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Table 3 Number of interviews and excerpts per CAS principle with illustration of an interview fragment

From: Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction

CAS principle Number of interviews where fragments have been found according to the CAS principle (GP/PHCT/CN) Number of excerpts according to the CAS principle (GP/PHCT/CN) Example of interview fragment coded under the CAS principle
1. Team members act autonomously guided by internalized basic rules 48 (16/14/18) 190 (40/62/88) I think I might have a talk to him about this, because, you know, I really don’t like nurses administering drugs without me knowing it. Or give some extra painkillers just like that. (GP)
2. Team members’ interactions are non-linear 11 (1/6/4) 11 (1/6/4) He broke it off quite abruptly. Erm, the procedure was what she was, yes, euh, I had the impression that he shot the messenger while he was talking about the procedure. If he doesn’t agree with the procedure, then he can question it, but he doesn’t have to shoot the messenger, I think. So erm it ended up us having to ignore the syringe driver. That he was going to see to it himself] (PHCT nurse, after an altercation between a GP and the PHCT nurse on medication dose)
3. The team has a history and is sensitive to initial conditions 44 (10/17/17) 130 (25/45/60) That’s right, yes yes. Personality, yes, plays a major role in everything. Yes Yes. I see that, if you look at all of our GPs we work with, and those with whom you work occasionally, or those with whom you work very often, then your communication is also very different. (CN) You will be more assertive in the presence of certain general practitioners. How many times have you worked with them? Erm. What are previous experiences with this general practitioner? If you’ve had a very bad experience, then you will also be much more cautious. Then I think: “Well, the previous experience wasn’t good, I have to make sure that this one goes well” (PHCT nurse)
4. Interactions between team members can produce unpredictable behaviour 21 (2/11/8) 38 (2/22/14) It depends on your openness as a doctor. If you have a closed mentality, then you will receive suggestions that you don’t really need, whether you like it or not. (GP)
5. Interactions between team members can generate new behaviour 25 (5/13/7) 54 (6/31/17) I go and ask the members of the palliative team. Is there a solution to this problem? And there’s also a development in this and those people are more aware of it. If we try to do it well, each from our own expertise and our own training background, you will reach a higher level together] (GP)
6. A team is an open system and interacts with its environment 31 (7/12/12) 70 (16/24/30) But I think it’s actually because of us that they can be admitted (PHCT), that’s not an obvious a step to take. So often, it’s the hospital that takes the first step. The patients are discharged from the hospital and then we have to take care of the aftercare. They are usually aware of the existence of a palliative service, but I still think we take the first step most of the time (CN)
And there are those who know it very well, of course. We also have several GPs who have followed the course (on palliative care), who are also well-informed. Sometimes, when I enter the place they approach me and say, ‘Have a look, I’ve done that calculation in such or such a way, what do you think. In consultation, that’s great, isn’t it? But there are different types of general practitioners. Yes, there is still a lot of work to be done] (PHCT)
7. Attractors shape the team functioning 52 (14/18/20) 180 (26/50/104) In the case of older doctors, it is usually the case that we try to give them the impression that the decision is theirs, but in most cases, we have talked them into it. How can we give them the sense that they made the decision while arriving at a point where it becomes doable for our patient? (CN)