Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members’ interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour. An interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle. All CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members’ interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified. This study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.

Dialogue interpreter training has traditionally focused on the way in which the interpreter manages, and maintains, verbal interaction between the primary participants while it seems to overlook the importance of specific non-verbal aspects that are inherent in mediated interaction. This article presents an alternative method for the training of medical interpreters by drawing on research on non-verbal communication in interpreter-mediated consultations with a view to drawing attention to the interpreter’s impact on the patient’s inclusion in a patient-centred framework during mediated consultations. More specifically, it provides evidence of non-verbal interaction that might open up new trajectories in the interpreters’ training by foregrounding the impact of the interpreter’s and others’ direction of gaze and body orientation on the accomplishment and maintenance – or lack thereof – of a patient-centred framework of communication. The present article reports on findings that emerged from the analysis of selected excerpts of authentic interpreter-mediated consultations within the framework of a training experiment. Coded instances of interaction are analysed by relying on Goffman’s ‘ratification process’, Goodwin’s ‘participation and engagement frameworks’ and Norris’ ‘modal density foreground–background continuum’. Hospital ethical approval and participants’ written informed consent were obtained prior to the collection of data.

Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.

Although the interpreter’s function in interaction has attracted significant interest in the literature, the focus is often restricted to verbal interaction alone. This paper introduces an analytical framework, based on Goffman’s construct of role, to examine how participants’ actions: (i) carry communicative meaning that complements their use of language; ii) are interdependent with those of other participants. The analysis also takes into account the normative frameworks which, to a certain extent, shape the interpreter’s and the doctor’s actions. Transcribed excerpts of two authentic medical consultations are examined, along with video stills. The recordings, with interpreting between Dutch and Russian, were made at a Belgian hospital; informed consent and ethical approval were obtained. It is shown that interpreters’ use of non-verbal resources can favour the patient’s inclusion in interaction when s/he is bypassed by the doctor, possibly interested in involving only the interpreter and in leaving little, if any, opportunity for the patient’s voice to be heard.