Teamwork is a fundamental component in the organization of health care services, particularly in highly complex settings such as emergency departments, where care requires timely and effective coordination among multiple professionals. In this context, physicians and nursing professionals play a central role in coordinating care through processes involving organized interaction, role interdependence, and shared decision-making, with the aim of ensuring continuity and quality of care (1).

In this regard, teamwork is defined as the structured interaction between two or more individuals who share common goals, with clearly defined roles and interdependent responsibilities aimed at optimizing the quality of care and patients’ health outcomes (2-5). In health care settings, its implementation has been associated with significant improvements in patient safety, the reduction of adverse events, and the optimization of care processes (6,7).

However, the effective functioning of teamwork does not depend exclusively on structural factors, but also on professionals’ attitudes toward collaboration, which directly influence interprofessional communication, decision-making, and conflict resolution within the health care team (8).

Despite the evidence regarding its benefits, several factors hinder the effective development of teamwork in health care services. These include workload overload, inefficient communication, inadequate leadership styles—understood as leaders’ limited capacity to promote environments based on effective communication—mutual respect among professionals, shared decision-making, and the persistence of traditional hierarchical models that restrict the equitable participation of team members (6,7,9).

Likewise, limited psychological support, understood as the scarce availability of formal institutional strategies aimed at stress management, emotional well-being, and psychosocial support for staff, may affect interaction among team members and decision-making in high-pressure environments (10). In the case of nursing personnel, unfavorable working conditions and unsupportive organizational environments are factors that may lead to demotivation and negatively affect team dynamics (9,11).

In Latin America, the shortage of human resources for health, particularly in nursing, represents an additional challenge to team functioning, as it affects service responsiveness and the quality of care (12). This situation is intensified in areas such as emergency care, where high care demand, urgency, and case complexity require a high level of coordination among professionals and functional units (13,14).

In particular, hospital emergency departments are characterized by high patient turnover, constant care pressure, and the need for coordination among different functional areas, which requires efficient teamwork in clinical practice. However, in the Ecuadorian context, scientific evidence on teamwork in health care remains limited, particularly in specific hospital settings, thereby restricting the identification of gaps and opportunities for improvement in both professional training and work environments.

The hospital where the study was conducted is a public general hospital that serves a high volume of patients in the emergency department. It is organized into functional areas such as diagnostic and clinical support services, urgent care and critical care areas, as well as specialized clinical areas, and is oriented toward providing immediate care and observation, which entails constant coordination among health care professionals.

In this context, it is relevant to analyze attitudes toward teamwork as a key organizational construct in emergency settings, where effective coordination is a determinant of quality of care. Therefore, the objective of the present study was to describe attitudes toward teamwork among health care professionals working in the emergency department of a public general hospital in southern Ecuador, in order to generate evidence that contributes to strengthening organizational strategies aimed at improving the performance of the health care team.

Of the 65 professionals working in the emergency department (44 physicians and 21 nurses), 30 participated in the study, distributed equally between physicians (n = 15) and nursing professionals (n = 15). The main reasons for nonparticipation included staff rotation, employment termination, and voluntary refusal.

As shown in Table 1, the mean age was 29.5 years, with the highest proportion in the 20- to 29-year age group (46.7%; n = 14). Female participants predominated (73.3%; n = 22). The distribution by profession was homogeneous, with an equal proportion of nursing and medical professionals (50%; n = 15, respectively). Regarding areas of practice, diagnostic and clinical support predominated (36.7%; n = 11), followed by specialized clinical areas (33.3%; n = 10).

Table 1. Table 1. Sociodemographic characteristics of the health care team

Table 2 shows sociodemographic differences between nursing and medical professionals. Among nursing professionals, female participants predominated (86.7%; n = 13), whereas the distribution among medical professionals was more balanced (60% female; 40% male). Regarding training background, most nursing professionals were trained in public institutions (93.3%; n = 14), unlike medical professionals, among whom a more homogeneous distribution between public and private institutions was observed. With respect to work experience, the group with less than one year of experience predominated among nursing professionals (46.7%; n = 7), whereas among medical professionals the highest proportion was concentrated in the 1- to 5-year experience group (53.3%; n = 8).

Table 2. Table 2. Sociodemographic characteristics by profession

Table 3 presents the overall distribution of attitudes toward teamwork in the emergency department. A total of 43.3% (n = 13) of participants reported moderate disagreement, whereas 56.6% (n = 17) were classified within agreement categories.

Table 3. Table 3. Overall perception of attitudes toward teamwork

Table 4 shows a positive consensus in the dimension “Attitudes toward the value of being a team,” with a predominance of responses in agreement categories and mean scores above 5, suggesting a possible ceiling effect. Although minimum values of 1 were recorded for some items, their frequency was low. Items 3 and 19 showed the highest percentages of disagreement (10.0% and 13.3%, respectively).

Table 4. Table 4. Results for Dimension 1: Attitudes toward the value of being a team

Note.

Data were grouped from 1 to 3 as disagreement and from 4 to 6 as agreement.

The results shown in Table 5 indicate a neutral perception in the dimension “Attitudes toward team efficiency,” with mean scores ranging from 3.0 to 3.5. Item 8 showed a differentiated pattern within the dimension, with a minimum value of 4, in contrast to the remaining items, whose minimum values were lower. In the dimension “Attitudes toward the physician’s collaborative role within the team,” heterogeneity in responses was observed. Item 4 recorded the highest proportion of disagreement (56.6%), whereas agreement predominated in items 6, 13, and 17.

Table 5. Table 5. Results for Dimensions 2 and 3 of the Attitudes Toward Teamwork Scale Note.

Data were grouped from 1 to 3 as disagreement and from 4 to 6 as agreement.

Finally, Table 6 shows that women had a higher proportion of agreement toward teamwork (43.3%). Regarding profession, physicians showed more favorable attitudes (33.3% agreement vs. 16.6% disagreement); meanwhile, among nursing professionals, similar proportions of agreement (23.3%) and disagreement (26.6%) were observed, with a slight predominance of the latter.

Table 6. Table 6. Comparison of sociodemographic variables and attitudes toward teamwork Note.

Data were grouped from 1 to 3 as disagreement and from 4 to 6 as agreement.

A relevant finding is that the urgent care and critical care area showed the greatest resistance to teamwork (20.0% disagreement vs. 10.0% agreement), in contrast to diagnostic and clinical support, where greater favorability was observed (23.3% agreement vs. 13.3% disagreement). Regarding training institution, personnel trained in private institutions showed a higher proportion of agreement (20.0% vs. 6.6% disagreement), whereas those trained in public institutions showed a balanced distribution (36.6% in both categories).

In this study, the overall assessment of attitudes toward teamwork showed that 43.3% of participants reported moderate disagreement, whereas 56.6% expressed agreement. This pattern reflects a heterogeneous perception of teamwork in the emergency department and suggests the coexistence of positive appraisals together with operational barriers in care practice. This finding is relevant because it highlights a gap between the conceptual recognition of teamwork and its effective implementation in clinical practice.

Consistently, Huber (20) notes that organizational factors such as service structure, insufficient training, and interprofessional communication may influence perceptions of teamwork. In addition, previous studies have shown that favorable working conditions, characterized by peer support and effective communication, are associated with positive attitudes toward teamwork and better care outcomes (13,21). However, unlike these contexts, the results of the present study suggest that a positive appraisal of teamwork does not necessarily translate into its effective implementation, which may be mediated by the operational conditions inherent to emergency departments.

Regarding Dimension 1, Attitudes toward the value of being a team, the results show a positive consensus, with mean scores above 5 in most items. This indicates that participants widely recognize the benefits of teamwork for quality of care, decision-making, and efficiency in care delivery. These findings are consistent with the literature, which highlights that teamwork is associated with higher job satisfaction and better clinical outcomes (9,22). Likewise, according to some systematic reviews, teamwork favors care planning, increases quality of care, and improves therapeutic success (23, 24).

In contrast, Dimension 2, Attitudes toward team efficiency, showed neutral perceptions, with mean scores ranging from 3.0 to 3.5 and balanced distributions between agreement and disagreement in several items. This finding reinforces the existence of a gap between the conceptual appraisal of teamwork and its implementation in care practice. One possible explanation for this discrepancy is that, although professionals recognize its benefits, the operational dynamics of emergency departments may limit its effective application.

In particular, item 8, related to patient satisfaction in teamwork contexts, showed a different distribution pattern, with a minimum value of 4, indicating lower disagreement compared with other items. Overall, these results reflect divergent perceptions regarding the operational efficiency of teamwork, suggesting that its impact on care is recognized, but its implementation may be perceived as complex or demanding in terms of time and coordination.

This variability may be explained by contextual factors inherent to emergency departments, such as care overload, time pressure, and case complexity. In this regard, it has been documented that high-demand settings may hinder effective team coordination, even when teamwork is positively valued (9,14). Similarly, evidence shows that, in complex health care contexts, teamwork requires structured communication, coordination, and leadership processes to achieve effective performance (5,25).

In Dimension 3, Attitudes toward the physician’s collaborative role within the team, variable results were observed. In item 4, which assesses the physician’s authority to modify the care plan, disagreement predominated, suggesting lower acceptance of rigid hierarchical models. In contrast, other items recognize the physician’s role within the team. These results are consistent with studies highlighting a trend toward more participatory models of decision-making within health care teams (6). Likewise, it has been reported that interaction among professionals in care planning is increasingly based on communication and consensus (26).

Finally, regarding sociodemographic variables, a higher proportion of agreement toward teamwork was observed among women. With respect to profession, medical professionals showed more favorable attitudes, whereas nursing professionals showed a more balanced distribution between agreement and disagreement. Greater favorability was observed in diagnostic and clinical support areas, in contrast to urgent care and critical care, where disagreement predominated. These results should be interpreted with caution, since the study was not designed to assess causal associations between sociodemographic variables and attitudes toward teamwork (27).

These findings may be related to the specific working conditions in each area. In urgent care and critical care services, characterized by high care pressure, rapid decision-making, and heavy workloads, the implementation of teamwork may be perceived as more complex. In contrast, in areas with lower operational pressure, team coordination may develop in a more structured manner.

This study provides information in the Ecuadorian context on attitudes toward teamwork in emergency departments and shows a high conceptual valuation of teamwork coexisting with neutral perceptions regarding its operational efficiency. This finding represents a relevant contribution by highlighting a dissociation between the ideal of teamwork and its implementation in highly complex care contexts.

Likewise, the results identified differences according to area of practice and profession, which may guide the design of specific organizational strategies to strengthen teamwork in highly complex contexts. The findings support the need to strengthen organizational strategies aimed at teamwork in emergency departments, including training, improved communication, and optimization of coordination among professionals. In this context, the recommendations of international organizations such as the Pan American Health Organization and the World Health Organization on interprofessional education may be relevant for improving the performance of the health care team (28).

The present study showed that attitudes toward teamwork among health care professionals in emergency departments are heterogeneous. Although teamwork is highly valued conceptually as a key component of quality of care, neutral perceptions regarding its operational efficiency persist, highlighting a gap between the ideal of teamwork and its implementation in clinical practice. Differences were also identified according to area of practice and profession, with greater difficulties observed in high-pressure care settings, underscoring the need to strengthen organizational strategies aimed at improving its implementation.

This study has limitations that should be considered when interpreting the results. The small sample size and the use of intentional non-probability sampling limit the generalizability of the findings. Voluntary participation may have introduced selection bias. Likewise, the use of a self-report instrument entails a risk of social desirability bias. The study was limited to health care professionals working in the emergency department and did not include other team members or data on shifts or specific roles, which limits a comprehensive understanding of the phenomenon. Finally, the cross-sectional design prevents the establishment of causal relationships between variables.

The authors declare that they have no conflicts of interest regarding the publication of this scientific article. This contribution is intended to improve the administration and management of hospital areas in Ecuador.

The authors received no funding from any institution, whether public, private, or nongovernmental.