Understanding teamwork in rapidly deployed interprofessional teams in intensive and acute care: A systematic review of reviews

Abstract

The rapid increase of acute and intensive care capacities in hospitals needed during the response to COVID-19 created an urgent demand for skilled healthcare staff across the globe. To upscale capacity, many hospitals chose to increase their teams in these departments with rapidly re-deployed inter-professional healthcare personnel, many of whom had no prior experience of working in a high-risk environment and were neither prepared nor trained for work on such wards. This systematic review of reviews examines the current evidence base for successful teamwork in rapidly deployed interprofessional teams in intensive and acute care settings, by assessing systematic reviews of empirical studies to inform future deployments and support of rapidly formed clinical teams. This study identified 18 systematic reviews for further analysis. Utilising an integrative narrative synthesis process supported by thematic coding and graphical network analysis, 13 themes were found to dominate the literature on teams and teamwork in inter-professional and inter-disciplinary teams. This approach was chosen to make the selection process more transparent and enable the thematic clusters in the reviewed papers to be presented visually and codifying four factors that structure the literature on inter-professional teams (i.e., team-internal procedures and dynamics, communicative processes, organisational and team extrinsic influences on teams, and lastly patient and staff outcomes). Practically, the findings suggest that managers and team leaders in fluid and ad-hoc inter-professional healthcare teams in an intensive care environment need to pay attention to reducing pre-existing occupational identities and power-dynamics by emphasizing skill mix, establishing combined workspaces and break areas, clarifying roles and responsibilities, facilitating formal information exchange and developing informal opportunities for communication. The results may guide the further analysis of factors that affect the performance of inter-professional teams in emergency and crisis deployment.

Fig 1. PRISMA flow chart.

The PRIMSA diagram details our search and selection process applied during the review.

Fig 2. Overview of JBI appraisal table.

The Figure outlines the results of using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Synthesis (Copyright JBI 2020) on the 15 selected articles.

Fig 3. Integrative narrative synthesis process.

The Figure details the integrative narrative synthesis process applied during the review (adapted from Popay et al., 2006).

Fig 4. Graphical representation of thematic relationships in reviewed papers.

The graph displays the relative importance of the themes by size of the nodes (based on the number of references), the relationships between nodes based on the physical closeness and the size of the connecting lines (derived from the number of references shared by individual themes) and the modularity of the themes (derived from the thematic closeness to each other). The graph further displays the presence of four thematic factors represented by different colours.