Four different professions were interviewed, represented by 28 individuals (Table 1). From these shared experiences, a total of 108 critical incidents was identified. The first analysis phase resulted in a median of four (range 0–6) identified critical incidents per participant.. These were further grouped into experiences concerning the critical incident.

Table 1 Characteristics of the participants (n = 28)

The most frequently described experience of a critical incident was related to the “ways of communication that enabled interprofessional teamwork” (32%). Experiences related to “teamwork organization-related functions and routines” and “the importance of support from colleagues” each accounted for one-fifth of the critical incidents (20% and 19%, respectively) (Table 2).

Table 2 Types of critical incidents associated with interprofessional teamwork in the ED

The second and third phases of the analysis generated eight main categories and associated subcategories (Table 3). The described experiences within these categories and subcategories reflected both enablers of and barriers to interprofessional teamwork. From the summary of the categories and subcategories in Table 3, supporting quotes are presented in Table 4.

Table 3 Categories and subcategories derived from the qualitative content analysisTable 4 Categories, subcategories and quotes from the qualitative content analysisSalience of reflection

In the first category, participants referred to reflections as a learning activity, i.e., an essential factor in professional growth as individuals within interprofessional teams. The first subcategory, self-awareness to scrutinize oneself, describe reflections upon the ability to deliver competence to the fullest potential and giving a motivation for scrutinizing oneself (Table 4, IP19). Participants described the value of receiving feedback about personal qualities in work situations involving close collaboration. However, this was often self-initiated. Thus, the lack of feedback in close connection with the assessment of patients in the ED led to hesitation and the questioning of professional ability (Table 4, IP 18). The second subcategory, team reflection as a way of interprofessional learning, relates to crucial confirmation and reassurance to be able to progress and work to the best of one’s professional ability. Participants expressed disappointment with the deprioritization of standard debriefing protocols. In particular, HCPs were not able to step away from the emergency care and reflect on their conscious and unconscious actions to lift team spirit and increase motivation (Table 4, IP 7).

Professional experience makes a difference

Knowing clinical routines and mastering professional competence were parallel ways of describing the importance of professional experience. This category encompasses three subcategories. First, experience is a crucial component of professional practice, refers to the level of professional experience and how adequately the patients received care. For example, introduction to the ED work environment for newly graduated HCPs or HCPs under training was described as inadequate. HCPs tied to other units with irregular work shifts in the ED lacked ED-specific skills, routines, and consistency, which hindered the work progress of the team. Thus, inexperienced members demonstrated more teamwork failures, which were considered crucial when the decisions depended on a specific profession's function (Table 4, IP 6). In addition, frequent changes of HCPs were described as contributing to the loss of teamwork spirit and diminished trust in the capacity of the team. When participants were familiar with team members’ professional skills and established routines, a sudden change of HCPs would create dissatisfaction. For the second subcategory, expectation of professional experience, participants described situations in which the management had fostered the expectation among newly employed HCPs that little experience was needed for the work at hand. Thus, the anticipation of other team members’ experience within a team was described as crucial and related to the specific profession and the length of clinical work experience. The subsequent teamwork was experienced as decisive depending on which team member was involved and their professional role. An imbalance in the levels of professional experience of team members represented a challenge. Nevertheless, lack of experience within a team could, if mutual awareness of communication existed, create satisfactory interprofessional teamwork. The expectation of functional teamwork emerged from work experiences with colleagues who practiced successful interprofessional teamwork (Table 4, IP 19). The need for continuous development and training, the third subcategory, reflects experiences regarding clinical education and simulation training. The simulation training united team members and allowed the sharing of information about ED-specific routines in acute situations and in interprofessional teamwork. Clinical training in emergency care and emergency medicine was referred to as highly important for creating a structured work flow and becoming aware of interprofessional teamwork roles (Table 4, IP 18). Lack of an introductory phase and professional training, as well as insufficient implementation of work routines (see also the category of Management support, structure and planning) were described as factors that delayed the assessment process for the patient. In these cases, HCPs had to navigate the work environment on their own, which generated feelings of insecurity for both the team and the individual HCP (Table 4, IP 21).

Demanding physical and psychosocial work environment

This category highlights aspects of the possibility to perform optimal interprofessional teamwork within the ED environment. For the first subcategory, the physical work environment, participants described the importance of working in close physical connection to each other, enabling rapid assistance and communication. However, this was not always preferable in narrowly spaced working environments, especially when the clinical situation worsened. Colleagues with good intentions rendered assistance in such situations, even though this increased crowding, and working in a confined area became more difficult (Table 4, IP 6). Furthermore, the noisy environment with loud alarms and patient crowding in the ED disturbed the working environment (Table 4, IP 9). Second, dealing with emotions related to stress, participants described the challenge of balancing the onerous demands of severely ill patients with providing a satisfactory level of care for all patients. Occasionally, this led to colleagues speaking harshly and loudly (i.e., screaming) during communication with colleagues. At the same time, participants referred to the work in the ED as uniquely demanding and challenging, where they needed to conceal their feelings (Table 4, IP 2).

Balancing communication demands

This category includes those attributes that hinder or enable interprofessional team communication, and consists of three subcategories. The first subcategory, applying communication (tools, climate and attitudes) relates to experiences regarding the challenge of exchanging information and, thus, balancing the demands of listening and sharing information. To balance the needs for different verbal communication tools, speaking up and closed loops and even interruptions by colleagues, were described as common and successful if used correctly (Table 4, IP 11) Participants described nursing staff and physicians who were familiar with the ED as those who established the standard ways of working. Colleagues with an unpleasant attitude were socially accepted in the ED due to their position in the internal ranking order, based on years of clinical experience and popularity. If these attributes were used in a permissive way, it was constructive. Interprofessional team members, consulting within the ED, had to be attentive to the standards so as not to create conflicts or to feel uncomfortable in their communication (Table 4, IP 8). The second subcategory, the art of concise and clear information, highlights the challenge of communicating precise information with the correct details on the intended occasion. Participants expressed the view that more details should be written in the medical record rather than being verbally reported to the whole team, to avoid creating confusion. In contrast, other participants pointed out the importance of ‘thinking aloud’ as a way to avoid missing any input from colleagues in the interprofessional team (Table 4, IP 15). The third subcategory, silent communication, relates to eye contact, facial expressions, and gestures between HCP team members. This was described by participants as something that increased or sometimes replaced verbal communication. For example, a silent question was posed through facial expressions and thoughts that could not be addressed aloud were transmitted via gestures (Table 4, IP 17). Handwritten notes about laboratory tests or prescriptions were described as silent communication that lay outside the patients’ hospital records.

Lacking management support, structure, and planning

Participants shared experiences about the given prerequisites for the interprofessional team. This category has three subcategories. First, ED considered an unsuitable place of care, participants reported advanced and time-consuming healthcare situations in a suboptimal hospital location, the ED. HCPs were forced to take on unfamiliar advanced medical treatments or for which there was a lack of sufficient space, time and equipment. While the advanced medical treatment was described as being successfully implemented in the ED, with the interprofessional team, it was not however beneficial for the long-term primary patient plan. Thus, this subcategory was further described as a hazard to other waiting patients (Table 4, IP 9). Regarding the second subcategory, mismatch of available resources and excessive workload, participants reported experiencing direct shortages of resources, i.e., HCPs and beds, which posed a challenge to the efficiency of the interprofessional teamwork. When the number of visiting patients increased (crowding), HCPs were challenged to prioritize patients and possible interventions (Table 4, IP 16). Participants further described a lack of time to execute routines that would advance the teamwork (Table 4, IP 27). Insufficient time for care resulted in exacerbated situations and caused patients to deviate from their care plan. The third subcategory, discordant view on strategies of care, is concerned with experiences regarding strong confidence in traditional working routines. Situations were described in which nursing staff had become so used to the absence of physicians from the team that they no longer cared about the consequences (Table 4, IP 5). Participants further reported dysfunctional collaborations between wards and the ED, and a lack of mutual understanding of the requirements of the daily work and associated obstacles. Another example in this subcategory was the experiences of managers who directed the work from a distance, addressing statistical numbers but lacking oversight and appreciation of the quality of the bedside care and the issues that mattered on the floor of the ED (Table 4, IP 24).

Tensions between professional role and responsibility

This category relates to experiences with crossing the line, personally and professionally. For the first subcategory, gender roles and hierarchies of expertise, experiences were stated regarding issues with collaboration due to gender affiliation and gender stereotypes, as well as non-dependent professional roles (Table 4, IP 1). Gender schisms were described as an accepted feature of the ED. Specifically, male colleagues were described as being more readily incorporated into the team than their female colleagues, a hierarchy in which women were ranked lower than men. The second subcategory, violation of personal and professional integrity, brought forth experiences related to situations in which HCPs pushed colleagues to make a rapid and unpremeditated assessment. Team members from other professions were spoken of in a disparaging way when they questioned the wisdom of certain decisions (Table 4, IP 2). Furthermore, participants described experiences where colleagues suggested a treatment but were verbally reprimanded for violating interprofessional boundaries.

Different views on interprofessional teamwork

This category, which is concerned with experiences of how interprofessional teamwork is considered as a functional unit, comprises three subcategories. First, inadequate involvement/intrusion by the patient, participants described situations in which patients directly influenced the interprofessional teamwork negatively. Patients with long waiting times interrupted the teamwork with questions and a need for care. There were situations in which the patients overheard inappropriate discussions of the ambition levels of the care and delicate questions about medical restrictions (Table 4, IP 6). Second, personal relations and favoritism, participants described trust, based on personal relations, as being more robust in a professional teamwork. The hierarchy was less-evident and the communication was more-effective. There were situations where colleagues favored some persons over others, and this compromised the teamwork (Table 4, IP 25). In the third subcategory, perspective on teamwork attributes, participants referred to the team leader as someone who had the clear function of leading the team and directed all the team members in accordance with their distinct roles. To deliver adequate patient care within a reasonable timeframe, teamwork was described as being dependent upon a leader who was physically present. However, the expectations that the interviewees had of the leader were described related to a personal quality rather than the profession of the leader (Table 4, IP 15). Participants described different views of teamwork and how this affected interprofessional interactions. Moreover, participants expressed a demand of guidelines as how to collaborate interprofessionally to avoid different views on teamwork (Table 4, IP 25).

Confidence in interprofessional team members

This category recognizes the need for mutual assistance and the impact of given or absent support. For the first subcategory, joint team assessments, participants described the value of assessing patients together, using the interprofessional expertise and resources within the team. Concurrently, situations in which colleagues from different professions were favored or alternatively rejected by team members were regarded as poor interprofessional teamwork. Work responsibility was individually linked and referred to as a collective interaction (Table 4, IP 12). Mutual need for interprofessional support constitutes the second subcategory. Participants shared experiences of vulnerability and complete dedication to the patient with their colleagues. This action encouraged confidence in team members (Table 4, IP 7). Participants described feelings of frustration when the experience of supporting colleagues could not be applied in all situations, which is when the absence of support became evident (Table 4, IP 14). In contrast, participants also shared experiences of unsupportive colleagues who acted as poor role models for their profession. These colleagues were associated with substandard treatment and negative attitudes towards patients (Table 4, IP 21).