Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review
Authors: Sangaleti Carine , Schveitzer Mariana Cabral , Peduzzi Marina , Zoboli Elma Lourdes Campos Pavone , Soares Cassia Baldini 
Published: November 2017

EXECUTIVE SUMMARY

Background
During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork.

Objective
The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.

Inclusion criteria Types of participants
The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included.

Phenomena of interest
The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.

Context
The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded.

Types of studies
The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Search strategy
A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered.

Methodological quality
Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically.

Data extraction
Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

Data synthesis
Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software.

Results
This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings:i. The health professional's experience of teamwork and interprofessional collaboration process is based on daily practices triggered by users’ needs, and include integration, trust, respect, openness to collaboration, a feeling of belonging, humility, and time to listen and talk. Teamwork and interprofessional collaboration require communication and sharing to ensure frequent contact and sociability, appreciation and knowledge of different practices and professional roles, especially in complex cases, and shared leadership to deal with conflicts and tensions.ii. The health professional's experience with conditions and consequences of teamwork and interprofessional collaboration shows the importance of a care philosophy guided by the connection with the patient and family. This is especially evident in the papers dealing with the Brazilian Family Health Program. This generates gains in collaborative care such as continuity of action, improvement in relations, time saving and continual learning. Teamwork is a practice facilitated by individual and collective initiatives in the areas of labor and management, although there are still structural, ideological, organizational and relational barriers.iii. The health professional's experience of teamwork and interprofessional collaboration is determined by the biomedical paradigm, social division of labor, provision of services in the referral network, and specific training in teamwork through undergraduate study and in the workplace.

Conclusions
This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.