health systems , particularly those in industrialized countries , are struggling to meet both the needs of aging populations and growing numbers of clients with multiple and complex health issues.1 additionally , health systems face cost constraints , workforce shortage pressures , and increasing complexity of required health care knowledge.24 historically , interactions between health professionals have been authoritarian and dominated by doctors.5 faced with multiple health system challenges , governments are advocating for more team - based approaches to health care,3,6,7 to increase the number and balance of complementary contributions to client - focused care.8 a recent report on team - based health care emphasizes the potential of teams to improve the value of health care.9 health professionals working in teams to deliver health care is neither a new concept nor a new practice . the concept of team care was mooted and documented as early as 1920 , in a report to the uk minister of health10 recommending that  general practitioners ; visiting consultants and specialists ; officers engaged in communal services ; visiting dental surgeons ; [ and ] workers in ancillary services  work together in primary health centers . the practical implementation of health care teams can be traced to the development of engel s 1977 biopsychosocial model of health.1113 the model incorporates social , psychological , and behavioral dimensions of illness13 and seeks to address inadequacies in the traditional biomedical model of care in which disease , and not the client , predominates.14 engel13 asserted that a more holistic model of care could be achieved with a shift in focus from doctor - centric service delivery to health care services delivered by teams of professionals . a search of the cinahl database for english - language text using the terms health care team  or interdisciplinary ,  and  multidisciplinary  are terms used to describe both members of different professions working together as health care teams and ways in which health care teams collaborate . inconsistencies in terms used to describe health care teams in either context , including the interchangeable use of terms , are apparent in the literature and are highlighted by numerous researchers.8,1519 a search of the literature did not find any reviews that have specifically considered patterns of terminology usage . while standardized definitions of terms used to describe different health care teams may not be feasible , given the complexity of health care contexts , gaining an understanding of current patterns of usage will contribute to greater consistency in the use of terminology . gaining an understanding of how and in which context health care team descriptors are being used provides a departure point from which stakeholders can reflect on terminology usage prior to developing interprofessional education programs , conducting research , writing policy , or developing teams . consistency in the use of terms to describe different health care teams in policy , education , training , clinical practice , and research could improve communication between sectors , enable individual groups to focus on improving the contribution that each make to the client health care journey , and provide greater clarity for consumers . until now there has been no review of the use of terminology relating to health care teams . a clearly identified gap in the literature makes the findings of this integrative review significant in developing this substantive area of inquiry . the purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams . a search of the cinahl and web of science ( thomson reuters web of knowledge ) databases was conducted using the following criteria : english - language text published between 2000 and 2011 . tx all text  field in cinahl and in the  ts ( topic )  field in web of science were interprofessional  or multidisciplinary combined with  and  health team  or  health care team . dissertations and theses abstracts of all journal articles returned in the search were screened and the articles were retained if the abstract included one or more of the terms interprofessional , multiprofessional , interdisciplinary or multidisciplinary and the term  health team  or  health care team .  the full text of retained articles was then screened and the articles were retained if they included a definition of interprofessional , multiprofessional , interdisciplinary , or multidisciplinary ; if they identified health care team members ; and if they related to health care teams in health practice settings . this resulted in 17 journal articles being included in this integrative review ( table 1 ) . it enables a fuller understanding of phenomena , as it allows for the inclusion of literature related to studies using diverse methodologies.20,21 as the phenomenon of this review is the use of terminology to describe health care teams , included journal articles were not methodologically critiqued or assessed using a hierarchy of evidence - for - practice , although assessment is often performed in literature reviews . during the literature search for this integrative review , the authors found a substantial number of journal articles relating to health care teams in the context of education . the authors observed that the term interprofessional is consistently used in relation to the joint education of health professionals from various health professions and disciplines . a separate review of the literature would need to be conducted to provide evidence for this observation . the authors acknowledge that the terminology used in health care education may affect the terminology used in practice . however , given the extent of literature relating to health care teams in educational contexts , journal articles relating to health care teams in the context of education were excluded from this literature review . included articles were reviewed to ascertain how terminology used to describe health care teams is defined in the literature . comparative analysis of journal articles resulted in findings that relate to frequency of terminology usage , justifications for use of specific terminology , commonalities and patterns related to country of origin of research studies and health care areas , ways in which terminology is used structure of team membership , and perspectives of definitions used . the discussion section of this article contextualizes findings in this review within the broader literature . this integrative review of the literature found that the term multidisciplinary is used more frequently than other terms to describe health care teams . of the 17 journal articles included in this review , nine use multidisciplinary , four use interdisciplinary , and three use interprofessional ; the remaining article uses both multiprofessional and interprofessional ( table 1 ) . while all studies define the term used , only four studies justify their choice of terminology . solheim et al23 acknowledge distinctions between the terms multidisciplinary and interdisciplinary and base their use of multidisciplinary  on the value of having more than one discipline on a team . atwal and caldwells24 use of the term multidisciplinary in their study is justified as follows :  the experience of working together in a multidisciplinary team was one that was common to all nurses within the study area , whereas working interprofessionally was less well understood . gibbon et al25 chose to use the term multiprofessional in reference to the structural components of a team and the term interprofessional in reference to processes of intervention . kvarnstrms26 study into health professionals perceived difficulties in teamwork uses the term interprofessional , stating :  the prefix profession thus different[iates ] from the term  discipline in the sense that disciplines may be regarded as academic disciplines or sub - specialties within professions . the term multidisciplinary is used in the two australian studies relating to chronic disease.27,28 of the four studies conducted in the united states , three relate to geriatric care and all three use the term interdisciplinary.11,29,30 there is no consistency of terminology usage in the three canadian studies included in this review : delva et al31 use the term interdisciplinary , shaw32 uses interprofessional , and haggerty et al33 use multidisciplinary . although , the article by haggerty et al33 does not define the members of a multidisciplinary team per se , the study includes family physicians , nurses , academics , and decision makers , and it asks participants to define an operational definition for  multidisciplinary team . this question resulted in more than 80% of haggerty et als33 study participants agreeing to the following definition for multidisciplinary teams : practitioners from various health disciplines [ who ] collaborate in providing ongoing health care.33 findings indicate that terminology used to describe health care teams refers in some instances to the structural component of a team ; for example , gibbon et al25 use the term multiprofessional to describe teams in their study . delva et al31 use the term interdisciplinary to define the collaborative ways in which groups of professionals work together to develop processes and plans for patients . shaws32 use of the term interprofessional , as defined by damour and oandasan,34 encompasses both dimensions of collaboration and professions working together ( refer table 1 ) . regardless of the terms used and regardless of whether the terminology describes members of different professions working together in a team or the way in which team members collaborate , all included journal articles refer to the structural composition of health care teams . teams are composed of members from a range of professional backgrounds and disciplines ( table 1 ) . doctors and nurses are members of all health care teams featured in the included literature . generally , teams also include a range of allied health professionals and other specialist health professionals , depending on the health area and setting in which the teams operate . delva et al31 include receptionists , secretaries , and administrative staff as members of interdisciplinary teams in primary care teaching practices . a study by mills et al35 includes indigenous health service managers and district health service managers as members of interprofessional health care teams in remote areas of queensland , australia . chaplains are included as members of interdisciplinary geriatric and palliative care teams in the study by goldsmith et al.29 medication and medication management are key elements in the treatment of most health conditions ; pharmacists , however , are included as health care team members in only three30,32,36 of the 17 articles included in this review . almost all of the journal articles include definitions of health care teams that reflect a provider - centric perspective . of the 17 articles , only one32 includes a definition that refers to the participation of patients . other definitions that refer to patients tend to reflect a traditional model of care in which health professionals are active participants and patients are passive recipients of care . for example , in the article by atwal and caldwell,24  team members [  ] make contributions to patient care  ; in the article by chan et al,27  a leader [  ] takes responsibility for overall patient care  ; and in the article by molleman et al,36 care providers collectively [ discuss ] a patient leading to [  ] decision - making and action . conversely , damour and oandasans34 definition of interprofessional , as adopted by shaw,32 suggests that patients are encouraged to play an active role in teams , as teams thylefors et al37 assert that , in the broader literature , interprofessional , multiprofessional , interdisciplinary , and multidisciplinary appear to be the terms most frequently used to describe health care teams . although standardized definitions for each term have not been broadly adopted , the interprofessional education collaborative expert panel,38 in a 2011 report on collaborative practice , recommends terminology and operational definitions around interprofessional team work . additionally , conceptual frameworks that situate teams on a collaborative continuum also provide guidance around terminology usage.39,40 nonetheless , the broader literature shows some generally accepted features of commonly used terminology . multi  generally refers to team members from different disciplines working parallel to one another to treat clients . members share information but do not necessarily share common understandings , and the group does not generally follow formal processes.17,26,42,43 the prefix  inter  means  between ; among [  ] mutually ; reciprocally.41 the literature suggests that interprofessional and interdisciplinary health care teams tend to have more formal structures , such as shared decision - making and conflict resolution processes . members work interdependently to pool their knowledge in order to achieve a common goal that results in more than the sum of its parts.12,15,17,42,43 the notions of interdependence and shared decision making feature in numerous definitions ; however , in each instance the authors use the term multidisciplinary ( refer table 1 
 36,44,45 ) . these discrepancies support extant literature that highlights inconsistencies in terminology usage and interpretations.8,1519,46,47 the terms interprofessional , multiprofessional , interdisciplinary , and multidisciplinary are terms frequently used to describe health care teams . however , these terms are not always defined . a particular case in point is an article by maslin - prothero.48 multidisciplinary teams are referred to 31 times in the article without the author once defining what is meant by the term . the reader does not know who the members of the team are or how the author defines the term multidisciplinary . well - read scholars may quickly assume a definition based on prior knowledge , regardless of its fit with the type of team referred to in the text . by authors and editors making an assumption that the reader will know what the term used means , they are neglecting the fact that a broad audience , including students , clinicians , policy makers , and academics , access published research . providing definitions to key terminology used in both published and gray literature enriches the reader s experience . analysis of literature included in this review within a broader literature context highlights factors that may influence terminology usage . of the three australian studies included in this review , two relate to chronic disease , and in both instances the articles use the term multidisciplinary.27,28 in contrast , us studies in the areas of geriatric , palliative , and elder care feature the term interdisciplinary.11,29,30 use of the term multidisciplinary in the context of the australian studies included in this review27,28 reflects australian policy decisions . for example , multidisciplinary care and multidisciplinary teams are features of most chronic disease strategies in australia.4953 however , in these strategies reference to multidisciplinary care and multidisciplinary teams is generally only in relation to the structural dimension of professional representation and , in the case of the strategy in new south wales,51 to the setting in which teams work . the strategy in queensland52 is the only australian chronic disease strategy to provide a specific definition of multidisciplinary teams . the key feature that differentiates the interprofessional teams referred to in this particular strategy from the multidisciplinary teams referred to in the other state strategies and in the australian national strategy is the inclusion of the consumer  as a key member of the care team . the use of the term interdisciplinary in us studies relating to geriatric , palliative , and elder care reflects training and care models used in these specialty health areas and highlights linkages between training and practice.11,29,30 the importance of providing an interdisciplinary training environment to promote interdisciplinary care models is best evidenced in the area of geriatrics . in 1997 the john a hartford foundation funded the development of eight national geriatric interdisciplinary team training programs in the united states , and this led to approximately 1800 students and 150 practicing health professionals being trained in this area.16,55 approaches to both geriatric and palliative care are grounded in an interdisciplinary / biopsychosocial care model.29,56 this model promotes holistic , client - focused care delivered by interdisciplinary teams , and it is an integral component of the philosophy of care used in these specialty areas.56,57 so just how important is the labeling of health care teams ? mccallin8 contends ,  it is possible that the labels assigned to people working together [  ] are relatively unimportant ,  particularly when terminology does not reflect the way in which team members interact and deliver care . however , as ovretveit58 cautions , current issues relating to terminology usage arise when designing and improving teams , as  people use the same word to mean something different . holmes et al16 consider that  efforts to understand teams fully are hampered due to the diversity of terms in which they are described and conceptualized [  ] definitional clarity [  ] [ is therefore a ] perquisite [ sic ] to further research on teams .  adopting an overarching term such as  team - based care ,  as defined by mitchell et al,9 is also worth serious consideration . an over arching term that encompasses the principles of team care may well alleviate the need to label specific teams , thereby avoiding inconsistencies in terminological usage . consideration of these comments and the findings of this literature review suggest that either the development of a common understanding of current terminology or the adoption of an overarching term to describe health teams would be valuable and would support consistency in the use of terminology in policy , education , training , clinical practice , and research . a search strategy using a broader time frame may provide evidence of the influence of historical socialization patterns in terminology usage , as mccallin8 suggests . because of the large number of articles sourced and the pace of health care changes , the authors elected to limit the literature search to this time frame . this review also included refining search strategies , which required journal articles to include a definition of terminology used and a list of health care team members . a quantitative study of terminology usage that excludes refining search strategies may provide a broader picture of terminology usage and significant evidence of inconsistencies in terminology usage referred to in the broader literature . additionally , the use and definition of specific terms may differ more extensively between countries and health systems than those referred to in this review . as population health care needs change , the trend towards teams of health professionals from various disciplines working together to deliver coordinated client care is undeniable . this review demonstrates that a range of terms  interprofessional , multiprofessional , interdisciplinary , and multidisciplinary  are used to describe health care teams . patterns of use of the term interdisciplinary are clearly identified in the us geriatric care literature , while the use of multidisciplinary in the two australian chronic disease studies is reflective of australian state and national strategies . it is now more than a decade since ovretveit58 concluded that research , discussion , and decision making around  which type of team is best for a particular purpose and setting  requires stakeholders to be able to describe a team . the growing emphasis on interprofessional education and learning within health care and the development of recommended operational definitions and conceptual collaborative frameworks to guide terminology usage , may result in shared definitions that are used in both education and practice . however , the terminology used in national policies and strategies influences the terminology used in funding applications , and the researchers who submit these applications are employed in the tertiary institutions educating the future health workforce . stakeholders across the entire health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful . notwithstanding some congruence in terminology usage , this review highlights inconsistencies in the literature and suggests that broad debate among policy makers , clinicians , educators , researchers , and consumers is still required to reach useful consensus .
purposehealth systems around the world are struggling to meet the needs of aging populations and increasing numbers of clients with complex health conditions . faced with multiple health system challenges , governments are advocating for team - based approaches to health care . 
 key descriptors used to describe health care teams include  interprofessional ,   multiprofessional , 
 interdisciplinary ,  and  multidisciplinary . 
 until now there has been no review of the use of terminology relating to health care teams . 
 the purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams.methodsan integrative review of the literature was conducted because it allows for the inclusion of literature related to studies using diverse methodologies . 
 the authors searched the literature using the terms interprofessional , multiprofessional , interdisciplinary , and multidisciplinary combined with 
 health teams  and  health care teams .  refining strategies included a requirement that journal articles define the term used to describe health care teams and include a list of health care team members . 
 the literature selection process resulted in the inclusion of 17 journal articles in this review.results:multidisciplinary is more frequently used than other terminology to describe health care teams . 
 the findings in this review relate to frequency of terminology usage , justifications for use of specific terminology , commonalities and patterns related to country of origin of research studies and health care areas , ways in which terminology is used , structure of team membership , and perspectives of definitions used.conclusion:stakeholders across the health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful . notwithstanding some congruence in terminology usage 
 , this review highlights inconsistencies in the literature and suggests that broad debate among policy makers , clinicians , educators , researchers , and consumers is still required to reach useful consensus .