Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice

Introduction

Dow and colleagues’ (2017) recent editorial entitled Teamwork on the rocks: Rethinking interprofessional practice as networking offers an important contribution to the literature. Their editorial summarises key experiences from a study that examined how healthcare professionals involved in the care of patients with colorectal cancer access, and review electronic health records. In their analysis of these data, the authors found little evidence of interprofessional teams; rather they found the existence of ‘networks of electronic collaboration among the healthcare professionals caring for each patient’ and that the ‘size and complexity of these networks provided some startling insights into the barriers to interprofessional practice’ (p. 677).

Based on this study, Dow et al. (2017) argue that we need to expand the notions of interprofessional practice to encompass both teams and networks. As the authors state, ‘these networks are too unwieldy to be trained as discrete teams’ (2017 p.677). Consequently, they argue that the current collaborative competency framework developed by the Interprofessional Education Collaborative (2016) needs further consideration. Specifically, in addition to the domain ‘teams and teamwork’ Dow et al. (2017) argue that the competency domain of ‘networking’ should be added to provide explicit opportunities for learners to engage with large nebulous groups and so better equip them for the realities of clinical practice. Dow and colleagues (2017) conclude that ‘while teamwork has been the dominant conceptualisation for interprofessional practice over the past two decades, we suggest that networking is an additional important conceptualisation for interprofessional practice’ (p. 678).

This editorial picks up on the argument presented by Dow and colleagues (2017) to reinforce the need to expand traditional notions of interprofessional practice, which have almost exclusively been based on teamwork, to include a second category, networking. However, we push the argument further to suggest other forms of interprofessional work (collaboration and coordination) also need to be added in order to provide a more realistic account of the different forms of interprofessional practice that exist.

A critical analysis of the teamwork literature

Nearly a decade ago, with colleagues, two of us published a textbook entitled, Interprofessional Teamwork for Health and Social Care (Reeves, Lewin, Espin, & Zwarenstein, 2010). In this book we undertook an analysis of teamwork typologies published in the literature over the past 30 years (e.g. Headrick, Wilcock, & Batalden, 1998; Sundstrom, De Meuse, & Futrell, 1990). Specifically, we analysed over 20 descriptions of teamwork from which we obtained five common elements: shared identity, clear roles/tasks/goals, interdependence of members, integration of work, and shared responsibility. For us, these five elements helped define the essence of a team, but they missed a sixth element: the predictability, urgency and complexity of a team’s actual work (which we termed ‘team tasks’) that affect the delivery of patient care. Collectively, we argued that these six elements contributed to impact the effectiveness of different teams in different clinical settings to provide well-coordinated and safe care (Reeves et al., 2010).

Teamwork models

In our analysis of the literature we also found that authors provided a range of different typologies for varying team formations (e.g. Drinka & Clark, 2000; Jelphs & Dickinson, 2008). In general, we found that this literature appeared to (implicitly) suggest that teams could be placed on a single spectrum of quality, from ‘poor teams’ (e.g. those who do not work in an integrated fashion and interact infrequently) to ‘good teams’ (those who share an integrated approach and interact on a regular basis). For example, a model developed by Katzenbach and Smith (1993) argued that there are five contrasting types of team: working groups (in which members hold some shared information and undertake some team activities, but where there is no joint responsibility or clear definition of team roles), pseudo teams (where members are labelled as a ‘team’ but, in reality, have little shared responsibility or coordination of their teamwork), potential teams (in which members are beginning to work in a collaborative manner but have few of the factors needed for effective teamwork, such as the sharing of common team goals), real teams (where members share common goals and share some accountability), and high performance teams (in which members all hold a clear understanding of their roles, all share common team goals and, in addition, encourage members’ personal development). For us, this model appeared to have confounded team performance and team type, since Katzenbach and Smith’s (1993) descriptions of ‘potential’, ‘real’, and ‘high performance’ teams essentially described team function rather than different categories/types of teamwork (Reeves et al., 2010).

As a result of this problematic approach to conceptualising teams and teamwork, we argued that these typologies provided both a normative and a linear understanding teamwork—one in which teams may progress from a state of poor functioning to a better performance (Reeves et al., 2010), rather than one which offered a thoughtful insight into the nature of collaborative practice. Indeed, we noted that this literature seemed to be based on a presumption that teams operating at ‘lower ends’ of these different typologies (e.g. working groups, pseudo teams) should aim to improve their collaborative function in order to reach their ‘upper ends’ (e.g. real teams, high performance teams).

A new typology of interprofessional practice

The need for a contingency approach

Given the limitations of these typologies, we argued that a contingency approach was needed when thinking about interprofessional practice. Such an approach, we stressed, would take into account the six elements we found to affect collaboration: shared team identity, clear roles/goals, interdependence, integration, shared responsibility, and team tasks (Reeves et al., 2010). We saw that each of these elements can be viewed as a continuum along which a particular team/group can be placed, for example, from having a weak team identity to having a strong, shared team identity. We noted that teams/groups may vary in their location along each of these dimensions independently. For instance, a team that had a strong shared team identity may, at the same time, have more loosely integrated work practices. For us, a central tenet of this approach was that teams and teamworking should not be regarded as moving along a single, linear, hierarchical spectrum from weak to strong; rather we argued for a more nuanced conceptualisation in which the design of the team needed to be matched to it's clinical purpose(s) in order to serve the local needs of patients—the contingency approach (Reeves et al., 2010).

Given this approach, we argued that practitioners working together needed to think about their main purpose(s) and also how they could respond to local clinical/patient needs. Therefore, we stressed that teamwork was just one of the forms of interprofessional work alongside other forms, specifically, collaboration, coordination and networking.

To help understand these differing, though interconnected, types of interprofessional work, we presented the following definitions:

Interprofessional teamwork

This form of practice encompassed a number of core elements previously mentioned, including (but not restricted to): shared team identity, clarity, interdependence, integration, and shared responsibility. In this type of formation team tasks were regarded, in general, as unpredictable, urgent and complex.

Interprofessional collaboration

This was seen as a ‘looser’ form of interprofessional work when compared to teamwork. Its key difference was that shared identity and integration of individuals were seen as less important in collaborative groups than in teams. However, collaboration is similar to teamwork in that it required shared accountability between individuals, some interdependence between individuals, and clarity of roles/goals. In this arrangement team tasks were regarded as generally a little more predictable, less urgent and complex.

Interprofessional coordination

This form of interprofessional practice was seen as similar to collaboration in terms of shared identity. However, integration and interdependence were viewed as less important. Team tasks were regarded as even more predictable, less urgent and less complex than collaboration. However, coordination was seen as similar to collaboration in that it did require some shared accountability between individuals and clarity of roles, tasks, and goals.

Interprofessional networks

This type of interprofessional arrangement was one in which shared team identity, clarity of roles/goals, interdependence, integration and shared responsibility were seen as less essential than coordination. In networks, tasks were also viewed as predictable, non-complex and non-urgent. As a result, networks could be virtual in nature—where members did not necessarily meet face-to-face, but could communicate in an asynchronous manner by use of email or online video/audio conferencing.

Given these differing types of interprofessional work, we argued that depending on local clinical/patient needs, other forms of work may be more effective than a teamwork approach. For example, in a primary care practice setting, where clinical work was, on the whole, predictable, relatively non-complex and non-urgent, a networking arrangement would provide an effective type of working arrangement; as opposed to an intensive care unit where the nature of the clinical work can be more unpredictable, more complex and urgent in nature, a teamwork arrangement would be more suitable. Also, based on the contingency approach, we noted that depending upon changes in the nature of clinical work the normal networking arrangement in a primary care clinic could shift (temporarily) to a teamwork arrangement if a patient experienced a cardiac arrest, to meet this change in clinical need.

New notions of competence

While we agree with the argument proposed by Dow et al. (2017) that the Interprofessional Education Collaborative (2016) competency framework needs to add a networking domain alongside the teams and teamwork domain, to better equip learners from different health care professions for the realities of clinical practice, these two activities only represent a partial range of the interprofessional competencies needed. To ensure learners are provided with a comprehensive insight into the various elements of interprofessional practice, two other forms of interprofessional work, collaboration and coordination, need also to be included. This would form a more realistic framework which encompasses all the key domains—teamwork, collaboration, coordination and networking—related to collaborative competence.

Concluding comments

This editorial extended the argument presented by Dow and colleagues (2017) that traditional notions of interprofessional work have almost exclusively been based on an uncritical understanding of teamwork as a singular phenomenon. Agreeing with Dow et al (2017) that we need also to include networking, we argued for adding other forms of interprofessional work: interprofessional collaboration and coordination, as important additions in the future refinement of collaborative competence. Working together we have been validating the Reeves et al (2010) model to see how the four categories (teamwork, collaboration, coordination, networking) resonate with empirical studies. A paper describing this work will be published later this year (Xyrichis, Reeves, & Zwarenstein, forthcoming).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.