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Table 4 Facilitating and hindering factors for information exchange and sharing of expertise, according to the CAS principles

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

Facilitating factors for information exchange and sharing of expertise (CAS principle) Hindering factors for information exchange and sharing of expertise (CAS principle)
Sharing the same mission of delivering quality care – the willingness to act in the patient’s best interests stimulates discussions and shared-decision making (1)  
Professional hierarchy – PHCT nurse spends time deliberating treatment options with GP (1)
Creating horizontal collaborative relationships from the start facilitates open interaction (3)
Professional hierarchy – nurses acting autonomously without deliberation results in atmosphere of distrust (3)
Doctors stressing hierarchy structure might hinder open communication (3).
Nurses being dependent on doctors for their daily work and therefore hesitate to comment upon doctor’s decisions even when they disagree (4)
Unresolved communication conflicts (2)
Previous positive experiences resulting in mutual respect of each other’s knowledge and expertise (3) Previous negative experiences – GPs insufficiently informing CNs on patient’s medical status or ignoring expert palliative care advice results in atmosphere of distrust (3)
Knowing each other’s strengths and weaknesses results in tailored communication (3)
Doctor’s education in palliative care facilitates discussions with PHCT experts (6)
Using practice guidelines helps nurses prepare a discussion with doctors (6)
Lack of interprofessional training inhibits effective teamwork (6)
Acknowledging and respecting each other’s competences results in deliberation and shared decision-making as peers (7).
Valuing interprofessional relationships trigger anticipatory interprofessional communication in complex cases to avoid bedside discussions (7)
Nurses sometimes avoid confronting doctors with their differing views not to harm relationships. This results in missed learning opportunities (7)
Tradition of systematic and frequent communication facilitates the initiation of a deliberation in case of problems (3) Communication problems in the past like being unavailable for others or unwilling to negotiate treatment excludes professionals from future interaction (3)
Unwillingness to collaborate or not feeling the need to collaborate at the start (3)
Sharing information prompts the recipients of information to share information as well (3)  
A kick-off meeting at the start of the collaboration leads to better communication throughout the collaboration (3)  
Extra fee compensates for time-consuming interactions (6).
Mass media and general public ideas trigger more frequent and intense team discussions on complex cases (6)
Unavailability due to workload, time restraints diminish interaction (6)
Striving for personal and professional wellbeing triggers interprofessional debriefing after emotional experiences or conflicts with patients (7)
Nurses’ hesitation to take up responsibility on their own makes them seek support and deliberate with others, even during out-of-hours service (7)