Table 3 A summary of emerging themes and sub-themes

1. Dynamic nature of team composition

‘Core’ or routine team

• Stable and permanent in constitution (members often physically present in NBU)

• Minimal intra- and inter-cadre teamwork due to high patient to staff ratios

• Consequently, care provision is largely fragmented, focused on task execution

• Implicit goals/targets, that are assumed to be shared among providers

• These targets are not just implicit but also ad hoc and reactional

Emergency team

• Dynamic and time-related membership

• Mostly constituted during scenarios/situations considered as emergency e.g., resuscitations

• Often multidisciplinary, demonstrating efficient collaboration and coordination, and broken professional boundaries

Temporary ad hoc teams

• Innovative informal teams assembled to cope with high human resource demands

• Included participation of students, support staff and mothers in executing ‘core’ team tasks

• Characterised by informal task-sharing and task-shifting

• While it provided opportunities for patient-centered care, had negative consequences on the quality of care

2. The role of team relationships in nurturing team climate

• Positive relationships characterised by intra-cadre dependence and personal bonding appeared as a coping mechanism in this context

• We observed lots of intra-cadre collaboration and support for one another, e.g. colleagues covered shifts/tasks for each other through local arrangements.

• Interactions within the ‘core’ team encouraged learning, we observed lots of knowledge and skills sharing between nurses and junior doctors/clinical officers

• Leadership practices adopted were key in promoting team cohesion and positive team working

• E.g., Distributed forms of leadership promoted an open environment for interaction and collaboration rather than a hierarchical/authoritative one which undermined collective participation in decision-making.

• Opportunities for information sharing and communication also promoted positive relationships: informal messaging apps such as WhatsApp emerged as useful spaces for both formal and informal communication

3. The value of routines and rituals to NBU teams

• Institutionalized formal and informal routines and rituals such as monthly departmental meetings, daily prayers, and morning devotions shaped team cohesion, by enabling bonding over shared values and beliefs

• A mission driven institutional culture seemed to promote openness, and co-existence between teams

• On the contrary, inefficient bureaucracy and inertia which seemed persistent in public sector limited opportunities for interactions in both formal and informal routines