Nonetheless, participants were optimistic about developments such as the pan-Canadian Health Human Resources planning framework, as well as two 2005 reports from the Health Council of Canada, which reference teamwork and collaboration (Health Council of Canada 2005a, 2005b). The work of the IECPCP was often cited and seen as a hopeful example of longer-term funding commitments that could assist policy change. In the immediate future, the participants called for a national policy forum on collaborative practice to be convened, including discussion on topics such as research and evaluation dimensions to best practices, lessons learned, return on investment, impacts of these projects, change in policy and policy buy-in.
The greatest obstacle to change is arguably the hierarchical culture of healthcare. Entrenched attitudes about scopes of practice, professional "turf" and historical power structures can sabotage the essence of what teamwork is. Providers need to address their personal power issues, adopt common goals, break down hierarchies and then educate patients about how each team member contributes to their care.
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It is difficult to imagine who could oppose implementing effective teamwork as a way to improve healthcare. Even casual observers would likely equate the healthcare sector with teams and teamwork, and cite the history of nursing as an example. However, in healthcare delivery, teams rarely exist that incorporate different professions and occupations, as well as patients and families.
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Practical and well-evaluated plans for implementing teamwork are fairly rare, although Oandasan et al. (2006) note that in health services research, there have been a number of recent attempts to capture and evaluate individual training programs to enhance teamwork, with some evidence of effectiveness. For example, they note that patient safety studies have found that team training and decision aids such as checklists and communication protocols can be used to improve team processes and reduce adverse events (Hoff et al. 2004; Lingard et al. 2004; Pronovost et al. 2003).
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Teamwork requires an explicit decision by the team members to co-operate in meeting the shared objective. This requires that team members sacrifice their autonomy, allowing their activity to be coordinated by the team, either through decisions by the team leader or through shared decision making. As a result, the responsibilities of professionals working as a team include not only activities they deliver because of their specialized skills or knowledge, but also those resulting from their commitment to monitor the activities performed by their teammates, including managing the conflicts that may result (Oandasan et al. 2006).
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Formidable barriers that arise out of this culture include the self-regulation of professions, current malpractice and liability laws and funding and remuneration models. All these discourage and deter the establishment of teams. For instance, current malpractice legislation places responsibility solely on individuals. Regulations that support teamwork, on the other hand, would refocus this "culture of blame" to a culture of patient safety and risk management. Much work needs to be done to clarify the accountability for non-physician team members in performing shared tasks. As for remuneration models, traditional fee-for-service payment systems for physicians impede movement toward collaborative care. What is more, no financial incentives exist that tie funding to collaboration and teamwork efforts, unlike initiatives in other countries such as England (Oandasan et al. 2006).