۱- Introduction

۲- Method

۳- Results

۴- Discussion

۵- Conclusions

References

Abstract

Healthcare is increasingly complex and requires the ability to adapt to changing demands. Teamwork is essential to delivering high quality care and is central to nursing. The aims of this study were to identify the processes that underpin nursing teamwork and how these affect the care of older people, identify the relationship between perceived teamwork and perceived quality of care, and explore in depth the experience of working in nursing teams. The study was carried out in three older people’s wards in a London teaching hospital. Nurses and healthcare assistants completed questionnaires (n = ۶۵) on known dynamics of teamwork (using the Nursing Teamwork Survey) together with ratings of organisational quality (using an adapted AHRQ HSPS scale). A sample (n = ۲۲; ۳۴%) was then interviewed about their perceptions of care, teamwork and how good outcomes are delivered in everyday work. Results showed that many care difficulties were routinely encountered, and confirmed the importance of teamwork (e.g. shared mental models of tasks and team roles and responsibilities, supported by leadership) in adapting to challenges. Perceived quality of teamwork was positively related to perceived quality of care. Work system variability and the external environment influenced teamwork, and confirmed the importance of team adaptive capacity. The CARE model shows the centrality of teamwork in adapting to variable demand and capacity to deliver care processes, and the influence of broader system factors on teamworking.

Introduction

Despite intra and inter country differences in life expectancy, there has been a steadily rising increase in life expectancy over the last century (Leon, 2011). Alongside this population change, the demand for hospital care has been rising inexorably over recent years, especially for older people. The biggest increase in hospital admissions in the UK has been in the age group 65–۸۴, with hospital episodes rising by more than 2 million to 6.3 million over a ten-year period to 2017 (NHS Digital, 2017). Along with increased demand there is now increased focus on the quality of care received by older people. For example, in 2001 the Standing Nursing and Midwifery Advisory Committee identified significant problems in the quality of nursing care delivered to older patients in acute hospitals (SNMAC, 2001). More recently, health and social care policy initiatives for older people in the UK have included guidelines and standards produced by the National Institute for Health and Care Excellence (NICE), Care Quality Commission, Department of Health, Royal College of Nursing and Healthcare Improvement Scotland, indicating high levels of concern for this vulnerable population. Older people in hospital are at greater risk of experiencing adverse incidents including falls, pressure ulcers, infections, adverse drug reactions, delirium and incontinence (Sari et al., 2008; Long et al., 2013). Older patients (over 65) have complex care needs and are more likely to experience clinical complications, increased length of stay, and loss of functional ability following treatment in hospital (Long et al., 2013). These challenges of caring for older people in hospital mean that it is important that we understand how nursing teamwork contributes to the quality of care they receive. Quality is defined by the Institute of Medicine (1990) as having six dimensions: safety, clinical effectiveness, patient centred, timely, efficient and equitable. In this paper we focused on safety, clinical effectiveness and patient centredness.