Emerging Principles in Obstetric Teamwork

Sammanfattning: There is widespread consensus that teamwork constitutes one of the key requirements in today’s multidisciplinary and highly complex system of delivering care. In recent years, increasing attention has been given to questions of how to define, teach, measure, and improve teamwork in healthcare. However, one cannot help but feel a certain disconnect between this ongoing trend, with an associated bias towards judgmental and normative language, and contemporary thinking in safety science that explores concepts from complexity thinking, like emergence and resilience. By examining teams that manage peripartum emergencies in different settings and cultures, this study aimed to explore how successful teamwork is constructed and perceived by those directly involved in patient care and contrast these findings with traditional normative approaches. This qualitative, exploratory case study, based on interviews with healthcare practitioners in Heidelberg, Germany and Mbarara, Uganda, showed that teamwork was more often than not influenced by emergent phenomena, among them power relations in Heidelberg and resource constraints in Mbarara. Safety is created by negotiating conflicts and individual resilience rather than adherence to normative behavioral standards. However, these aspects are rarely represented in existing frameworks on team training or current teamwork literature, where the predominant strategy to achieve safety remains a traditional, reactive approach that regulates behavior and constrains performance variability. Teamwork, while indispensable in the highly subspecialized reality of healthcare, is oftentimes reduced to an aggregated set of individual behaviors. It appears that in the current state of entangled quality and safety agendas, medicine has settled for a reductionist and moral approach towards teamwork to manage the associated complexities, thereby accepting a simplistic but intellectually impoverished and ethically questionable understanding of the concept. Reinforced by the results of our study, we would contest that, despite the need for measurements and evaluation, the continuous integration of social and cultural aspects in teamwork research will most likely enrich the current discourse for a more humanistic and complete understanding of what happens in healthcare teams. Recognizing power dynamics at the workplace in an effort to understand team processes and guide the serious allocation of resources will certainly address current challenges faced by frontline medical staff more thoroughly than the application of normative frameworks.