Exploring and strengthening day-to-day teamwork in critical care: a qualitative study

Objective To examine how teamwork is enacted, constrained, and strengthened in the day-to-day practice of critical care units, and to identify participant suggested approaches to strengthen teamwork. Methods This qualitative study used interpretive description to explore clinicians' experiences of teamwork in critical care. Thirty-five healthcare professionals from six Canadian provinces participated in semi-structured interviews. Participants represented diverse roles, including nurses, physicians, respiratory therapists, pharmacists, and allied health professionals. Interviews were analyzed using an inductive and interpretive process involving open coding, constant comparison, and iterative theme development. Reflexivity was integrated throughout data collection and analysis to support credibility and interpretive coherence. Results Teamwork in critical care was described as a multidimensional social process shaped by four interconnected themes: (1) relational practice built through familiarity, trust, and shared experience; (2) leadership, hierarchy, and unit culture, including the ways relational power shaped psychological safety and collaboration; (3) communication and coordination challenges; and (4) structural barriers to integration, learning, and stability. Across these four themes, participants frequently described nurses as central coordinators of relational and informational work, in part because of their continuous presence at the bedside. Conclusions Participants’ experiences suggested that teamwork in critical care is a social process shaped by the dynamic interplay of relational practice, relational power, communication structures, and structural stability. Together, these conditions influenced participants' experiences of how clinicians connect, coordinate, and make decisions in the critical care context. Implications for clinical practice Participants identified relational stability, psychologically safe leadership, communication structures that support shared understanding, and staffing and orientation practices that promote continuity as potential points for strengthening teamwork. These participants suggested approaches warrant organizational consideration and prospective evaluation to determine their effects on teamwork in critical care settings.