthcare professionals and interventions that take staff away from “the patient bedside” need to be carefully planned and executed in order to achieve successful outcomes. Using the critical incident interview technique with a realist perspective allowed for unique insights into what mechanisms are “switched on / off” for healthcare professionals in various contextual conditions. Findings help to explain why certain interventions might fail or flourish depending on the conditions in which they are introduced and therefore have practical application. Conclusions: This study demonstrates the value of seeking insights from healthcare professionals in forming a programme theory on enablers and barriers to team interventions in an acute hospital context. Teams that consider creating these enabling conditions are likely to experience more successful outcomes. Lessons learned: While there is a significant amount of quality improvement work happening in acute hospital contexts, the focus of interventions tends to be the specific process or issue with little attention given to the contextual factors such as composition of the team, team dynamics, team communication or organisational supports. Understanding such contextual and process factors and how they contribute to the implementation of a team intervention has important implications for team performance and achieving integrated care. Limitations: Purposive sampling by operational managers may have skewed the type of healthcare professionals who were chosen for this study and may impact the generalisability of the findings. Suggestions for future Research: The next stage of the research will involve testing of the initial programme theory in two different contexts.