Team functioning in Neurorehabilitation: a mixed methods study.

The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.

Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams.

Previous studies have shown Relational Coordination improves team functioning in healthcare settings. The aim of this study was to examine the relational factors needed to support team functioning in outpatient mental health care teams with low staffing ratios. We interviewed interdisciplinary mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. We conducted qualitative interviews with 21 interdisciplinary team members across three teams within two medical centers. We used directed content analysis to code the transcripts with a priori codes based on the Relational Coordination dimensions, while also being attentive to emergent themes. We found that all seven dimensions of Relational Coordination were relevant to improved team functioning: frequent communication, timely communication, accurate communication, problem-solving communication, shared goals, shared knowledge, and mutual respect. Participants also described these dimensions as reciprocal processes that influenced each other. In conclusion, relational Coordination dimensions can play pivotal roles in improving team functioning both individually and in combination. Communication dimensions were a catalyst for developing relationship dimensions; once relationships were developed, there was a mutually reinforcing cycle between communication and relationship dimensions. Our results suggest that establishing high-functioning mental health care teams, even in low-staffed settings, requires encouraging frequent communication within teams. Moreover, attention should be given to ensuring appropriate representation of disciplines among leadership and defining roles of team members when teams are formed.

Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes.

BACKGROUND: Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. METHODS: A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. RESULTS: Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. CONCLUSIONS: This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation.

BACKGROUND: There is a lack of validated instruments examining dimensions of team functioning from the perspective of patients and families consistent with a conceptual framework. The study aimed to develop and assess the psychometric properties of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire. METHODS: A cross-sectional survey was undertaken in three studies. Data were collected from May-October 2016 for Study 1, April 2018-ongoing for Study 2, and October 2016 to June 2017 for Study 3. Online and paper versions of the self-administered questionnaire were available in English and in French. The initial questionnaire included 41 items. Study 1 included 320 respondents. Reliability was assessed using Cronbach alpha. Face validity (n = 250) was assessed using a structured questionnaire. Content validity was examined using subject matter experts and Spearman's item-total correlations. Construct validity was examined using known group comparisons (i.e., clinical specialty, education, length of follow-up, reason of consultation). Content analysis was used for open-ended questions. RESULTS: The questionnaire took 10 to 15 min to complete. Positive assessments were noted for instructions, formatting, font size and logical ordering of questions. In Study 1, reliability indices for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p <  0.001). Differences were noted between clinical specialties, education, length of follow-up, reason of consultation, low and high functioning teams. No differences were noted between English and French language respondents. Psychometric properties were re-assessed in Study 2 and 3 after unclear questions were reworked. Reliability indices for the subscales ranged from 0.76 to 0.94 and differences remained significant between low and high functioning teams. CONCLUSION: The final 43-item instrument is easy to administer to patients and families. The studies provide evidence of validity to support the propositions in the conceptual framework. The patient-level measures can be aggregated to the team, organizational or system level. The information can be used to assess healthcare team functioning in acute and primary care and determine the role patients and families are playing in teams. Further testing is needed with patients and families who are hospitalized or receiving care from teams in rural areas.

Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives.

Transitioning from profession-specific to interprofessional (IP) models of care requires major change. The Veterans Assessment and Improvement Laboratory (VAIL), is an initiative based in the United States that supports and evaluates the Veterans Health Administration's (VAs) transition of its primary care practices to an IP team based patient-centred medical home (PCMH) care model. We postulated that modifiable primary care practice organizational climate factors impact PCMH implementation. VAIL administered a survey to 322 IP team members in primary care practices in one VA administrative region during early implementation of the PCMH and interviewed 79 representative team members. We used convergent mixed methods to study modifiable organizational climate factors in relationship to IP team functioning. We found that leadership support and job satisfaction were significantly positively associated with team functioning. We saw no association between team functioning and either role readiness or team training. Qualitative interview data confirmed survey findings and explained why the association with IP team training might be absent. In conclusion, our findings demonstrate the importance of leadership support and individual job satisfaction in producing highly functioning PCMH teams. Based on qualitative findings, we hypothesize interprofessional training is important, however, inconsistencies in IP training delivery compromise its potential benefit. Future implementation efforts should improve standardization of training process and train team members together. Interprofessional leadership coordination of interprofessional training is warranted.

A boy and his AAC team: building instructional competence across team members.

Families and education professionals face unique challenges when working together to support augmentative and alternative communication (AAC) for a child who does not use speech and has only prelinguistic forms of communication. For this study, a family-school team was provided with a specially designed support package comprising training and one-on-one coaching in evidence-based instructional strategies. As part of a larger mixed methods investigation, a single-case experimental design was conducted to explore the effectiveness of the support package on facilitating team members' competence in AAC instruction and communication. In the case reported here, the support package improved instructional competence across all team members, which led to small, positive changes in the child's communication using AAC. However, it was not sufficient for overcoming contextual barriers and supporting adults' ongoing instructional adjustment to the level necessary to promote the child's independent communication via AAC. Implications of these findings for both practice and research are discussed.

How stressors are dynamically appraised within a team during a game: An exploratory study in basketball.

Little is known about how team sport athletes individually and collectively experience sources of stress during competitive sport encounters. This study aimed to examine the nature of the stressors team sport athletes appraised during games at individual and team levels, as well as their degree of synchronization during an unfolding game. Through individual self-confrontation interviews, the activities of nine basketball players of the same team were examined in detail. The results revealed that 12 categories of stressors were reported, and categorized into two larger units reflecting stressors perceived as affecting (a) "the team functioning as a whole" and (b) "a player's own functioning". Thus, the nature and degree of similarity of the game-specific stressors experienced by basketball players within a single team were identified during a game. In addition, the findings showed six different patterns of synchronizations of team members' stressors, as well as their changes over the course of the game. They provided support for the synchronized appraisal and experience of stressors within a team during a game. By adopting an interpersonal perspective and examining the temporal interplay in team members' activities, this study shed light on stress within teams.

'What vision?': experiences of Team members in a community service for adults with intellectual disabilities.

BACKGROUND: In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. METHODS: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. RESULTS: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. DISCUSSION: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.

Fluctuations of the experience of togetherness within the team over time: task-cohesion and shared understanding throughout a sporting regular season.

Based on a diagnosis action research design, the present study assessed the fluctuations of the team experience of togetherness. Reported experiences of 12 basketball team members playing in the under-18 years old national championship were studied during a four-month training and competitive period. Time series analysis (Auto-Regressive Integrated Moving Average procedures) served to describe temporal properties of the way in which the fluctuations of task-cohesion and shared understanding were step-by-step experienced over time, respectively. Correlations, running-correlations and cross-lagged correlations were used to describe the temporal links that governed the relationships between both phenomena. The results indicated that the task-cohesion dimensions differed mainly for shared understanding dynamics in that their time fluctuations were not embedded in external events, and that the variations in shared understanding tend to precede 'individual attractions to the task' variations with seven team practical sessions. This study argues for further investigation of how 'togetherness' is experienced alternatively as a feeling of cohesion or shared understanding. Practitioner Summary: The present action research study investigated the experience that the team members have to share information during practice, and the subsequent benefices on team cohesion. Results call for specific interventions that make team members accept the fluctuating nature of team phenomena, to help them maintaining their daily efforts.

Team members' emotional displays as indicators of team functioning.

Emotions are inherent to team life, yet it is unclear how observers use team members' emotional expressions to make sense of team processes. Drawing on Emotions as Social Information theory, we propose that observers use team members' emotional displays as a source of information to predict the team's trajectory. We argue and show that displays of sadness elicit more pessimistic inferences regarding team dynamics (e.g., trust, satisfaction, team effectiveness, conflict) compared to displays of happiness. Moreover, we find that this effect is strengthened when the future interaction between the team members is more ambiguous (i.e., under ethnic dissimilarity; Study 1) and when emotional displays can be clearly linked to the team members' collective experience (Study 2). These studies shed light on when and how people use others' emotional expressions to form impressions of teams.

Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis.

Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.

Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members.

Background: In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective: This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods: A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results: At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion: To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.

The relationship among intra-group communication, transactive memory systems, collective efficacy and team performance: A structural equation model analysis with Elite Footballers.

We explored the relationship among intra-group communication, collective efficacy, transactive memory systems and team performance. One hundred and seventy soccer players, aged between 14 and 38 years (M = 18.35, SD = 4.71), from eight national teams participated in this study. Data were analyzed using structural equation modeling. First, our analysis revealed that intra-group communication was positively related to transactive memory systems. Second, transactive memory systems was positively associated with collective efficacy and team performance. Third, our analysis revealed that collective efficacy mediated the relationship between transactive memory systems and performance. Altogether, our findings advance the literature by highlighting the relationship among intra-group communication, collective efficacy, transactive memory systems and team performance team processes. From an applied perspective, our findings suggest that systemic interventions simultaneously targeting various team constructs are important to enhance team functioning.Highlights The relationship among intra-group communication, collective efficacy, transactive memory systems and team performance were examined in national football teams.A cross-sectional design was developed and the data were analyzed using structural equation modeling.Players perceptions of high intra-group communication were positively associated with the development of transactive memory systems.Higher levels of transactive memory systems and collective efficacy were associated with better team performance.

Improving primary care team functioning through evidence based quality improvement: A comparative case study.

BACKGROUND: Provision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices. METHODS: We used a comparative case study in two VA medical centers (Sites A and B) that engaged in EBQI between 2014 and 2016. We analyzed multiple qualitative data sources: baseline and follow-up interviews with key stakeholders and provider team ("teamlet") members (n = 64), and EBQI meeting notes, reports, and supporting materials. RESULTS: Site A's QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time. CONCLUSION: EBQI enabled local QI teams and other stakeholders to develop and implement innovations to improve PC team processes and characteristics in ways that improved teamlet members' perceptions of team functioning. IMPLICATIONS: EBQI's multi-level approach may empower staff and facilitate innovation by and within teams, making it an effective implementation strategy for addressing unique practice-based challenges and supporting improvements in team functioning across varied clinical settings. LEVEL OF EVIDENCE: VI.

Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China: a qualitative study.

Background: Teamwork is essential for the quality and safety of care, and research on teamwork in health care has developed rapidly in many countries. However, evidence from less affluent, non-Western countries is scarce, while improving teamwork may be especially relevant to be able to increase the quality of care in these settings. This study aims to understand the main factors that influence, and interventions used to improve, the functioning of health care teams in the context of county-level hospitals in less affluent areas of China. Methods: We conducted semistructured interviews to explore the factors that influence team functioning and the interventions implemented to improve team functioning in these hospitals. 15 hospital presidents and 15 team leaders were selected as respondents. Results: From the interviews, we have identified five main factors that influence team functioning in these hospitals: "stuck in the middle", local county setting, difficulty in attracting and retaining talent, strong focus on task design, and strong focus on leadership. The interventions for improving team functioning can mostly be categorized as the following: 1) measures to attract and retain talent (e.g., increase salary, train talent in national or provincial level hospitals, and provide fast-track promotions), 2) interventions focused on monodisciplinary teams (e.g., changing the team structure and leadership, and skill training), and 3) interventions to establish and improve multidisciplinary teams (e.g., simulation training and continuous team process improvements). Conclusion: With the introduction of multidisciplinary teams, interventions into team processes have started to receive more attention. The findings depict an overview of the main factors and interventions as specifically relevant for team functioning in county-level hospitals in less affluent areas of China and may help these hospitals benefit from additional process interventions to improve teamwork and the quality of care.

A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline.

This study reviews findings for the first randomized controlled trial (RCT) on the Interconnected Systems Framework (ISF) for school mental health (SMH) and Positive Behavioral Interventions and Supports (PBIS). Since its development in the late 2000s, the ISF has been supported by federally funded centers for SMH and PBIS, and, guided by a national workgroup, is being implemented in >50 communities in the United States. This experimental evaluation of the ISF involved an RCT implemented in 24 schools in two southeastern states, with the ISF implemented in eight schools, PBIS alone implemented in eight schools, and typically co-located PBIS+SMH implemented in eight schools. Related to very poor implementation, documented by two sources of fidelity data, two ISF schools were dropped from major analyses; hence, the study used a treatment on the treated (ToT; Rubin, 1974) as compared to a more traditional Intent-to-Treat approach (ITT; Lachin, 2000). This is the first paper from this large study, with emphasis here on proximal variables and school discipline. Within schools' multi-tiered systems of support (MTSS), ISF schools delivered more Tier 2 (early intervention) and Tier 3 (treatment) interventions to a greater proportion of students than the other two conditions by the second year of the intervention. There was also a dramatic difference in the provision of interventions by community mental health clinicians in ISF schools (almost half of interventions delivered) as compared to PBIS+SMH schools (around 3% of interventions delivered), underscoring the critical role of the ISF in integrating clinicians into MTSS teams and core school functions in SMH. As compared to the other two conditions, ISF schools also had reduced office discipline referrals (ODRs) and in-school suspensions, as well as reduced ODRs and out-of-school suspensions for African American students. Findings are discussed in relation to future directions of education-mental health system partnerships in improving the delivery and impact of SMH programs and services, demonstrated in the ISF.

Will the real leaders please stand up? The emergence of shared leadership in semi-professional soccer teams.

OBJECTIVES: High-quality leadership is often regarded as one of the main sources of competitive advantage. Especially within sport teams, a team's leadership structure has historically been considered to be stable across the season, with the coach and team captain as the formal, and often sole, leaders. In line with recent organizational research, the present study aims to broaden this perspective by also taking informal leaders into account and exploring how leadership structures among athletes within sport teams evolve over the course of a season. DESIGN: Using social network analysis, we analyzed the leadership structure of 20 semi-professional soccer teams (N=460 players, Mage=23.50 years; SD=4.55) at the start of the season and then again halfway through the season. More specifically, for each team we constructed a leadership network for four leadership roles (task, motivational, social, and external leadership) at these two time points. RESULTS: Findings suggest that leadership structures in sport teams can change considerably over the course of the competitive season, thereby challenging the classic view of stable, vertical leadership structures. The transition to more shared forms of leadership can be attributed to the emergence of informal leaders over time as players engage more strongly in leadership roles. Furthermore, our results suggest that as teams evolve towards shared leadership their functioning and performance benefits from these changes. CONCLUSIONS: Based on these findings, we recommend that coaches actively implement a structure of shared leadership and seek to develop the leadership qualities of formal and informal athlete leaders.

Leading together towards a stronger 'us': An experimental test of the effectiveness of the 5R Shared Leadership Program (5RS) in basketball teams.

OBJECTIVES: Leadership has been suggested to be a key factor in gaining a competitive advantage as a team, with shared leadership being a better predictor of team functioning than vertical leadership. Although the benefits of shared leadership are well-documented, evidence about how to implement a shared leadership structure remains sparse. This leaves coaches with three key challenges: (1) identifying the best leaders; (2) defining what roles those leaders should fulfill; and (3) developing their leadership skills. Solutions to these challenges have been proposed in the 5R Shared Leadership Program (5RS) - a leadership development program that seeks to implement an effective structure of shared leadership within sports teams. DESIGN: To test the effectiveness of 5RS program, we conducted an experimental-comparison group intervention in which eight national-level basketball teams (N = 96) completed a questionnaire at two points in time (i.e., pre- and posttest). The teams in the intervention condition completed the 5RS program, in which we identified the leadership structure in their teams (through Shared Leadership Mapping), appointed the best leaders in their leadership role, and then developed their identity leadership skills. RESULTS: The results revealed that the 5RS program was successful in strengthening athlete leaders' identity leadership skills, and as a result also team members' identification with their team. Furthermore, in contrast to athletes in the comparison condition, athletes in the 5RS condition were able to maintain their levels of intrinsic motivation and commitment to team goals, while also reporting improved well-being. CONCLUSIONS: The present study provides encouraging evidence that, by implementing a structure of shared leadership and by promoting athlete leaders' identity leadership skills, the 5RS program is able to improve the team's functioning and the well-being of its members.

Team Processes and Outcomes During the AMADEE-18 Mars Analog Mission.

The aim of this study was to examine team functioning within the context of the AMADEE 18 Mars analog project, which took place in Oman in the winter of 2018. Five "Analog Astronauts" participated in this study. Each completed measures of individual-level variables, including demographics and personality, before the simulated Mars mission began. At several time points during the mission, and once at the end, participants completed measures of individual stress reactions, and teamwork-related variables, including several types of team conflict, citizenship behavior, in-role behavior, counterproductive behavior, and social loafing. Each participant also reported how well he or she felt the team performed. The results indicate an overall positive, successful teamwork experience. Factors including measurement issues, psychological simulation fidelity, and qualities of the team likely influenced these results. Measuring important team- and individual-level variables during additional space analog events, while considering factors related to psychological fidelity, will allow for the compilation of data to better understand the factors affecting teams in these unusual contexts.

Team approaches in palliative care: a review of the literature.

BACKGROUND: Interdisciplinary team involvement is commonplace in many palliative care settings across the world. Teamwork is perceived by many experts as an indispensable functionality of palliative care teams. Significantly different structural and functional attributes of these teams between regional and organisational contexts could potentially act both as strengths and weaknesses towards their overall productivity. The sustainability and resilience of the team also has an indirect bearing on the team functioning. AIM: This article describes international evidence on dynamic palliative care teams with a view of how and when they function efficiently or adversely. Emphasis is also placed on studies that suggest means to mitigate the conflicts and limitations of teamwork in palliative care and related healthcare settings. FINDINGS: Evidence strongly suggests that palliative care is best delivered through a multidisciplinary team approach. CONCLUSION: The overall performance of a healthcare team is largely determined by the supportive work environment built through effective communication, leadership skills and mutual respect.