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Abstract
Objective A multidisciplinary team is essential to providing high-quality, patient-centred care. However, its effectiveness can be either hindered or facilitated by various factors, such as the need for rapid decision-making, which may compromise patient outcomes despite individual efforts. The aim of this study is to synthesise the factors that may act as barriers and facilitators to the work of multidisciplinary teams in managing labour within acute care settings.
Design A systematic qualitative review and meta-synthesis was conducted following the five-step methodology proposed by Sandelowski et al.
Data source Three databases (Medline, Embase and Scopus) were systematically searched without time restrictions up to 25 May 2024.
Eligibility criteria for selecting studies Qualitative studies exploring perspectives, experiences and other similar factors were included. These studies were assessed for methodological quality using the Critical Appraisal Skills Programme.
Data extraction and synthesis The reviewers independently searched, screened and coded the results of the included studies. Data were synthesised using the method proposed by Thomas and Harden.
Results Seventeen studies were included in the meta-synthesis. Four key dimensions emerged, reflecting both the barriers and the facilitators of multidisciplinary team performances: (1) organisational variables, (2) individual variables, (3) collaborative variables and (4) role variables. A total of 36 variables were identified, which could function as barriers (n=6; eg, high staff turnover), facilitators (n=6; eg, strong listening skills) or both (n=24; eg, team climate), depending on the context.
Conclusions This meta-synthesis identifies specific barriers and facilitators and variables that can act as both. Understanding these factors enables targeted interventions to enhance the performance of multidisciplinary teams in clinical practice, particularly in acute care settings.
PROSPERO registration number CRD42022297395.
- Interprofessional Relations
- Emergency Service, Hospital
- Health Workforce
- Systematic Review
- QUALITATIVE RESEARCH
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- Interprofessional Relations
- Emergency Service, Hospital
- Health Workforce
- Systematic Review
- QUALITATIVE RESEARCH
STRENGTHS AND LIMITATIONS OF THIS STUDY
This study provides an indepth overview of the determinants of effective teamwork in acute care settings, achieved through a comprehensive meta-synthesis.
This systematic review follows Sandelowski et al methodology, allowing for a new interpretation of the original findings from the included studies.
A limitation of the study is that the search strategy did not explicitly include keywords related to individual health professions involved in acute care, potentially leading to the exclusion of relevant studies.
The final database search was conducted on 25 May 2024, which may result in the omission of more recent studies published after this date.
Background
In healthcare, a multidisciplinary team is defined as a group of healthcare professionals (HCPs) with diverse areas of expertise who collaborate to provide the best possible patient care.1 Over the past decade, teamwork has become increasingly central in healthcare, now considered essential to delivering high-quality, patient-centred care.2 The WHO, along with several other international institutions, acknowledges the critical importance of multidisciplinary collaboration in healthcare.3–6 Several studies7–11 have demonstrated that multidisciplinary teamwork offers numerous benefits both to HCPs and to patients. Within such teams, HCPs can work together, combining their skills to improve clinical care and therapy management. This collaboration has been shown to reduce adverse events and promote positive health outcomes,12 such as shorter hospital stays,13 increased patient satisfaction9 and decreased hospital mortality rates,14 particularly within the first 30 days of admission15 and in cases involving neurological conditions.14
In the literature, the term acute care (AC) setting refers to an environment where patients with acute conditions requiring urgent medical attention receive treatment.16 AC encompasses various healthcare sectors, including emergency care, urgent care, short-term stabilisation, prehospital care, critical care, trauma care and AC surgery.16 For instance, the emergency department (ED) offers services designed to restore, maintain and promote the health of patients requiring intensive medical or surgical interventions for acute conditions, trauma and emergent obstetric or gynaecological issues.16 17 As part of the broader AC setting, the ED highlights how the composition of multidisciplinary teams and the dynamics within them are crucial to achieving positive patient outcomes.11 18 The HCPs involved in multidisciplinary teams within AC settings include physicians from various specialties, surgeons, anaesthesiologists, nurses, health assistants, midwives, health technicians19 or therapists.20 However, there is no universal consensus regarding which professional roles should be included in AC teams given the wide range of healthcare professions involved.18 Team members are often broadly categorised into clinical roles, non-clinical roles or temporary positions, reflecting the diverse nature of AC teams.20
While multidisciplinary teamwork is a key objective for ensuring quality patient care in AC settings and is recognised as a vital component of effective healthcare delivery,21 achieving it remains challenging.22 Factors such as the need for rapid decision-making and the presence of diverse professionals with specialised skills can influence collaboration at all levels of care. These challenges can negatively impact team performance and patient outcomes, even when each individual is highly dedicated to achieving the best possible results.23 24 To date, no study has systematically synthesised these influencing factors. A deeper understanding of these elements could improve team organisation and management, while fostering more effective collaboration among HCPs in AC settings.22
Therefore, the aim of the study is to synthesise the factors that can hinder (barriers) or facilitate (facilitators) multidisciplinary teamwork in AC settings. To achieve this, the research question guiding the study is: ‘Which variables can hinder or facilitate multidisciplinary teamwork in AC settings?’
Methods
To address the research question, a systematic review of the literature was conducted to identify relevant studies, followed by a meta-synthesis using the Sandelowski et al.25 This approach was chosen because the research question requires an interpretative analysis of the original findings within a realistic methodological framework.25 26 The meta-synthesis process comprised five distinct stages: (1) definition of key concepts, (2) systematic literature review, (3) quality assessment of the included studies, (4) data analysis and calculation of the effect dimension and (5) synthesis of the results.
The meta-synthesis protocol is published on PROSPERO (protocol ID: CRD42022297395). To ensure transparency in reporting, both the methods and the findings were documented in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ),27as detailed in online supplemental appendix S2.
Supplemental material
Eligibility criteria, search strategy, screening, data extraction and quality
The inclusion criteria were focused on the following: (1) the concept of multidisciplinary teams, defined as groups of HCPs with diverse educational and professional backgrounds who collaborate to provide integrated, high-quality patient care1; (2) HCPs, as defined by the WHO3; (3) teams operating in AC settings, as defined by the Australian Institute of Health and Welfare17; (4) qualitative study designs, including phenomenological studies, ethnographies, grounded theory research and mixed-method or multimethod studies, provided that qualitative data could be clearly separated from quantitative data28 29; and (5) studies focusing on the experiences of a single professional category in relation to multidisciplinary teamwork. The exclusion criteria were as follows: (1) studies involving students, interns or residents; (2) studies investigating barriers and facilitators related to multiprofessional education rather than clinical teamwork; (3) studies conducted on non-graduate or lay professionals, except when these participants constituted less than 15% of the sample and their findings were considered particularly relevant; (4) studies not published in English or Italian; and (5) theses, dissertations and conference abstracts. Disagreements regarding the inclusion or exclusion of studies were resolved through consensus among the reviewers.
The search strategy was designed following the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Rresearch type) tool guidelines.30 Three electronic databases—Medline, Embase and Scopus—were systematically searched to identify all relevant studies. The final search was conducted on 25 May 2024. Tailored search strings were developed for each database to optimise the retrieval of relevant articles, and these are provided in online supplemental appendix S1. Due to the structure of the SPIDER tool,30 ,31 the specific AC setting of interest was identified by the reviewers during the screening process.
Supplemental material
After removing duplicate records, the screening process was done, involving two stages: title and abstract screening and full-text screening. Studies were initially screened based on their titles and abstracts. The remaining articles were reviewed in full by five independent reviewers (CR, LP, GB, FM, ES) using the Zotero reference management software.32 To ensure accuracy, one of the authors (GAn) independently verified the entire data extraction process. Additionally, a snowball search (both backward and forward citation tracking) was conducted at the end of the screening process to identify any relevant studies that may have been missed. These additional studies underwent the same screening procedures. Any disagreements regarding study inclusion were resolved through consensus within the research team.
Data were abstracted using a comprehensive data extraction form, which included the following study characteristics: author’s name, country, publication year, study design and method, type of study population, number and profession of the participants, findings and limitations (see table 1). To minimise bias, two independent reviewers conducted data extraction for each study. LP screened all papers, while GB, FM, CR and ES served as second reviewers. Discrepancies were discussed and resolved through consensus.
Characteristics of the included studies
The methodological quality of the included studies was independently assessed by the same group of reviewers using the Critical Appraisal Skills Programme (CASP) checklist.33 While there is no standardised agreement on quality assessment in meta-synthesis, Sandelowski et al 25 argued that excluding studies based solely on quality is undesirable. Therefore, although the quality of each study was assessed, it was not used as an exclusion criterion. The CASP tool consists of 10 appraisal items evaluating the trustworthiness, relevance and quality of studies. Each question offers three response options—‘yes’, ‘cannot tell’ and ‘no’—with scores assigned as follows: 1 point for ‘yes’ and 0 for ‘cannot tell’ or ‘no’.34 Higher total scores indicate higher methodological quality. Any discrepancies in quality assessment were discussed among the authors and resolved through consensus.
Synthesis and data analysis
Data analysis was conducted using inductive thematic analysis, following the method proposed by Thomas and Harden.35 The results from each included study were entered into Microsoft Excel and organised within an ad-hoc data extraction template. The data were then read in full and analysed through line-by-line coding. Text segments that lacked relevant content were not coded. The reviewers extracted only the findings directly related to the research question. During the coding process, new codes were generated and continuously integrated with existing ones. These codes were then grouped into a hierarchical structure, allowing for the synthesis of similar data and the development of new themes.35 The final set of themes was further refined and combined, following the recommendations of Sandelowski et al.25 Each theme represents a distinct conceptual area relevant to multidisciplinary teamwork in AC settings. The thematic synthesis was conducted manually by the same five authors, with constant and ongoing comparison of results to ensure consistency and reliability. To assess the relative magnitude of the findings, two types of effect sizes were calculated. The intrastudy intensity effect size was calculated as: (number of studies containing the outcome/total number of outcomes among studies)×100.25 36 This metric reflects how prominently an outcome appeared across different studies. The interstudy frequency effect size was calculated as: (number of outcomes in each study/total number of outcomes among studies)×100.25 36 This measures the frequency of specific outcomes within individual studies relative to the total pool.
To maintain the trustworthiness and rigour of the analysis, several strategies were employed: (1) a systematic literature search strategy was used to ensure comprehensive coverage; (2) the research team was multidisciplinary, providing diverse perspectives; (3) multiple reviewers were engaged at different stages of the review to minimise bias; and (4) frequent meetings were held to discuss challenges, align strategies and ensure consistency throughout the process.
Patient and public involvement
Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this review.
Results
Database searches yielded a total of 16 097 studies. After removing duplicates and screening titles and abstracts, 244 studies remained for full-text reviews. Of these, 15 studies met the inclusion criteria. Additionally, the snowball searching process (backward and forward citation tracking) identified two more studies, bringing the total number of included studies to 17. The study selection process is illustrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. 37 For further details, refer to figure 1.
Flow chart of the search strategy and results.
Characteristics of the studies
All included studies were published between 2004 and 2022 (see table 1). Approximately 35% of the studies were conducted in Europe.7 38–42 Nearly half (47%) of the studies were conducted in the Americas, specifically in the USA,43–46 Canada23 47 and South America.48 49 The remaining studies were carried out in Oceania50 51 and in the Middle East.52
Most of the included studies explored the experiences, feelings and perceptions of members of multidisciplinary teams working in AC settings. Approximately one-third of the studies specifically focused on identifying barriers and facilitators of effective teamwork. All studies employed a qualitative research design, with the exception of three mixed-method studies.38 47 48 Among the qualitative studies, eight studies used a descriptive qualitative method,23 40 44–49 two adopted a phenomenological methodology43 50 and two employed an ethnographic approach.41 42 The remaining five studies did not specify their qualitative methodology. However, this lack of detail was not considered a source of bias, as the studies still provided valuable insights relevant to the research phenomenon and were therefore included. Regarding data collection methods, the majority of studies relied on a single method, with 47% using semistructured interviews as the primary tool38–40 47–49 51 and 11% employing focus groups.45 50 The remaining studies used a combination of two different data collection methods, enriching the depth of the qualitative data.
The participants across the included studies consisted of nurses (n=354), doctors (n=140), rehabilitation technicians (n=58) and other HCPs (n=30). All studies were multiprofessional, with the exception of three studies that focused on a single professional group.38 45 50 The work experience of the professionals ranged from a minimum of 2 months44 to a maximum of 38 years.43 47 Four studies did not report the participants’ years of work experience. In studies where the average years of work experience were provided,23 44–47 49 52 the average was generally less than 11 years, except for two studies reporting averages of 15 years40 and 16 years.50 Most studies described the experiences of professionals from a minimum of two46 52 to a maximum of six different healthcare roles working within AC settings.39 The most frequently reported AC settings included general (n=2) and neonatal (n=3) intensive or subintensive care units, polytrauma units (n=4), stroke units (n=3) and cardiac care units (n=2). Some AC settings were located within specialised facilities classified as level 2,23 level 347 51 and level 4 centres,44 while others were based in general teaching hospitals.40 43 45 The patient populations treated in these settings varied widely, encompassing individuals from neonatal to geriatric age groups.
For additional details not included in table 1, refer to online supplemental appendix S3.
Supplemental material
Quality appraisal of the included studies
The methodological quality of the included studies was generally high, as detailed in table 2. However, only four studies achieved the highest quality scores, reflecting strong methodological rigour.41 42 47 49 The analysis revealed that most studies demonstrated adequate goal setting, employed appropriate data collection methods, maintained rigour in data analysis and presented their results clearly (table 2). Nonetheless, the research design was found to be insufficiently detailed in seven studies,23 38 43 46 50–52 which limited the transparency and replicability of their methodologies. Additionally, studies published before 2010 often provided limited attention to ethical considerations by either omitting ethical discussions or addressing them superficially.39 43 45 46 51 Furthermore, several studies failed to adequately acknowledge or address potential biases arising from the researcher–participant relationship,7 39 44 46 50 52 which could influence data interpretation. These issues are discussed in detail in table 2.
Quality assessment of the included studies using the Critical Appraisal Skills Programme (CASP)
The data abstraction and synthesis process identified four distinct main themes, each representing a conceptual area that encapsulates the barriers and facilitators of multidisciplinary teamwork in AC settings. The main themes are (1) organisational variables, (2) individual variables, (3) collaborative variables and (4) role variables. These themes are graphically depicted in figure 2. Each main theme was further divided into subthemes, grouping variables that operate within the same action domain influencing the functioning of the multidisciplinary teams. Within each subtheme, the variables were categorised based on their potential to act as barriers, facilitators or neutral variables (with a dual connotation, functioning as either barriers or facilitators depending on the specific context analysed). The highest intrastudy intensity was observed in the studies by Khademian et al 52 and Lapierre et al,23 both reporting 100% intensity. Notably, both studies were conducted in trauma centres, where multidisciplinary collaboration is often critical. In contrast, the lowest intrastudy intensity was reported by Simmon and Sherwood45 and Atwal and Caldwell,38 with an intensity of 50%. These studies focused on the perceptions of a single professional group, which may have limited the breadth of perspectives on multidisciplinary teamwork.
Tree diagram of the results. Red cells indicate the barriers, green cells indicate the facilitators and yellow cells indicate variables that are both facilitators and barriers.
Organisational variables
The organisational variables identified in the synthesis were categorised into two subthemes: (1) ward organisational variables and (2) hospital organisational variables. The ward organisational variables refer to elements related to the day-to-day management of multidisciplinary teams within AC settings. These include factors such as workflow processes, communication practices, staffing levels, resource allocation and coordination of daily activities that directly influence team dynamics and patient care. In contrast, the hospital organisational variables pertain to broader clinical governance decisions that shape the operational framework within which multidisciplinary teams function. This includes institutional policies, leadership styles, strategic planning, administrative support and the overall healthcare system structure that can either facilitate or hinder effective teamwork.
Ward organisational variables
This subtheme encompasses four neutral variables: (1) operational work planning, (2) existence of procedures and protocols, (3) holistic care environment and (4) presence of a multidisciplinary team routine. This subtheme demonstrated an interstudy frequency of 65% (table 3).
Intrastudy intensity and frequency of subthemes
Operational work planning meant effective integration of activities and the sharing of common strategies, such as conducting a presurgical briefing, facilitated teamwork and improved care coordination.23 47 52 Conversely, disorganised activities46 and unclear task arrangements50 acted as barriers, leading to fragmented workflows and communication breakdowns within the team. The existence of clear procedures and protocols facilitated the internalisation of appropriate care behaviours,49 which is particularly critical in AC settings, where rapid decision-making is essential.23 40 46 Standardised protocols help streamline processes, reduce ambiguity and promote consistency in patient care.
A holistic care environment acted as a facilitator when HCPs in the multidisciplinary team were motivated to enhance the quality of patient care46 and improve the effectiveness of treatment outcomes.48 52 This approach fosters a patient-centred culture that values comprehensive care beyond isolated clinical interventions. A predefined, consolidated, stable and shared multidisciplinary team routine facilitated the management of at-risk interventions by promoting coordinated actions and clear role delineation.40 42 49 However, when such routines became overly rigid, they led to work fragmentation between different professional groups, making care practices mechanical and superficial, thus acting as a barrier to effective teamwork.42 49
Hospital organisational variables
This subtheme consists of four variables, with the first two identified as neutral variables and the other two as barriers: (1) workload, (2) resources (principals and devices), (3) system rigidity and (4) staff turnover. This subtheme had an interstudy frequency of 71% (table 3).
A high workload is often attributed to patient overflow to AC services,49 52 compelling HCPs to prioritise certain tasks while potentially neglecting others.42 High workloads are frequently associated with chronic understaffing or unplanned staff absences, which strain team dynamics and reduce the quality of care.7 23 48 52 Conversely, a manageable workload allows sufficient time for completing tasks, thus facilitating collaboration and improving team efficiency. The availability of essential clinical resources, such as medical devices, equipment and adequate spaces, acts as a facilitator of effective multidisciplinary teamwork in AC settings.23 52 However, the lack of necessary apparatus and inadequate workspaces can create barriers, often triggering conflicts within the team due to resource scarcity and operational inefficiencies.47
Excessive organisational system rigidity, characterised by inflexible procedures and strict hierarchical structures, was identified as a barrier to multidisciplinary teamwork.7 23 42 46 Such rigidity limits the autonomy of HCPs, discourages open communication and hinders adaptive, patient-centred care practices essential in dynamic AC environments. High staff turnover negatively impacts multidisciplinary teamwork by disrupting team cohesion, impeding the development of professional skills and creating instability in work relationships.43 It can lead to feelings of inadequacy among new recruits and strain existing team dynamics, resulting in a loss of institutional knowledge and reduced overall performance.42 45 52
Individual variables
The individual variables identified in the synthesis were categorised into three subthemes: (1) individual personality variables, (2) individual variables of motivation and (3) individual know-how variables. The first were linked to personal characteristics of the team members, such as traits related to communication style, adaptability, emotional intelligence and interpersonal skills. These characteristics can influence how effectively team members interact, collaborate and respond to the challenges of working in AC settings. Individual motivation variables represent motivational factors that drive each HCP to work towards shared goals within the multidisciplinary team. These variables include intrinsic motivations such as professional commitment, sense of responsibility and desire to improve patient outcomes, as well as extrinsic motivators such as recognition, career advancement opportunities and organisational support. Individual know-how variables refer to the technical competencies and clinical expertise that HCPs must possess to perform effectively in AC settings. These include both specialised medical knowledge and practical skills necessary for managing complex clinical situations, ensuring patient safety and contributing to effective decision-making within the team.
Individual personality variables
This subtheme includes five variables, categorised as facilitators, neutral variables and a barrier: (1) listening skills (facilitator), (2) respect (facilitator), (3) attitude (neutral variable), (4) empathy (neutral variable) and (5) egoism (barrier). The interstudy frequency effect size for personality variables was 76% (table 3).
Effective listening skills are essential to fostering reciprocal communication, allowing team members to exchange feedback constructively.51 This two-way dynamic promotes better understanding, reduces misunderstandings and strengthens team collaboration. Respect within the team is demonstrated through simple gestures such as greeting colleagues and expressing appreciation for their contributions.42–44 This fosters a positive work environment, enhances mutual trust and encourages open communication. Attitude serves as a neutral variable, functioning as either a facilitator or a barrier depending on the context. A proactive attitude enhances teamwork by promoting engagement and responsibility.43 52 However, it can be influenced by the emotional state and stress levels of HCPs, potentially hindering performance under adverse conditions.23 Empathy facilitates positive relationships among HCPs, fostering emotional connections and understanding within the team.42 Conversely, the absence of empathy can hinder teamwork, leading to detachment and poor interpersonal dynamics.50 52 Egoism is a clear barrier to effective multidisciplinary teamwork, as it occurs when HCPs prioritise personal interests over the common goals of the team.45 50
Individual variables of motivation
This subtheme includes two variables, both identified as facilitators for multidisciplinary teamwork: (1) external motivators and (b) internal motivators. The interstudy frequency effect size for motivation variables was 35% (table 3).
External motivators include factors such as recognition, professional development opportunities, financial incentives and organisational support. These elements can enhance job satisfaction and encourage active participation in multidisciplinary teams.23 52
Internal motivators are intrinsic factors that drive HCPs to contribute effectively, such as a sense of professional duty, personal growth, commitment to patient care and a desire to achieve common goals within the team.52 These motivators promote self-driven engagement and resilience, especially in high-pressure AC environments.47 50
Individual know-how variables
This subtheme consists of a single neutral variable: competence skill. The interstudy frequency effect size for this variable was 82% (table 3).
Competence skill refers to the technical knowledge and clinical expertise that HCPs possess, which are essential for effective performance within multidisciplinary teams. When team members are competent and confident in their skills, the multidisciplinary team tends to be more relaxed, fostering a sense of security and readiness to manage emergencies efficiently.51 Conversely, a lack of competence can lead to anxiety, frustration and reduced team effectiveness, potentially compromising patient care.
Collaborative variables
The collaborative variables identified in the synthesis were categorised into three subthemes: (1) working environment, (2) sharing and (3) communication.
Collaborative variables related to the working environment
This subtheme includes four variables, classified as facilitators and neutral variables: (1) implicit team rules (facilitators), (2) value of teamwork (facilitators), (3) synergy (neutral variable) and (4) team climate (neutral variable). The interstudy frequency effect size for this subtheme was 82% (table 3).
Implicit team rule refers to a set of self-determined, informal guidelines developed within the team to promote cohesion of intentions and activities.39 These rules facilitate the fluidity of care delivery, ensuring that team members align their efforts seamlessly in dynamic AC environments.43 49 The recognition of the value of teamwork strengthens the sense of belonging among HCPs, fostering mutual respect and preventing conflicts within the team.23 This shared appreciation enhances collaboration, accountability and team resilience. Synergy acts as a neutral variable, with its impact depending on the team’s dynamics. When present, it promotes a willingness to collaborate, where team members function like pieces of a puzzle, each essential to achieving the ‘complete picture’.39 Conversely, the absence of synergy can create an ‘invisible wall’ between HCPs,41 leading to fragmented care, with individuals focusing solely on their own tasks rather than on shared goals.51 Team climate influences the overall work environment. A positive climate, characterised by a relaxed and pleasant atmosphere, facilitates effective teamwork, improving morale and communication.39 40 However, a negative climate, often driven by factors such as high staff turnover or excessive workload, creates a stressful environment that hinders collaboration and reduces team efficiency.52
Collaborative variables related to sharing
This subtheme includes five variables, classified as neutral variables and barriers: (1) sharing (neutral variable), (2) time for the team (neutral variable), (3) trust (neutral variable), (4) corporatism (barrier) and (5) preconceptions (barrier). The interstudy frequency effect size for this subtheme was 82% (table 3).
Sharing of objectives, experiences and knowledge facilitates effective teamwork in AC settings.40 47 It fosters a sense of unity, as if the team functions as a ‘single, collective mind’,46 creating a ‘smooth flow’ akin to a machine with well-lubricated gears.43 In contrast, the absence of sharing leads to feelings of inadequacy among HCPs who feel excluded from decision-making processes, thereby diminishing team cohesion and performance.41 46 Allocating dedicated time for the team is crucial to fostering collaboration, as it allows HCPs to anticipate colleagues’ needs and coordinate more effectively.43 49 When HCPs lack time to engage with their team, it results in fragmented communication and prevents the team from functioning cohesively.39
Trust is fundamental for building strong interpersonal relationships within multidisciplinary teams, fostering open communication and effective delegation of responsibilities.43 Conversely, the lack of trust hinders teamwork, as it creates doubts about colleagues’ competence, leading to a reluctance to delegate tasks and causing team members to feel undervalued.41 Corporatism acts as a barrier when HCPs from the same professional category tend to form exclusive groups, thereby excluding colleagues from other specialties.51 This behaviour fosters ‘siloed’ thinking, limits interdisciplinary collaboration and undermines the principles of integrated patient care. Preconceptions manifest as assumptions, role stereotypes and biases based on personal sympathies or ‘second-hand’ information.51 These preconceived notions, often shaped by generalisations or informal judgments (eg, based on ‘what everyone says’), obscure the true competencies of colleagues, limiting opportunities for effective collaboration and mutual respect.46
Collaborative variables related to communication
This subtheme includes three neutral variables: (1) work conflicts, (2) communication tools and styles and (3) freedom of expression. The interstudy frequency effect size for this subtheme was 100% (table 3), highlighting its central role in multidisciplinary teamwork within AC settings.
Work conflicts can facilitate multidisciplinary teamwork when they are successfully identified and resolved, fostering opportunities for growth, improved communication and strengthened collaboration.45 Constructive conflict resolution encourages dialogue, problem-solving and innovation. However, when conflicts remain unresolved, they hinder communication, disrupt team dynamics and foster feelings of hostility and mistrust, ultimately compromising patient care. The use of effective communication tools and styles acts as a facilitator when interactions are clear, timely and purposeful, ensuring that critical information is accurately shared across the multidisciplinary team.46 Effective communication minimises misunderstandings, enhances coordination and supports quick decision-making, which is essential in fast-paced AC environments. Conversely, ineffective communication methods can lead to delays, errors and fragmented care. Freedom of expression within the team enables HCPs to openly share their needs, concerns and divergent points of view without fear of being misunderstood or judged.39 40 This openness fosters psychological safety, promotes active participation and enhances team learning. In contrast, the absence of freedom of expression leads to an environment where opinions are imposed,38 and team members experience fear of asking questions and are reluctant to initiate meaningful dialogue, thereby limiting opportunities for collaborative problem-solving.51
Role variables
The role variables identified in the synthesis were categorised into two subthemes: (1) role assigned, by colleagues, formally and informally; and (2) professional role, related to the profession of the different HCPs within the multidisciplinary team.
Role variables related to the role assigned
This subtheme contains two neutral variables: (1) informal leadership and (2) formal leadership. The interstudy frequency effect size for this subtheme was 53% (table 3).
Informal leadership acted as a facilitator when individuals naturally emerge as leaders in emergency or extraordinary situations, effectively guiding the team through high-stress conditions based on their competence and decision-making skills.51 However, it can become a liability when leadership roles are assumed based solely on professional seniority7 rather than their technical skills or expertise.41 This can lead to ineffective decision-making and undermine team performance. Formal leadership facilitates multidisciplinary teamwork when the leader is recognised and respected, providing clear direction and ensuring that roles and responsibilities are well defined.52 Conversely, it can be an obstacle when the designated leader lacks experience or competence,41 leading to poor guidance, reduced team cohesion and ineffective coordination.
Role variables related to the professional role
This subtheme includes three variables, classified respectively as a facilitator, a neutral variable and a barrier: (1) role clarity, (2) role interrelationship and (3) role intrusion. The interstudy frequency effect size for this subtheme was 88% (table 3).
Role clarity facilitates multidisciplinary teamwork by promoting mutual respect among colleagues through clearly defined roles,44 47 skills and responsibilities. When team members understand their specific functions, it reduces role ambiguity, minimises conflict and enhances collaborative efficiency.44 47 The role interrelationship serves as a neutral variable, fostering effective teamwork when based on mutual trust among HCPs.43 In environments where informal hierarchies are minimised and flexible work dynamics are encouraged, multidisciplinary teams can function cohesively with greater adaptability.51 However, without clear boundaries, role overlaps may occur, potentially leading to confusion. Role intrusion represents a barrier to effective teamwork and occurs when HCPs overstep the boundaries of their specific professional competencies, encroaching on the responsibilities of others.52 This often results in breakdown in communication,38 tension among team members and diminished trust, ultimately compromising patient care.
Discussion
This systematic review synthesised the variables that act as barriers and facilitators of multidisciplinary teamwork in AC settings. A total of 8 barriers, 7 facilitators and 24 neutral variables were synthesised. These variables were systematically classified and grouped into themes and subthemes to clarify their nature and influence on team dynamics. The facilitators of multidisciplinary teamwork were primarily linked to individual characteristics, such as respect among team members, presence of internal/external motivators and a strong collaborative background, fostering effective interpersonal relationships and shared goals. In contrast, the barriers were mostly associated with organisational factors, including extreme system rigidity, high staff turnover and the absence of sharing, leading to disrupting team cohesion and continuity of care. Finally, the neutral variables were predominantly related to both individual and organisational characteristics. They encompassed factors connected to the roles of HCPs and the dynamics of collaboration within multidisciplinary teams. Depending on the context, these neutral variables could function as either facilitators or barriers, influencing the effectiveness of teamwork in diverse ways.
Implications for the practice
To synthesise the barriers and facilitators of multidisciplinary teamwork in AC settings, each variable connected to both the collective dynamics of teamwork and the individual characteristics of team members was systematically categorised.14 15 18 Some variables emerged more frequently than others during the synthesis, as shown in table 3. When these variables are modifiable, it becomes imperative to address them to enhance the effectiveness of multidisciplinary teams. Organisational culture plays a crucial role in this context. Behruzi et al 53 emphasised that the loss of a strong organisational culture negatively impacts the performance of multidisciplinary teams, particularly in terms of care quality. This finding is supported by Weaver et al,54 who highlighted that attitudes towards organisational norms, policies and procedures significantly influence patient safety in AC settings.
One of the most prominent barriers identified is the excessive turnover of HCPs. High turnover rates create workplace instability, leading to increased stress for existing team members, who must continuously supervise and mentor new colleagues.45 The need for ongoing training disrupts team cohesion and reduces efficiency. Furthermore, literature consistently describes high turnover as a hostile factor to the effectiveness of multidisciplinary teamwork. It introduces challenges such as increased workload complications, heightened organisational uncertainty, ambiguity in roles and responsibilities, increased risk of errors and workplace competition.55 To mitigate these barriers, healthcare authorities should invest in resources aimed at fostering a stable and continuous working environment. Creating conditions where HCPs can build long-term professional relationships promotes familiarity, enhances collaboration and ultimately improves the quality of patient care.56 A supportive work culture that values team stability is essential to optimising multidisciplinary team performance in AC settings.
Similarly, a high workload has been identified as a significant barrier, hindering the ability of multidisciplinary team members to work effectively in synergy.7 42 48 50 52 Excessive workload leads to fragmented communication, reduced collaboration and compromised patient care. To address this challenge, Gill et al 57 proposed the implementation of fast-track organisational models as a potential solution. These models are designed to predict recovery times, enable a more homogeneous distribution of workload across the team and reduce bottlenecks in AC settings, enhancing overall efficiency.
Within the realm of collaborative variables, the concept of sharing emerged as a key factor, encompassing both shared experiences and shared objectives. Shared experiences allow team members to navigate daily professional situations together, fostering stronger interpersonal relationships and enhancing trust within the team. Importantly, shared experiences do not have to be limited to real-life clinical situations—they can also be simulated to strengthen team dynamics. This is particularly relevant in the context of trauma care, where the creation and maintenance of effective trauma teams require specific training strategies targeting teamwork and interaction, as well as simulations of critical situations to improve coordination and response under pressure.58
The implementation of shared objectives can be facilitated through the introduction of organisational tools, such as multiprofessional audits. Sykes et al 59 highlighted the value of these audits, which can be conducted before an intervention, to clarify roles, objectives and planning (briefing); or after an intervention, to evaluate performance, discuss outcomes and identify areas for improvement (debriefing).60 The audits serve as critical reflection points where the team can assess the situation, identify challenges and critical issues, propose solutions and implement strategies. According to Sykes et al,59 audits are essential to ensuring the quality of healthcare services, promoting continuous learning and reinforcing team cohesion. However, the effectiveness of audits is influenced by several factors, including the presence of a supervisor to guide the discussion, the documentation of findings through structured reports and the team’s perception of the audit’s credibility and relevance. Crucially, audits must be conducted in a supportive environment. Sykes et al 59 emphasised that audits involving ‘punitive feedback’ should be strictly avoided, as they can create a culture of fear, undermine trust and discourage open communication. Instead, audits should focus on constructive feedback, fostering a learning culture that values continuous improvement over blame.
Incorporating shared educational moments represents a strategic approach to support and enhance collaboration within multidisciplinary teams. Eddy et al 61 emphasised that all team members should be encouraged by their organisations to participate in teamwork educational programmes, as these initiatives foster a positive learning culture and strengthen interprofessional relationships.
In addition to collective educational efforts, the technical skills of HCPs play a pivotal role in determining the efficacy of the multidisciplinary team.43 Teams composed of professionals with strong technical competencies are better prepared to manage emergencies with confidence, minimising anxiety and frustration during high-stress situations.51 Many health structures actively invest in the continuous professional development of their staff, recognising that ongoing training is essential to maintain high levels of clinical competence, ensure up-to-date knowledge of medical advancements and support the efficient functioning of the healthcare system.62 63 However, technical proficiency alone is not sufficient. Good technical skills must be complemented by high-quality communication and strong non-technical skills (eg, leadership, decision-making, situational awareness). These non-technical skills are increasingly recognised as critical components of multidisciplinary teamwork, with evidence showing their strong correlation with improved patient outcomes.64
Eliminating corporatism and reducing professional individualism are crucial steps towards fostering a cohesive and efficient multidisciplinary team. Buscemi et al 65 emphasised that the modern healthcare environment demands effective multiprofessional collaboration to improve the quality of patient care. This collaboration becomes more effective when HCPs are able to respect and evaluate each other’s perspectives and communicate effectively, sharing a common professional language. To achieve this, interprofessional education should be integrated into both academic curricula and professional development programmes. Practical interventions to promote a collaborative climate include multidisciplinary courses in university programmes, workshops focused on communication tools and regular multiprofessional meetings to encourage interprofessional dialogue and mutual understanding.66
The significance of formal leadership emerges clearly, particularly in situations where multidisciplinary teams need a central figure of reference to guide and coordinate their efforts. Effective formal leadership is characterised by a clearly defined role, formally recognised both by the organisation and the team, and the ability to inspire confidence and serve as a guide for the team members.67 A formal leader should exhibit active listening skills to understand and address the needs of team members, maintain a system-wide perspective, considering both the immediate and long-term sustainability of team dynamics, and demonstrate commitment to continuous improvement in both team performance and healthcare delivery.23 50 52 Labrague et al 67 supported this view, highlighting that authentic leadership is key to creating a healthy work environment and promoting self-efficacy among team leaders. Authentic leaders build trust, encourage open communication and foster professional growth within their teams. Furthermore, Specchia et al 68 emphasised that formal leaders have the responsibility to promote technical and professional competencies among HCPs and actively work to enhance job satisfaction, recognising that motivated, satisfied professionals contribute to better patient outcomes and stronger team cohesion.
Strengths and limitations
The strengths of this research are primarily linked to the quality of the included studies and the methodological rigour applied throughout the synthesis process. All included studies demonstrated high methodological quality, as assessed using the Critical Appraisal Skills Programme. Moreover, the systematic nature of the entire study selection process, ranging from the comprehensive screening of records to the rigorous data analysis, enhances the credibility of the review. The meta-synthesis was conducted following the Thomas and Harden method,35 which is recognised for its robust approach to qualitative data synthesis. This methodological rigour contributes significantly to the validity and consistency of the results. Finally, the application of appropriately selective inclusion criteria ensured that only relevant, high-quality studies were included. This strategic selection process allowed for the synthesis of studies with optimal results, directly addressing the research question and enhancing the relevance and applicability of the review’s conclusions.
Despite its strengths, this study has several limitations that should be acknowledged. First, in some of the included studies, the sample size was limited or disproportionate in terms of representing the various healthcare professions. Nurses were often the predominant group, with other HCPs under-represented. This imbalance may affect the generalisability of the findings across all professional categories involved in multidisciplinary teams. Second, there were instances where the methodological details provided in the studies were unclear. While some studies were broadly classified as employing a ‘qualitative’ approach, they lacked specific information regarding the qualitative methodology used, such as whether it followed phenomenological, ethnographic or grounded theory principles. This lack of detail may have influenced the depth of analysis in the synthesis. Additionally, this meta-synthesis only included studies published in English, which introduces language bias. It is possible that relevant studies published in other languages were not captured, potentially limiting the comprehensiveness of the review.
Furthermore, due to the challenges in creating an exhaustive search string that could encompass all potential HCPs involved in typical AC settings, some relevant studies may have been inadvertently missed during the search process. This limitation reflects the complexity and variability of multidisciplinary team compositions across different healthcare systems. Finally, the date of the last database search was 25 May 2024. Therefore, any studies published after this date were not included in the analysis, which may affect the timeliness of the findings, particularly in a rapidly evolving field like AC teamwork.
Implication for future research
Future studies should focus on evaluating the effects of the strategies described in this review to further enhance multidisciplinary teamwork in AC settings. Keller et al 69 have recently explored the application of behavioural science to AC teams, identifying key research priorities to guide future investigations. These priorities are structured around six critical topics: (1) interventions to improve team processes, (2) dealing with and implementing new technologies, (3) understanding and measuring team processes, (4) organisational aspects impacting teamwork, (5) training and health professions education and (6) organisational and patient safety culture in healthcare.
Data availability statement
No data are available.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
References
Footnotes
LP and CR are joint first authors.
X @MassimoGuasconi
LP and CR contributed equally.
Contributors GAn conceived the study and designed the protocol. LP, ES, GB, CR and FM performed the literature search. LP, ES, GB, CR, FM and GAn selected the studies and extracted the relevant information. LP, ES, GB, CR, FM and GAn synthesised the data and wrote the first draft of the paper. MG, AB, GAr, LP, ES, CR and GB critically revised the successive drafts of the paper. LP is the guarantor of the review. All authors approved the final version to be submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.