Journal of Clinical Nursing 2001; 10: 419428

Review
Interdisciplinary practice a matter of teamwork: an integrated
literature review
ANTOINETTE M C CALLIN B A , M A , P h D , R G O N
Senior Lecturer, School of Health Sciences, College of Humanities and Social Sciences,
Massey University, Auckland, New Zealand
Accepted for publication 26 October 2000

Summary
The aim of this literature review is to explore the development of
interdisciplinary practice.
The terms interdisciplinary, multidisciplinary, and inter-professional are
problematic. Denitions must be viewed carefully, as interpretations tend to
reect historical socialization patterns that are now out of kilter with
contemporary understandings.

Changing inter-professional interactions, teams and teamwork are examined;

ndings indicate that explanations of interdisciplinary teamwork should be allinclusive of the particular cultural conditions and contextual determinants that
affect team practice.

Findings need to be viewed with caution because what is applicable in one

country may not be automatically transferable to another, where particular sociopolitical contexts shape interdisciplinary practice.

Keywords: interdisciplinary teams, inter-professional interactions, multidisciplinary collaboration, teams, teamwork.

Introduction
Interdisciplinary practice refers to people with distinct
disciplinary training working together for a common
purpose, as they make different, complementary contributions to patient-focused care (Leathard, 1994). Interdisciplinary teams may be a means to reduce costs
associated with major social reforms in post-industrial
society (Bell, 1973; Drucker, 1994). Health reforms have
affected many health professionals, who question how the
Correspondence to: Antoinette McCallin, 28 Mappin Place, Chatswood,
Auckland, New Zealand (e-mail: mccallin@ihug.co.nz).
2001 Blackwell Science Ltd

traditional, altruistic values of equity, equality of access,

and free delivery of care can be integrated into an
organizational service culture that emphasizes scal management in a free competitive market (Wells, 1995).
Subsequent tensions between consumers, managers and
professionals affect inter-professional collaboration, which
refers to the way in which people work with each other
(Cole & Perides, 1995; Shipley, 1995; Sullivan, 1998).
Collaboration was expected to promote coordination,
cooperation and sharing (Baggs & Schmitt, 1988). Collaboration between health professionals is increasingly
popular in organizations that are managed under the
corporate governance model (Perkins et al., 2000) that
419

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A. McCallin

demands clinical accountability (Degeling et al., 1999) and

integrated care (Davies, 1999). While some health service
providers have embraced the team-based organization in
efforts to create new modes of service delivery for the
modern-day context (Manion et al., 1996), there is little
empirical evidence to suggest that interdisciplinary teams
improve patient outcomes (Zwarenstein & Reeves, 2000).
In this paper, literature from health, sociology, and
organizational management is reviewed. The paper opens
with a brief outline of issues that have inuenced
interdisciplinary practice. Next, basic terminology is
dened, changing inter-professional interactions are discussed, and the differences between teams and teamwork
are examined in depth.
Literature was gathered from Medline, Psyclit, and
Socioabs. Keywords included inter-professional practice,
inter-professional collaboration, collaboration, interdisciplinary practice, multidisciplinary practice, multidisciplinary teams, trans-professional practice, self-managed
groups, teams, teamwork, inter-professional relations, and
professional practice.

The initial search

Medicine and nursing are the mainstays of most special
service teams and the two professions have worked
together, surviving times of harmony and heresy across
the centuries (Colliere, 1986; Ehrenreich & English, 1973;
Gamarnikow, 1978; Davies, 1995). Evidence of mutually
supportive relationships is scarce, while antagonism about
medical monopoly and medical control is well-documented (Atkinson, 1983; Freidson, 1986; Abbott, 1988).
Physicians have seemingly enjoyed a high prole in a
society that supposedly refuses to value caring (Reverby,
1987). This state of affairs may be changing.
Today, medicine, nursing, and allied health professionals
are required to provide integrated care in an inter-professional context that supports specialization, rationalization,
maximization, and avoids duplication (Leathard, 1994).
Inter-professional work may well be a new fashion, indeed a
new model of care. Rhetoric on the topic is extensive
(Bishop & Scudder, 1985; Ovretveit, 1993; Casto & Julia,
1994; Gabe et al., 1994; Leathard, 1994; Petersen, 1994;
Soothill et al., 1995). More evidence is needed to evaluate
whether inter-professional work affects patient outcomes.
Study of the term `inter-professional' led to a review of
the literature on the professions. The medical sociology
literature was scanned to clarify the socio-historical factors
that had inuenced professional practice (Ehrenreich &
English, 1973; Ehrenreich, 1978; Dingwell & Lewis, 1983;
Freidson, 1986, 1988, 1994; Turner, 1987; Abbott, 1988).

Issues of power, knowledge, control, gender and status

relationships dominated all accounts (Etzioni, 1969;
Ashley, 1976; Bishop & Scudder, 1985; Willis, 1989;
Daniel, 1990; Hugman, 1991; Fox, 1992; Witz, 1992).
Tensions between professional practitioners were clear.
Nowadays, the traditional arguments are less plausible, as
the contextual determinants shaping professional understandings 30 and 40 years ago are dubious in a society that
has moved on (Greenwood, 1957; Vollmer & Mills, 1966;
Becker, 1970; Hughes, 1971; Johnson, 1972; Roth, 1974;
Freidson, 1977). Overall, historical denitions overlapped,
and differences were subtle (Millerson, 1964; Horobin,
1983). Conclusions should be reviewed cautiously, as it
cannot be assumed that ndings are automatically transferable into the current context that demands modern
styles of interaction and behaviour.

Some basic terminology

The professional literature on inter-professional practice is
sparse. Leathard (1994) believed that inter-professional
work issues must be documented because the concept is
new. Certainly, prexes such as inter, multi, and trans are
used randomly. The Chambers Dictionary (Schwarz et al.,
1993) parallels multi with many. Multidisciplinary is
identied as `involving a combination of several (academic)
disciplines, methods'. Inter is a prex denoting `between,
among, in the midst of; mutual, reciprocal; together'. The
word interdisciplinary means `involving two or more elds
of study', while trans is explained as `across; beyond;
through'. However, when denitions are transferred into
the health sector, distinctions seem imprecise. If meaning
blurs, do differences matter?
Leathard (1994) grouped problematic terms such as
collaboration, trans-professional, interagency, partnership
and interdisciplinary (to name a few) according to
concepts, generic issues or processes. This was a useful
exercise, although the ne nuances associated with context
and service altered understanding again. Sorrells-Jones
(1997) sought to simplify matters:
Multidisciplinary refers to a team or collaborative
process where members of different disciplines assess
or treat patients independently and then share the
information with each other. Interdisciplinary
describes a deeper level of collaboration in which
processes such as evaluation or development of a plan
of care is done jointly, with professionals of different
disciplines pooling their knowledge in an independent manner.
Multidisciplinary focused on the tasks identied with
an individual's professional work, while the interdisci 2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

Interdisciplinary practice
plinary concept emphasized collective action and processorientation (Sorrells-Jones, 1997). The different focus may
mirror changes in a society that recognizes the importance
of integrating tasks and processes in synergistic human
interactions.
Problematic terminology is well-documented (Engel,
1994; Harbaugh, 1994; Rawson, 1994; Ovretveit, 1996).
Ovretveit (1996) studied inter-professional work, suggesting that it was much broader than teamwork. He classied
teams according to their levels of integration and the
assumption that collective responsibility affected resource
allocation, membership, client pathways and management.
Rawson (1994) struggled with semantics, although he
did not dwell on labels like inter-professional, interdisciplinary, multidisciplinary or trans-professional. Believing
that team practice was simply work, he advised researchers
to clarify what professional practitioners did and why, and
to discover how professional positions and tasks were
integrated in inter-professional work. Rawson's approach
was useful in some ways but less helpful in others, because
it reected major historical issues associated with the poor
concept denition in the professions (Freidson, 1994).
While the arguments were quite reasonable, few researchers or writers have dened concepts in a post-modernist
world, which recognizes multiple meanings. One exception is the concept analysis of collaboration (Henneman
et al., 1995).
Overall I argue that the descriptions in the professional
literature are so diverse that meaning is murky. Nevertheless, this state of affairs is consistent with a postmodern perspective in which there is no one truth (Craib,
1992).

Changing inter-professional interactions

Health service restructuring supports collaborative interaction. Jones et al. (1997a) noted that contemporary
collaboration is very different from the hierarchical
interactions that pervaded hospital bureaucracies in the
past. Historically, inter-professional interactions were
authoritarian and dominated by physicians (Fagin, 1992).
For example, Stein (1967) argued that nurses supported
the medical control of decision making, although they
inuenced decisions surreptitiously, behind the scenes.
Inter-professional interactions gradually altered when
primary nursing and the nursing process were introduced
in the 1980s (Lyon, 1993). Traditional inter-professional
interactions were threatened when nurses openly challenged medical control by articulating nursing decision
making in the nursing process. Primary nursing furthered
professional development (Klein, 1983) and improved the
2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

421

nursing visibility in patient care, but it challenged

established interactions between doctors and nurses.
The introduction of total patient care in the 1990s altered
inter-professional interactions once again, as nancial issues
and evidence-based practice affected service delivery. The
emphasis moved to interdisciplinary teamwork, as health
professionals were forced to recognize the need for different
professional contributions to patient care in the restructured workplace (Stein et al., 1990). Teamwork became the
central focus for specialist service delivery, and hospital
managers promoted collaborative interactions as the key to
efcient, effective care (Minnen et al., 1993). Teamwork
became a strategy for change. Changing structures required
new processes to sustain work redesign, and at this point the
outcomes for patient care were seldom mentioned because
effectiveness was always related to cost savings.
Strangely enough, collaborative interactions are little
researched (Jones, 1997b). Jones used participatory action
research to investigate how health workers in a patientfocused orthopaedic unit in the United States dened
multidisciplinary collaboration. Even though the nonmedical disciplines emphasized role sharing and role
co-ordination, medical people did not share that perception and medical roles remained the same. Over and over
again, roles and communication recur as the most
signicant factors underpinning successful teamwork
(Pike, 1991; Trueman, 1991; Fagin, 1992; Goldman et al.,
1992; Ovretveit, 1993; Birchall, 1997; Jones, 1997b).
Role redenition affects inter-professional interactions.
Jones et al. (1997a) reported decreased multidisciplinary
collaboration when major roles were redened in a patientfocused care unit in a tertiary care centre in the United
States. In this quasi-experimental study, while patient
satisfaction improved and length of stay decreased, collaboration declined, despite a 2-year participatory planning
programme, 12 weeks of competency-based training, and
sessions on communication, assertiveness, delegation, team
building, and change. Decentralizing structures did not
automatically alter traditional inter-professional interactions (Keatinge, 1995). Role socialization in the health
professions is strong, and the call for collaboration relies on
changing attitudes. So while patient-focused care may
increase patient satisfaction (Brett & Tonges, 1990; Ritter
& Tonges, 1991), the simple re-allocation of tasks cannot
mask potential problems of collaboration that are more
complex (Zwarenstein & Reeves, 2000). Collaboration may
not improve patient outcomes (Zimmerman et al., 1993).
Townsend (1993) decided that continuous support from
management was the key to successful inter-professional
interactions. Apparently, constant management input is
important if hierarchical relationships are abandoned

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A. McCallin

(Evans, 1994). In contrast, lack of training and support

fostered failure (Birchall, 1997). Interestingly, negative
staff responses were preventable if volunteers were
psychologically screened for coping skills, problemsolving aptitude, work commitment, and tolerance of
uncertainty (Eubanks, 1992). Unmistakable administrative
commitment was the key to success (Johnston & Cooper,
1997).
As expectations for inter-professional interactions
changed cautiously, staff development and interdisciplinary training classes increased (Curran, 1994; Seago, 1997).
Clark et al. (1994) argued that clinicians who were
engaged in change management from the beginning were
better change agents. The speed of change was signicant.
Brider (1992) observed that, when health professionals
were exposed to extensive change, support declined.
Moving too fast made any alteration of well-entrenched
behaviour unrealistic in the restructuring environment.
Successful change was easier when health professionals
shared a common approach. Planning care together was
not especially new, but questioning the efciency and
effectiveness of interdisciplinary practice was different
(Capuano, 1995). Overall I argue that, if inter-professional
interactions were slow to change, this was not entirely
unreasonable during health reforms. Restructuring tasks
was the rst priority, while the processes of interprofessional interaction were of secondary importance.

Teams and teamwork what is the difference?

When business principles were introduced into the health
services, the team concept was adopted as a strategy to
coordinate services under the new horizontal management
structures (Kerfoot, 1996). Organizational downsizing and
rightsizing undermined most disciplinary power bases
because teams were designed to function across traditional
institutional boundary lines (Bresnen & Fowler, 1996).
The team-based organization was well proven in management circles (Reich, 1987; Lawler, 1992; Recardo et al.,
1996; Bolman & Deal, 1997). In health care, teams were
seen as one way to redesign work and to provide quality
services. Manion et al. (1996) suggested:
The magnitude and complexity of these challenges
are such that no individuals, no leaders, can meet
them successfully without the full involvement and
commitment of their employees. Teams are a way to
tap into the potential of our employees the potential
to contribute in signicant ways, to accept increasingly higher levels of responsibility, and to reap the
benets when employees feel the commitment that
ownership of their work brings.

Teams and teamwork are not new. There is, however,

little research evidence about teamwork in the health
services. Cott (1997) observes that there is much rhetoric
on how to set up teams, while the process of teamwork has
not been studied systematically.
Teamwork is not the same thing as a team. Katzenbach & Smith (1993) see the team as a means rather than
an end, while teamwork is about performance and how to
achieve the primary objective. Manion et al. (1996) argue
that if the concepts of team and teamwork are used
interchangeably, meaning becomes vague. They reiterated that `a team is a specic structural unit in the
organization', and proposed that `teamwork is the way
people work together cooperatively and effectively'. They
suggest:
A team is a small number of consistent people
committed to a relevant shared purpose, with common performance goals, complementary and overlapping skills, and a common approach to their work.
Team members hold themselves mutually accountable for the team's results or outcomes.
Kane (1975) reviewed earlier denitions of teamwork.
Recurrent themes included a common purpose, professional contributions, skills, communication, coordination,
cooperation and joint thinking. She concluded that `a
common objective, different professional contributions,
and a system of communication' were important for interprofessional practice. Her observation that the complicated variables and structures affecting team practice
reected authors' biases still stands 25 years later. Unexamined assumptions mask the multiple complexities which
affect modern-day interdisciplinary practice.
Despite this, the skilfully managed and monitored team
is a powerful change agent (West & Poulton, 1997), even if
teamwork is supposedly at odds with traditional medical
socialization. For example, Berwick (1996) argued that
medical single-mindedness is contrary to the concept of
collectivity which underpins teamwork, although individuality can be integrated into the team approach. The
`bigger picture, and the citizenship skills emphasize
connections and interdependency, and have not been
central to [medical] training or to [the formation of] their
professional identity'.
Few health professionals are taught teamwork skills.
Hilton (1995), in an ethnography with physiotherapists,
concluded that poor understanding of roles, skills and
expectations caused team conict and subsequent failure.
Health professionals need to be taught team skills as
undergraduates if the negative stereotyping associated
with particular occupations is to be avoided (Pietroni,
1991).
2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

Interdisciplinary practice
Sex-role stereotyping also inuences inter-professional
understandings (Pietroni, 1991; Kendrick, 1995; Mackay,
1995). Gender hierarchy is not exclusive to the health
sector, occurring across organizations (Morgan, 1997).
Gender and social class may still reinforce typical male
and female images of men and women in society that
doctors cure, while nurses care; that doctors are dominant,
while nurses are passive (Stein, 1967). Campbell-Heider &
Pollock (1987) contended that, while physicians favoured
authoritarian team interactions, nurses sought mutually
collegial relationships with physicians. Stereotyping can
block understanding, although many professional people
recognize that society has moved beyond gender issues
and the separate, single-issue movements that were
necessary at one time, and has moved on to embrace
new community structures (Friedan, 1997).
Clark (1997) and Hilton et al. (1995) advocated that
stereotyping must be addressed in the early stages of
professional education if inter-professional practice is a
genuine goal. Carpenter (1995) conrmed inter-professional stereotyping among nursing and medical students,
but reported positive benets from shared inter-professional learning. Lary et al. (1997) piloted a problem-based
learning programme with students from dental hygiene,
physical therapy and physician assistant courses. Increased
interaction strengthened collegiality overall. Expanding
higher faculty involvement in patient care and research
was equally effective in improving relationships between
medicine and nursing (Fagin, 1992).
Many writers have concluded that separate disciplinary
education does not foster inter-professional practice
(Stein, 1967; Fagin, 1992; Beattie, 1995; Clark, 1997).
Separatism denies students the opportunity to develop
collaborative relationships essential for cross-fertilization
between disciplines (Larson, 1995).
Gordon et al. (1996) described a multi-site collaborative
interdisciplinary programme for undergraduate health
professionals in the United States and found that positive
collaborative interactions can never be taken for granted.
Participative learning experiences may nurture interprofessional interactions, which also need to be extended
into the clinical setting (Clark, 1997). Students must
practise collaboration with other health professionals
(Hilton et al., 1995).
Poulton & West (1993) argued, however, that there is
little evidence that teams collaborate better as they work
together. In their view, team success depends on crossfunctional management reviewing teamwork. West &
Poulton (1997) found that effective team function declined
when individual team members had separate lines of
management. They compared the performance of 1555
2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

423

respondents from 68 primary health care teams with

multidisciplinary teams from the UK National Health
Service, oil companies, community psychiatric teams and
social service teams. Participation, innovation, task orientation, and clarity and commitment to team objectives
were measured. Primary health care teams scored signicantly lower on all factors because they could not develop
clear, shared objectives. The health and business sectors
appear to socialize trainees quite differently (Mickan &
Rodger, 2000).
The cultural tension between the business culture and
the culture of care inuences collaborative practice
(Chapman et al., 1995). In a study of 21 participants from
different community health services in the UK, cultural
tension was serious but not insurmountable, when dialogue developed in shared learning experiences. Team
learning promoted team effectiveness.
Team effectiveness has been poorly researched. Although West & Wallace (1991) linked team effectiveness to
team innovation, measurable indicators of the concepts
were unclear. Pearson & Spencer (1995) observed that team
effectiveness developed from `agreed goals and aims;
effective communication; patients receiving the best possible care; and individual roles [were] dened and understood'. Process and outcome issues were equally inuential.
The absence of comment about performance or competency, the baseline prerequisite to teamwork, is interesting.
Communication denitely affects teamwork, even
though individuals can sabotage inter-professional interactions if they are protecting personal reputations (Chapman et al., 1995). Kezsbom et al. (1989) warned that all
groups are not teams, and too many teams are simply
groups. They also argued that an effectively functioning
team integrates group effort, complementary competence
and skills with the identied goals.
Long (1996) used a qualitative approach to study team
members' understanding of teamwork following a 3-day
residential team-building workshop. Ten participants
were interviewed before and after the workshop. Again,
it was noted that role clarication and hierarchical
attitudes blocked communication. However, the time
spent together helped because participants returned to
work better prepared to address concerns. Reservations
about joint work may disappear once people get to know
each other better (Chapman et al., 1995). Far too often
collective understanding simply does not develop at all
because health professionals have little opportunity to get
to know each other in a more personal sense, away from
the workplace.
Informal interactions help team members to identify
similarities and differences. Platt (1994) focused on the

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A. McCallin

cultural values embedded in social interactions and noted

that team processes supporting a common purpose are
critical in teamwork. Even though differences can be put
aside if the patient is placed in the centre, we still do not
know whether patient outcomes improve.
However, patient interests are not always central to
teamwork. Grifths & Luker (1994) explored intra-professional relationships between community nurses. Organizational rules that promoted team functioning did not
necessarily benet the patient. Data from participant
observation of 130 home visits and interviews with 16
district nurses revealed that the nurses used unspoken rules
to support colleagues and avoid conict. These rules
reduced patient choice and compromised the quality of care.
Nonetheless, the self-directed work team may improve
job performance (Ling, 1996). Evaluation of a small
sample from a multidisciplinary team that included
nurses, rehabilitation social services, aides and clerical
staff in a large home health care agency in Northern
California using a quasi-experimental design suggested
that the self-directed team performed better than the
control group. Team organization improved group cohesiveness, productivity, problem solving and collaboration
despite the traditional, hierarchical organizational structure that was also undergoing change.
Another theme evident in the literature concerned
collective activity, which was linked to status. Wiles &
Robinson (1994) interviewed community nurses from 20
family centred practices in the UK. Many participants had
attended team-building workshops and reported that
attitude change was more likely when changing roles
elevated status. A different survey of 93 health care
workers in three inter-professional teams in long-term care
in Canada recorded collaborative teamwork that was
conned to the better educated higher status professionals
(Cott, 1997). Lower status staff were labelled as workers
because of their close involvement with manual work.
These workers, however, had little say in team decision
making, which was controlled by the higher status staff
with the greater intellectual input.
Value systems affect teamwork. Successful teamwork
revolves around a common worldview (Waugaman, 1994).
Wilmot (1995) reported that nurses valued individualism,
caring, autonomy, holism and patient well-being, while
social workers internalize collectivity, liberty, equality and
justice. Attitudes are not xed, however, and develop
amidst mutual interaction and reection in a dynamic
social environment (Clark, 1997). Disciplinary socialization can be problematic, although differences are overcome when a team adopts pluralistic worldviews which are
client-focused (McCallin, 1999b).

Group structure inuences teamwork in the restructuring workplace. Pedersen & Easton (1995) identied the
characteristics of a winning team. Themes included
common goals, clearly dened roles, commitment, support
and encouragement, trust, respect, communication, competence and skills, and the ability of team members to
function as a unit rather than as a group of individuals.
Pederson and Easton emphasized that teamwork has to be
worked at by individual staff members who have a
personal investment in the team's success. These ideas
support a philosophy of collaborative practice that is
underpinned by cooperation and interdependence.
The literature reveals a new emphasis on synergy and
collectivity (Evans, 1994; Kezsbom et al., 1989; Kerfoot,
1996). If synergistic relationships are the preferred option,
the team approach may need to change as well, so that
`collective entrepreneurship, endeavours in which the
whole of the effort is greater than the sum of individual
contributions' can emerge (Reich, 1987). In this instance,
attitudes and thinking will also need to change if health
professionals are to rethink their professional responsibilities and reframe their team responsibilities (McCallin,
1999a).
New ways of thinking are important, as one health
professional can no longer meet all client needs (Harbaugh, 1994). Problems associated with disciplinary
diversity fade once the team focuses on patient outcomes. Dialogue seems to be the key to success, as it
facilitates discussion of the team philosophy, values and
a shared approach to quality service provision (Wilmot,
1995). If dialogue is not well established, service
provision deteriorates because team members are
unwilling to discuss and work through their differences
and put clients in the centre (McCallin, 1999b). Working
together to provide positive outcomes for clients may
well be an ideal that is the exception rather than the rule
(King et al., 1993).
Conict is a barrier to teamwork (Beattie, 1995).
Anecdotal accounts document conict among professional groups (Hugman, 1991; Grifths & Luker, 1994;
Hilton, 1995; Long, 1996). West & Field (1995) and
Field & West (1995) interviewed 96 people from primary
health care teams in the UK, and concluded that
effective teamwork was unlikely when professional
boundaries are inexible. For example, discipline specic
management lines made it harder to arrange team
meetings to facilitate dialogue. The fact that formal
team meetings may not be the best place to discuss
differences was not considered (McCallin, 1999a).
Bennett-Emslie & McIntosh (1995) reviewed 14 general
practices, interviewing a sample of 70 general practition 2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

Interdisciplinary practice
ers, health visitors and health workers in the UK.
Participants identied the frequency of team meetings as
the single most critical factor that fostered collaborative
teamwork. Although regular meetings did not guarantee
effective teamwork, any opportunity for communication
improved inter-professional relationships (McClure, 1984;
Cartlidge et al., 1987).
While there is much rhetoric on how to set up teams
and manage them, research explaining how interdisciplinary team members manage their concerns and work
together in everyday practice is minimal. One grounded
theory study in New Zealand (McCallin, 1999b) explains
how 44 participants from four teams in two major acute
care settings worked in interdisciplinary teams. The study
of participants' patterns of behaviour suggests that, when
interdisciplinary practice is well established, an attitude of
cooperative inquiry pervades joint actions and interactions
that focus on meeting service needs.

Conclusion
The examination of inter-professional relationships and
the effect these have on teams and teamwork is extensive.
In much of the literature, concepts have been studied
separately, and so the linkages to contexts and the broader
socio-historical background were notable for their absence.
The picture of teams, their work and process is skewed, as
emphasis on one topic is often at the expense of another.
Conceptual rigour is required if we are to understand what
we are talking about.
It is possible that the labels assigned to people working
together in restructuring health care organizations are
relatively unimportant. What is important is what teams
do, how they do it, whether it improves patient outcomes,
and whether it benets the organization and the service
funder. More research is needed to provide empirical
evidence, grounded in practice, of the processes which
teams use as they work and interact together in the current
context of health care. More importantly, we need to know
whether effective interdisciplinary practice improves outcome management.

References
Abbott A. (1988) The System of Professions: An Essay on the Division
of Expert Labour. University of Chicago Press, Chicago.
Ashley J.A. (1976) Hospitals, Paternalism, and the Role of the Nurse.
Teachers College Press, New York.
Atkinson P. (1983) The reproduction of the professional community. In The Sociology of the Professions: Lawyers, Doctors and
Others (eds Dingwell R. & Lewis P.). Macmillan Press, London,
pp. 224241.
2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

425

Baggs J.G. & Schmitt M.H. (1988) Collaboration between nurses

and physicians. IMAGE: Journal of Nursing Scholarship 20(3),
145149.
Beattie A. (1995) War and peace among the health tribes. In
Interprofessional Relations in Health Care (eds Soothill K., Mackay
L. & Webb C.). Edward Arnold, London, pp. 1130.
Becker H.S. (1970) The nature of a profession. In Sociological Work:
Method and Substance (ed. Becker H.S.). Aldine, Chicago.
Bell D. (1973) The Coming of the Post-Industrial Society: a Venture in
Social Forecasting. Basic Books, New York.
Bennett-Emslie G. & McIntosh J. (1995) Promoting collaboration in
the primary care team the role of the practice meeting. Journal
of Interprofessional Care 9(3), 251256.
Berwick D.M. (1996) Ideas for medical education. Academic
Medicine 71(9), 972.
Birchall J.L. (1997) Patient-focused care: anatomy of a failure.
Holistic Nursing Practice 11(3), 1720.
Bishop A.H. & Scudder J.R. (1985) Caring, Curing, Coping: Nurse,
Physician, Patient Relationships. University of Alabama Press,
Alabama, AL.
Bolman L.G. & Deal T.E. (1997) Reframing Organisations: Artistry,
Choice, and Leadership, 2nd edn. Jossey-Bass, San Francisco.
Bresnen M. & Fowler C. (1996) Strategies, structures and expertise:
A study of intramanagerial relations in medium sized rms. In
New Relationships in the Organised Professions (ed. Fincham R.).
Avebury Ashgate Publishing Ltd., Aldershot, UK, pp. 2145.
Brett J.L. & Tonges M.C. (1990) Restructured patient care delivery:
evaluation of the Pro ACT model. Nursing Economics 8, 3644.
Brider P. (1992) The move to patient-focused care. American
Journal of Nursing 92(9), 2633.
Campbell-Heider N. & Pollock D. (1987) Barriers to physician
nurse collegiality: an anthropological perspective. Social Science
and Medicine 25(5), 421425.
Capuano T.A. (1995) Clinical pathways: practice approaches,
positive outcomes. Nursing Management 26(1), 3437.
Carpenter J. (1995) Doctors and nurses: stereotypes and stereotype
change in interprofessional education. Journal of Interprofessional
Care 9(2), 151161.
Cartlidge A., Bond J. & Gregson B. (1987) Interprofessional
collaboration in primary health care. Nursing Times 83, 4548.
Casto R.M. & Julia M.C. (1994) Interprofessional Care and
Collaborative Practice: Commission on Interprofessional Education
and Practice. Brooks/Cole, Pacic Grove, CA.
Chapman T., Hugman R. & Williams A. (1995) Effectiveness of
interprofessional relationships: a case illustration of joint working.
In Interprofessional Relations in Health Care (eds Soothill K.,
Mackay L. & Webb C.). Edward Arnold, London, pp. 4661.
Clark P.G. (1997) Values in health care professional socialisation:
implications for geriatric education in interdisciplinary teamwork.
Gerontologist 37(4), 441451.
Clark C.M., Steinbinder A. & Anderson R. (1994) Implementing
clinical paths in a managed care environment. Nursing Economics
12(4), 230234.
Cole R. & Perides M. (1995) Managing values and organisational
climate in a multiprofessional setting. In Interprofessional Relations in Health Care (eds Soothill K., Mackay L. & Webb C.).
Edward Arnold, London, pp. 6274.
Colliere M.F. (1986) Invisible care and invisible women as healthcare providers. International Journal of Nursing Studies 23(2),
95112.

426

A. McCallin

Cott C. (1997) We decide, you carry it out: a social network analysis

of multidisciplinary long-term care teams. Social Science and
Medicine 45(9), 14111421.
Craib I. (1992) Modern Social Theory: from Parsons to Habermas, 2nd
edn. St Martin's Press, New York.
Curran C.R. (1994) Work redesign: the key to true health care
reform. In Current Issues in Nursing (eds McCloskey J.C. & Grace
H.K.), 4th edn. Mosby, St Louis, MO, pp. 460466.
Daniel A. (1990) Medicine and the State: Professional Autonomy and
Public Accountability. Allen and Unwin, Sydney, Australia.
Davies C. (1995) Gender and the Professional Predicament in Nursing.
Open University Press, Buckingham, UK.
Davies P. (1999) Making sense of integrated care in New Zealand.
Australian Health Review 22(4), 2544.
Degeling P., Sage D., Keenedy J., Perkins R. & Zhang K. (1999) A
comparison of the impact of hospital reform on medical
subcultures in some Australian and New Zealand hospitals.
Australian Health Review 22(4), 172188.
Dingwell R. & Lewis P., eds. (1983) The Sociology of the Professions:
Lawyers, Doctors and Others. Macmillan Press, London.
Drucker P.F. (1994) Post-capitalist Society. Harper Business, New
York.
Ehrenreich J. (1978) The Cultural Crisis of Modern Medicine.
Monthly Review Press, New York.
Ehrenreich B. & English D. (1973) Witches, Midwives, and Nurses: a
History of Women Healers. Feminist Press, New York.
Engel C. (1994) A functional anatomy of teamwork. In Going
Interprofessional: Working Together for Health and Welfare (ed.
Leathard A.). Routledge, London, pp. 6474.
Etzioni A. (1969) The Semi-Professions and Their Organisation. Free
Press, New York.
Eubanks P. (1992) Work redesign calls for new pay and performance
plans. Hospitals 10, 60.
Evans J.A. (1994) The role of the nurse manager in creating an
environment for collaborative practice. Holistic Nursing Practice
8(3), 2231.
Fagin C.M. (1992) Collaboration between nurses and physicians: no
longer a choice. Academic Medicine 67(5), 295303.
Field R. & West M.A. (1995) Teamwork in primary health care:
perspectives from practices. Journal of Interprofessional Care 9,
123130.
Fox N.J. (1992) The Social Meaning of Surgery. Open University
Press, Milton Keynes, UK.
Freidson E. (1977) The futures of professionalisation. In Health and
the Division of Labour (eds Stacey M., Reid M.E., Dingwell R. &
Heath C.). Croom Helm, London, pp. 1438.
Freidson E. (1986) Professional Powers: a Study of the Institutionalisation of Formal Knowledge. University of Chicago Press,
Chicago.
Freidson E. (1988) Profession of Medicine: a Study of the Sociology of
Applied Knowledge. University of Chicago Press, Chicago.
Freidson E. (1994) Professionalism Reborn: Theory, Prophecy, and
Policy. University of Chicago Press, Chicago.
Friedan B. (1997) Beyond Gender: the New Politics of Work and
Family. Woodrow Wilson Centre Press, Washington, D.C.
Gabe J., Kelleher D. & Williams G., eds. (1994) Challenging
Medicine. Routledge, London.
Gamarnikow E. (1978) Sexual division of labour: the case of
nursing. In Feminism and Materialism: Women and Modes of

Production (eds Kuhn A. & Wolpe A.M.). Routledge & Kegan

Paul, London, pp. 96123.
Goldman A.H., Kilroy C.L. & Pike A.W. (1992) 7GRYZMISH:
toward an understanding of collaboration. Nursing Clinics of
North America 27(1), 4759.
Gordon P.R., Carlson L., Chessman A., Kundrat M.L., Morahan
P.S. & Headrick L.A. (1996) A multisite collaborative for the
development of interdisciplinary education in continuous
improvement for health professions students. Academic Medicine
71(9), 973978.
Greenwood E. (1957) Attributes of a profession. Social Work 2,
4455.
Grifths J.M. & Luker K.A. (1994) Intraprofessional teamwork in
district nursing: in whose interest? Journal of Advanced Nursing
20, 10381045.
Harbaugh G.L. (1994) Assumptions of interprofessional collaboration: interrelatedness and wholeness. In Interprofessional Care
and Collaborative Practice: Commission on Interprofessional Education and Practice (eds Casto R.M. & Julia M.C.). Brooks/Cole,
Pacic Grove, CA, pp. 1121.
Henneman E.A., Lee J.L. & Cohen J.I. (1995) Collaboration: a
concept analysis. Journal of Advanced Nursing 21, 103109.
Hilton R.W. (1995) Fragmentation within interprofessional work: a
result of isolationism in health care professional education and the
preparation of students to function only in the connes of their
own disciplines. Journal of Interprofessional Care 9(1), 3340.
Hilton R.W., Morris D.J. & Wright A.M. (1995) Learning to work
in the health care team. Journal of Interprofessional Care 9(3),
267274.
Horobin G. (1983) Professional mystery: the maintenance of
charisma in general medical practice. In The Sociology of the
Professions: Lawyers, Doctors and Others (eds Dingwell R. &
Lewis P.). Macmillan, London, pp. 84105.
Hughes E.C. (1971) The Sociological Eye. Aldine, Chicago.
Hugman R. (1991) Power in Caring Professions. Macmillan, London.
Johnson T.J. (1972) Professions and Power. Macmillan, London.
Johnston C.L. & Cooper P.K. (1997) Patient-focused care: what is
it? Holistic Nursing Practice 11(3), 17.
Jones R.A.P. (1997a) Forward. Holistic Nursing Practice 11(3),
vivii.
Jones R.A.P. (1997b) Multidisciplinary collaboration: conceptual
development as a foundation for patient-focused care. Holistic
Nursing Practice 11(3), 816.
Jones K.R., DeBaca V. & Yarbrough M. (1997a) Organisational
culture assessment before and after implementing patient-focused
care. Nursing Economics 15(2), 7380.
Jones R.A.P., Dougherty M. & Martin S. (1997b) Program
evaluation of a unit reengineered for patient-focused care. Holistic
Nursing Practice 11(3), 3146.
Kane R. (1975) Interprofessional Teamwork. Syracuse University
School of Social Work, Manpower Monograph no. 8, Syracuse,
NY.
Katzenbach J.R. & Smith D.K. (1993) The Wisdom of Teams:
Creating the High-performance Organisation. Harper Collins, New
York.
Keatinge D. (1995) Collegiality and collaboration: attitude or
structure? In Issues in Australian Nursing 4 (eds Gray G., Pratt R.
& Macklin J.). Churchill Livingstone, Melbourne, Australia,
pp. 407421.

2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

Interdisciplinary practice
Kendrick K. (1995) Nurses and doctors: a problem of partnership.
In Interprofessional Relations in Health Care (eds Soothill K.,
Mackay L. & Webb C.). Edward Arnold, London, pp. 239252.
Kerfoot K. (1996) Transprofessional patient care the nurse
manager's challenge. Nursing Economics 14(2), 123125.
Kezsbom D.S., Schilling D.L. & Edward K.A. (1989) Dynamic
Project Management: a Practical Guide for Managers and Engineers.
John Wiley, New York.
King L., Lee J.L. & Henneman E. (1993) A collaborative practice
model for critical care. American Journal of Critical Care 2(6),
444449.
Klein J.F. (1983) Problems with implementing primary nursing. In
The Nursing Profession: a Time to Speak (ed. Chaska N.L.).
McGraw-Hill. New York, pp. 580591.
Larson E.L. (1995) New rules for the game: interdisciplinary
education for health professionals. Nursing Outlook 43(4), 180185.
Lary M.J., Lavigne S.E., Muma R.D., Jones S.E. & Hoeft H.J.
(1997) Breaking down barriers: multidisciplinary education
model. Journal of Allied Health 26(2), 6369.
Lawler E.E. (1992) The Ultimate Advantage: Creating the Highinvolvement Organisation. Jossey-Bass, San Francisco.
Leathard A., ed. (1994) Going Interprofessional: Working Together for
Health and Welfare. Routledge, London.
Ling C.W. (1996) Performance of a self-directed work team in a
home healthcare agency. Journal of Operating Nurses' Association
26(9), 3640.
Long S. (1996) Primary health care team workshop: team members'
perspectives. Journal of Advanced Nursing 23, 935941.
Lyon J.C. (1993) Models of nursing care delivery and case
management: clarication of terms. Nursing Economics 11(3),
163169.
Mackay L. (1995) The patient as pawn in interprofessional
relationships. In Interprofessional Relations in Health Care (eds
Soothill K., Mackay L. & Webb C.). Edward Arnold, London,
pp. 349360.
Manion J., Lorimer W. & Leander W.J. (1996) Team-based Health
Care Organisations: Blueprint for Success. Aspen, Gaithersburg,
MD.
McCallin A.M. (1999a) Pluralistic Dialogue: A Grounded Theory of
Interdisciplinary Practice. Unpublished PhD Dissertation, Massey
University, Palmerston North, New Zealand.
McCallin A.M. (1999b) Pluralistic dialogue: a grounded theory of
interdisciplinary practice. Australian Journal of Rehabilitation
Counselling 5(2), 7885.
McClure L.M. (1984) Teamwork, myth or reality? Community
nurses' experience with general practice attachment. Journal of
Epidemiological Community Health 38, 6874.
Mickan S. & Rodger S. (2000) The organisational context for
teamwork: comparing health care and business literature. Australian Health Review 23(1), 179192.
Millerson G. (1964) The Qualifying Associations. Routledge and
Kegan Paul, London.
Minnen T.G., Berger E., Ames A., Dubree M., Baker W.L. &
Spinella J. (1993) Sustaining work redesign innovations through
shared governance. Journal of Nursing Administration 23, 3540.
Morgan G. (1997) Images of Organisation, 2nd edn. Sage, Thousand
Oaks, CA.
Ovretveit J. (1993) Coordinating Community Care: Multidisciplinary
Teams and Care Management. Open University Press, Buckingham, UK.
2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428

427

Ovretveit J. (1996) Five ways to describe a multidisciplinary team.

Journal of Interprofessional Care 10(2), 163171.
Pearson P. & Spencer J. (1995) Pointers to effective teamwork:
exploring primary care. Journal of Interprofessional Care 9(2),
131138.
Pedersen A. & Easton L.S. (1995) Teamwork: bringing order out of
chaos. Nursing Management 26(6), 3435.
Perkins R., Barnett P. & Powell M. (2000) Corporate governance of
public health services: lessons from New Zealand for the State
sector. Australian Health Review 23(1), 921.
Petersen A.R. (1994) In a Critical Condition: Health and Power
Relations in Australia. Allen & Unwin, Sydney, Australia.
Pietroni P.C. (1991) Stereotypes or archetypes a study of the
perceptions among health-care students. Journal of Social Work
Practice 5(1), 6169.
Pike A.W. (1991) Moral outrage and moral discourse in nurse
physician collaboration. Journal of Professional Nursing 7(6),
351363.
Platt L.J. (1994) Why bother with teams? An overview. In
Interprofessional Care and Collaborative Practice: Commission on
Interprofessional Education and Practice (eds Casto R.M. & Julia
M.C.). Brooks/Cole, Pacic Grove, CA, 310.
Poulton B.C. & West M.A. (1993) Effective multidisciplinary
teamwork in primary health care. Journal of Advanced Nursing 18,
918925.
Rawson D. (1994) Models of inter-professional work: Likely
theories and possibilities. In Going Interprofessional: Working
Together for Health and Welfare (ed. Leathard A.). Routledge,
London, pp. 3865.
Recardo R.J., Wade D., Mention C.A. & Jolly J.A. (1996) Teams:
Who Needs Them and Why? Gulf Publishing, Houston, TX.
Reich R.B. (1987) Entrepreneurship reconsidered: the team as hero.
Harvard Business Review, May-June, 7783.
Reverby S. (1987) A caring dilemma: womanhood and nursing in
historical perspective. Nursing Research 36(1), 510.
Ritter J. & Tonges M.S. (1991) Work redesign in the high-intensity
environment: Pro ACT for critical care. Journal of Nursing
Administration 21, 2635.
Roth J.A. (1974) Professionalism: the sociologist's decoy. Sociology
of Work and Occupations, 1(1), 623.
Schwarz C., ed. (1993) The Chambers Dictionary. The University
Press, Cambridge, UK.
Seago J.A. (1997) Five pitfalls of work redesign. Nursing Management 28(10), 4950.
Shipley J. (1995) Advancing Health in New Zealand. Government
Printer, Wellington, New Zealand.
Soothill K., Mackay L. & Webb C., eds. (1995) Interprofessional
Relations in Health Care. Edward Arnold, London.
Sorrells-Jones J. (1997) The challenge of making it real: interdisciplinary practice in a `seamless' organisation. Nursing Administration Quarterly 21(2), 2030.
Stein L.I. (1967) The doctornurse game. Archives of General
Psychiatry 16, 699703.
Stein L.I., Watts D.T. & Howell T. (1990) The doctornurse game
revisited. New England Journal of Medicine 322, 546549.
Sullivan T.J. (1998) Collaboration: a Health Care Imperative.
McGraw-Hill, New York.
Townsend M.B. (1993) Patient-focused care: is it for your hospital?
Nursing Management 24(9), 7480.

428

A. McCallin

Trueman M. (1991) Collaboration: a right and a responsibility of

professional practice. Critical Care Nurse 11(1), 7072.
Turner B.S. (1987) Medical Power and Social Knowledge. Sage,
London.
Vollmer H.W. & Mills D.J., eds. (1966) Professionalisation. Prentice
Hall, Englewood Cliffs, NJ.
Waugaman W.R. (1994) Professionalisation and socialisation in
interprofessional collaboration. In Interprofessional Care and
Collaborative Practice: Commission on Interprofessional Education
and Practice (eds Casto R.M. & Julia M.C.). Brooks/Cole, Pacic
Grove, CA, pp. 2331.
Wells J.S.G. (1995) Health care rationing: nursing perspectives.
Journal of Advanced Nursing 22, 738744.
West M.A. & Field R. (1995) Teamwork in primary health care 1:
perspectives from organisational psychology. Journal of Interprofessional Care 9(2), 117122.
West M.A. & Poulton B.C. (1997) A failure of function: teamwork
in primary health care. Journal of Interprofessional Care 11(2),
205216.

West M.A. & Wallace M. (1991) Innovation in health care teams.

European Journal of Psychology 21, 303315.
Wiles R. & Robinson J. (1994) Teamwork in primary care: the views
and experiences of nurses, midwives and health visitors. Journal
of Advanced Nursing 20, 324330.
Willis E. (1989) Medical Dominance: the Division of Labour in
Australian Health Care, Revised edition. Allen & Unwin, Sydney,
Australia.
Wilmot S. (1995) Professional values and interprofessional dialogue.
Journal of Interprofessional Care 9(3), 257266.
Witz A. (1992) Professions and Patriarchy. Routledge, London.
Zimmerman J.E., Shortell S.E., Rousseau D.M., Duffy J.D., Gillies
R.R., Knaus W.A. et al. (1993) Improving intensive care
observations based on organisational case studies in nine intensive
care units: a prospective multi-centre study. Critical Care
Medicine 21(10), 14431451.
Zwarenstein M. & Reeves S. (2000) What's so great about
collaboration?: we need more evidence and less rhetoric. British
Medical Journal 320(7241), 10221023.

2001 Blackwell Science Ltd, Journal of Clinical Nursing, 10, 419428