Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

Aim   Interdisciplinary team working is of paramount importance for the reform of primary care in order to provide cost effective and comprehensive care for patients and professional satisfaction for service providers.... [ view full abstract ]

Aim  

Interdisciplinary team working is of paramount importance for the reform of primary care in order to provide cost effective and comprehensive care for patients and professional satisfaction for service providers. Little is known about the factors that promote and inhibit teamworking in practice. It is imperative to address this gap in knowledge in order to understand how these act as levers and barriers to its normalisation.  This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1) barriers and facilitators to implementation of interdisciplinary teams in primary care and 2) the main research gaps. 

Review Methods

An integrative review following PRISMA guidelines was conducted.  Searches of ten international databases were conducted. Empirical papers (n=49), that provided data about at least two members of an interdisciplinary formal statutory team for the general population in primary care, were included for final analysis.  Data were analysed following the principles of deductive Framework Analysis using Normalisation Process Theory (NPT).  NPT describes four constructs known to impact on implementation processes: sense making, enrolment, enactment, and appraisal. 

Findings and Conclusion

The literature is dominated by a focus on interdisciplinary working between physicians and nurses. Physicians play a key role in encouraging the enrolment of others in team working and in enabling effective divisions of labour.  The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. This review has (1) identified gaps in knowledge relating to sense-making, enactment and appraisal work among professionals and (2) highlighted that the vision for interdisciplinary team working needs to be backed by a funding model that enables team working and (3) there is much to be done to improve primary care professionals’ knowledge of and trust in each other’s work.