Building collaborative capacity: Promoting interdisciplinary teamwork in the absence of formal teams

Background: Contradictory findings about the effectiveness of health care teams may relate to the actual structure of teams-loose rather than formal-and the nature of decision making-hierarchical rather than egalitarian. We introduce the concept of collaborative capacity-the likelihood that providers, no matter how brief their exchange, will collaborate as if they were members of an egalitarian team even in the absence of a formal team structure. Objective: To examine aspects and determinants of collaborative capacity, namely task interdependence, norms of working together, and egalitarian collaboration among interdisciplinary providers on health care units. Research Design: We collected survey data from unit-based staff in 45 units across 9 hospitals and 7 health systems in upstate New York. One thousand five hundred twenty-seven surveys were returned for an overall response rate of 68.5%. Results: Measures for team structure and collaboration do not vary significantly between hospitals, only by unit and occupational group, with higher status providers reporting greater interdependence, higher quality of interactions, and more collaborative influence in decision making. Clear task direction, namely an emphasis on patient-centered care, and organizational contexts supportive of work are both significantly associated with higher levels of task interdependence, quality of staff interactions, and collaborative influence. Conclusions: Collaborative capacity is somewhat constrained by a rigid hierarchy of health care occupations and division of labor that make teamwork more similar than different across hospitals. At the unit level, collaborative capacity may be improved, however, by an emphasis on patient-centered care and a context that supports providers' work.