Medical teamwork and the evolution of safety science: a critical review

Abstract

There is widespread consensus that teamwork constitutes one of the key requirements in today’s multidisciplinary and highly complex system of delivering care. In recent years, increasing attention has been given to questions of how to define, teach, measure, and improve teamwork in healthcare. However, one cannot help but feel a certain disconnect between this ongoing trend in healthcare with an associated bias towards judgemental and normative language, and contemporary thinking in safety science that explores concepts from complexity thinking, such as emergence and resilience. The aim of this critical review is to contrast prevailing approaches to teamwork in healthcare with current concepts in safety science. After identifying relevant articles through multiple formal search methods, we found that, although current teamwork literature acknowledges a lack of comprehensive investigations linking team training in healthcare and patient outcomes, the predominant strategy to achieve safety remains a traditional, reactive approach that regulates behaviour and constrains performance variability. As this strategy is focussed on competencies, much of the responsibility for unwanted results is pushed towards the ‘sharp end’ by the quality agenda, emphasizing personal and professional competence while obscuring systemic issues. Teamwork, while indispensable in the highly subspecialized reality of healthcare, is oftentimes reduced to an aggregated set of individual behaviours. It appears that in the current state of entangled quality and safety agendas, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept.