Section I of this book (Chapters 1, 2, 3, 4, and 5) describes the concept of a work team, differentiates different types of teams in health care, introduces the professionals who comprise healthcare teams, and explains the roles of patients and administrators. This section introduces the team and the members of the team. It sets the stage for what follows. Sections II-IV then build on this foundation by examining how effective teams and team members work and how we can advance the effectiveness of teams throughout health care.
Healthcare delivery is a specialized enterprise, and it promises to become more and more specialized as knowledge advances. Decades ago, most physicians in the United States were general practitioners. In 1940, 76% of physicians were general practitioners. By 1955, the proportion had declined to 56%; by 1969, it was 31% (Starr, 1982, pp. 358-359). In 2007, only 13.5% of physicians were family physicians or general practitioners, and 34.3% were practicing in all of the primary care fields combined—family medicine, general practice, internal medicine, and pediatrics (American Association of Medical Colleges, 2008). By then the American Medical Association was tracking counts of physicians in 33 specialties in addition to the primary care fields. Medicine has become highly specialized. Similar developments have occurred in nursing. Nursing now has registered nurses, licensed practical nurses, clinical nurse specialists in various fields, nurse practitioners, and doctors of nursing practice. Pharmacy has established specialties in nuclear pharmacy, pharmacotherapy, oncology pharmacy, and other fields.
Social workers and physical therapists are also specialized. The care of most patients is provided by several people practicing different professions. This fragmentation calls for teamwork to assure that they work together effectively.
Calls for improved interprofessional teamwork date back to at least the mid-1950s (Garrett, 1955). However, progress has been slow for several reasons. First, in their training, physicians and nurses and many other clinicians are imbued with the notion that they are individually responsible for what happens to their patients and that performance must be flawless (Leape, 1994). Although a more complex and realistic viewpoint is now gaining sway, for more than a century, clinical professionals finished their training believing that good outcomes were the results of individual effort and that mishaps were caused by individual mistakes. Teamwork had nothing to do with it, or so it was believed. Second, the members of each healthcare profession are educated in isolation. Pharmacists are educated in Colleges of Pharmacy; nurses, in Schools of Nursing; physicians, in Medical Schools; and so on. They rarely meet. One result is that they embrace the values, vocabulary, and conceptual frameworks of their own professions without any exposure to this same socialization process as experienced by students in other healthcare professions (Hall and Weaver, 2001). These values, vocabulary, and concepts are different in different professions as explained in Chapter 3, and ...