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Table 3 Categories and subcategories derived from the qualitative content analysis

From: Healthcare professionals’ perceptions of interprofessional teamwork in the emergency department: a critical incident study

Categories

Enablers of interprofessional teamwork in the ED

Barriers to interprofessional teamwork in the ED

Subcategories

Salience of reflection

Self-awareness to scrutinize oneself

Awareness of individual limits was used as a motivation to improve and maintain competency

Team reflection as a way of interprofessional learning

Sharing perspectives of the same experienced situation provided awareness of the team capacity and motivation

Self-awareness to scrutinize oneself

Lack of ability and opportunity to engage in self-reflection caused HCPs to exceed their limits or use to much self-critique

Team reflection as a way of interprofessional learning

Deprioritizing reflection within the team resulted in a failure of interprofessional teamwork

Professional experience makes a difference

Experience is a crucial component of professional practice

HCPs who had adequate academic and clinical experience to manage teamwork and patient assessment

Expectation of professional experience

Explicit expectations allowed interprofessional teams to adapt to a situation

Need for continuous development and training

Clinical education and simulation training led to stringency with respect to professional roles and the concept of teamwork

Experience is a crucial component of professional practice

Lack of experience (academic and clinical) hindered the teamwork and delayed the patient assessment

Expectation of professional experience

A preconception of professional experience had a negative impact on interprofessional teamwork

Need for continuous development and training

Lack of professional and clinical training led to misunderstandings and failure to carry out the work

Demanding physical and psychosocial work environment

The physical work environment

Positive aspects of being physically close

The physical work environment

Consequences of alarm fatigue, small assessment space and chaotic environment

Dealing with emotions related to stress

Stress-induced unpleasant behaviors during interprofessional teamwork and concealed emotions

Balancing communication demands

Applying communication (tools, climate, and attitudes)

The correct use of communication tools and the opportunity to work in an enabling team climate encompassing positive attitudes

Art of concise and clear information

The ability to address the intended information to the appropriate colleague, at the right time

Silent communication

Non-verbal behavior complemented or sometimes replaced verbal communication

Applying communication (tools, climate, and attitudes)

Inadequate use of communication tools and unpleasant attitudes led to teamwork failures

Lacking management support, structure, and planning

 

ED considered an unsuitable place of care

Patients received medically advanced treatments for which the HCPs lacked familiarity or had insufficient space, time or equipment in the ED

Mismatch of available resources and excessive workload

Shortage of resources

Discordant views on strategies of care

Differences of opinions across wards between management and staff with respect to the use of strategies and the focus of care as part of the interprofessional teamwork

Tensions between professional role and responsibility

 

Gender roles and hierarchies of expertise

Positioning and disagreements (gender norms and other hierarchies)

Violation of personal and professional integrity

Disrespect for professional expertise and overstepping boundaries

Different views on interprofessional teamwork

Personal relations and favoritism

Strong personal relationships with team members contributed to trust and psychological safety

Perspective on teamwork attributes

Clear interprofessional team goals and routines (i.e., leadership) guided the interprofessional team forward

Inadequate involvement/intrusion by the patient

Patients either interrupted the team or overheard inappropriate information

Personal relations and favoritism

Favoring colleagues based on personal relations and appreciation led to disrespect for others in the interprofessional team

Perspective on teamwork attributes

Lack of defined routines, purposes, and descriptions led to discrepant perceptions on how to carry out the interprofessional teamwork

Confidence in interprofessional team members

Joint team assessments

Additive value of the different areas of expertise generated a comprehensive assessment of the patient

Mutual need for interprofessional support

Sharing vulnerability and emotional dedication in the interprofessional team led to an increased feeling of being supported

Joint team assessments

Disregarding professional boundaries led to failed interprofessional teamwork, duplication of work, and work overload

Mutual need for interprofessional support

Frustration with unsupportive colleagues

  1. ED, emergency department; HCP, healthcare professional