Teamwork: Metaphors and Myths of Equality in the Health-Care Setting.

While it appears that there is a new and growing emphasis today on interprofessional education and collaboration among health-care providers, the effort has been underway for at least a century in the United States. The early twentieth century witnessed a significant growth in medical specialism and healthcare professions, and with that expansion came a concern for "teamwork."1 Much like today's advocates of enhanced patient care and knowledge sharing, early proponents of health-care collaboration believed that "teamwork would ennoble medicine."2In this brief essay, I trace the idea of teamwork as it is employed in multiple health-care settings, and by various scholars who have taken an interest in the concept as it is applied to improving health-care delivery. Defining what a team is in the health-care setting is challenging, for the makeup of workers varies immensely over time and between different health-care settings. Early conceptions of teamwork in medicine tended to focus on the work and relations between doctors, nurses, and (sometimes) social workers. Today, healthcare teams can include physicians' and nurses' assistants, pharmacists, allied health providers, medical technicians, community health workers, mental health workers, and myriad other health-care providers.Despite the wide variability in health-care teams, there is an almost unwritten and universal assumption that in order for teams to deliver good patient care, they must work together in a collaborative and collective fashion, keeping all lines of communication open, with a readiness to learn another health-care professional's expertise. Most articulations of teamwork embody a democratizing tone, insinuating that the togetherness that teams bring will elide any hierarchical distinctions between the various professions-and professional aides-who belong to the collective team. This essay demonstrates, however, that throughout the twentieth century, the rhetoric of collaboration has had the effect of reifying conventional power structures (with MDs and head nurses often holding the greatest power over all other health professionals and patients), while rendering the system of hierarchy less visible to those working within it.Prior to the mid-nineteenth century, the word "team" referred most often to animal labor and progeny and was rarely used to describe human activities or work.3 More specifically, the term described the labor performed by draught animals, beasts of burden who would be harnessed together to enforce physical unison and to accomplish tasks-whether it be tilling or transportation-set forth by a human master.4With the advent of the second industrial revolution, managers and economists increasingly began to apply the concept of teamwork to human labor. Efficiency engineers insisted on the need for teamwork in order to improve productivity (more output in less time) on factory floors.5 In order to reach higher levels of mass production during the early twentieth century, companies needed a stable workforce that would accept the constraints and discipline of an assembly line. What is more, business owners knew that all employees needed to believe that greater productivity leads to greater profit and that both were desirable for all members of the production "team." "The team idea," wrote the Business Training Corporation of New York in 1918, "is the winning idea. It represents the right attitude toward industrial work-the right attitude for the routine worker no less than for the foreman or other executive . . . it is the starting point for all advancement."6 Of particular concern for top management was to control the worker who exhibited "grouchiness, ill-humor, indifference, and unfairness," traits that could both leave a bad impression on consumers and cause further unrest and dissatisfaction among fellow workers.7 The new emphasis on teamwork-largely taught to and touted by the growing ranks of foremen in the 1920s and 1930s-emphasized that, to be a member of a team, one had to have the "right attitude" in order to turn a profit. …