Some unintended effects of teamwork in healthcare.

Teamwork has been emphasised as a key feature of health service reform, essential for safe, efficient and patient-centred care. Bringing together literatures from the sociology of healthcare and organizational theory, we examine how the teamwork phenomenon plays out in practice. Drawing upon material from two ethnographic studies, conducted in an operating theatre and a medical-records department in separate UK NHS hospitals, we explore some of the discursive teamwork practices of healthcare staff. Our analysis presents a very different picture from the normative, evangelistic promotion of teamwork within much management and health policy writing. We reveal how the ambiguity of teamwork opens up opportunities for a complex, diverse range of responses to the managerial discourse among diverse occupational groups, mobilizing the discourse to enact identity in different ways. We highlight how teamwork discourse can be instrumentally co-opted in the reproduction of the very occupational divisions it is designed to ameliorate, or simply ignored as irrelevant when compared to more attractive forms of collective identity. These responses challenge both those who believe that teamwork is a solution to problems in healthcare, as well as those concerned about the oppressive effects of pervasive managerialism. Copyright 2010 Elsevier Ltd. All rights reserved.