Power imbalances and hierarchy prevent doctors from working effectively in teams, research shows

Doctors under pressure are being prevented from working effectively in teams by power imbalances and negative hierarchies, a new study has found.

Continuity, good communication and effective leadership all lead to greater team efficiency and were found to make it much easier to resolve issues, ultimately having a positive impact on patient outcomes.

The research, carried out by Hull York Medical School colleagues at the University of York, explored how doctors and other health care professionals work together and across teams, what factors contribute to effective team working and the elements that make it more challenging.

Perceived power imbalances and hierarchies, when structures are multi-layered, steep and leaders are seen as being out of reach, were identified as major barriers, often leading to “intimidating, or often toxic or bullying cultures.” The research found this led to team members feeling unable to speak up, resulting in more errors and poor patient care.

High demands

Researchers found breakdowns in communication between specialties, which they said “clearly hindered effective teamworking.” High demands on services also played a significant role, with researchers describing the pressure to move patients through systems quickly, leading to stress, burnout and emotional exhaustion.

Dr. Paul Crampton, Director of the Health Professions Education Unit at Hull York Medical School who co-led the research, said, “The research provided a real opportunity to gain insight into the experiences of health care professionals in a range of roles across the UK and the critical importance of effective teamwork. We hope that this research will help to inform policy and practice across the UK—improving patient experience and outcomes.”

Extraordinary pressure

Charlie Massey, Chief Executive of the GMC, added, “We know health care teams across the UK are working under extraordinary pressures and facing evermore complex challenges. That can inevitably create friction and impact on effective teamworking. That’s why it’s vital every team member, regardless of experience, feels empowered to speak up. That doesn’t necessarily lie with individuals working within a team. It is a much bigger, cultural picture that all of us in the UK health systems must work harder to nurture and prioritize.”

Researchers spoke to doctors, health care professionals and teamwork experts across the UK to understand their experiences of working in health care systems. They looked at the type of teams doctors work in and how these can vary by career stage.

They also explored factors by organization, individual, team makeup and workplace environment. These were separated into “enablers”‘ and “barriers” for teamworking.

Enablers included:

• Ensuring time and structures are in place to allow teams to meet regularly
• A positive and supportive culture
• Effective communication
• Leaders who are understanding and approachable
• Clearly defined roles and respect for all team members
• Continuity and experience of those in newer roles.

Barriers included:

• Power imbalances and negative hierarchy
• High service demand and work pressures
• A lack of stability through transitory and rotational roles
• Poor leadership
• Poor communication
• Lack of identification of roles and needs of the whole team, including Equality, Diversity and Inclusion (ED&I) issues.

The research suggested that employers should focus on nurturing supportive work environments, prioritizing the “enablers,” as well as strengthening staff development opportunities and following best organizational practices to encourage teamwork.

Open communication

The study also said teamwork should be focused on more during medical undergraduate training.

Mr. Massey added, “We know open communication leads to better care, that’s why teamwork is so vital. Encouraging these environments where teamwork can flourish can only lead to better outcomes for patients. This research provides invaluable insights into how we can. All of us in the UK’s health care systems should take note of these findings and be prepared to act on them.”