Team working for interprofessional collaboration 1. Learning Outcomes Describe team processes and the need for effective communication from team members Recognise the conditions for effective team working and your personal attributes as a team member Discuss why conflicts might occur within a team and identify possible solutions Voice over: Welcome to this e-lecture Team working for interprofessional collaboration. Interprofessional collaboration has been described by the Social Care Institute for Excellence (SCIE) as the activity of different professions working together co-operatively to improve both people's experience of the services they use, and the outcomes that can be achieved. This has been recognized as an important issue for a number of years and the World Health Organization s statement issued in 2010 emphasizes the fact that there is clear evidence that interprofessional collaboration improves patient/service user outcomes. Interprofessional collaboration is therefore pivotal to our optimizing the health and wellbeing of those we care for. Collaboration, by definition, cannot be an individualistic endeavour; collaboration indicates people working in partnership. This e-lecture will address some key points: Teams their nature and processes The individual in a team what type of team members are we as individuals and how does this influence our contributions? Interprofessional teams are interprofessional teams different to uni-professional teams? Conditions for effective team working what makes teams work? What part do organisations and professional cultures play, and how can we think about team working psychologically Why conflicts might occur conflict can be distressing and militate against working for the benefit of those we care for, what can go wrong? How effective teams use conflict positively conflict, although uncomfortable can also be used positively and not allowed to disrupt and destroy Page 1 of 8
2. Teams When considering the nature of teams we are thinking about what a team actually is. Jelphs and Dickinson (2008) give a useful overview when they indicate that teams tend to be smaller in number than groups; a team shares a vision, objectives and goals; there is interdependence in meeting these goals rather like pieces of a jigsaw; team members have complementary skills and understand the skills that each other have; a team has an identity in that it is recognisable to itself and to others; teams need and thrive on some sort of leadership. A team therefore, is a relatively small group of people the literature suggests not more than 15 members (see Meuller et al, 2000 and Belbin 2000), and its members work together, interdependently towards shared goals. Team processes infers issues of how teams work. Team working is seen as the solution to many of the complex challenges in contemporary health and social care. Jelphs and Dickinson (2008) suggest that the complexities and structural difficulties facing organisations require activities that are flexible and coordinated to meet the aims of the organisation, and team working can be an effective way of moving forward. If we refer back to the nature of teams we can derive some notion of how teams work effectively. If we accept that teams work with a shared vision, aims and objectives we can understand that communication is a vital issue not only between team members but across other teams, agencies and organisations. Communication is not just about coming to agreed definitions and understandings about the focus of the work, but being able to communicate these to others so that all other individuals, teams, agencies and organisations can understand the scope and potential of the team. Another aspect of communication is the appropriate sharing of information among other members of the team and other teams, organisations and agencies that require it to ensure the safety and care of those who access our services. Obviously this must occur within legal and ethical parameters. However inappropriate or misguided withholding of information has been central to many disasters within health and social care (see the Laming report (2003) of the Victoria Climbié inquiry for example). Such communication issues also relate to explaining, understanding and respecting the competence, knowledge and skills of each other within the team. Effective teams work within a framework of understanding the role that each other can play in meeting the needs of patients or service users. Effectiveness also includes the positive use of the interdependent aspects that can be brought into play by all members of the team. Page 2 of 8
3. The individual in a team team roles You may have already observed that some teams seem to work better than others. You will see during this e-lecture that there may be a number of factors involved in how well teams function. One aspect is the impact of the role individuals take within the team. Belbin s (1981) seminal work in the 1970s involved observing effective teams and determining why they worked so well. His observations led him to the conclusion that teams that carried out their functions effectively had a balance of team members who demonstrated certain behaviours, leading him to suggest that individuals carry out certain roles within teams. He defines a team role as describing how we tend to behave, contribute and interact with others in team situations. You may have carried out a team role inventory based on Belbin s work to identify your own team role and come to some recognition of how you tend to behave in a team. It is important to remember that any one person might undertake more than one of these roles, and Belbin s work does not suggest there has to be nine members in a team for it to be successful. Here is a recap of the team roles according to Belbin. They include: Plants: Their function is to generate new proposals and to solve complex problems. They are good at initiating and making sure projects keep progressing. Resource investigators: Their function is to explore and report back on ideas, developments and resources outside the group. They are good at networking and negotiating on behalf of the team. Co-ordinators: They work well with teams that have people with diverse skills and personal characteristics. They are good at working with peers and equals and tackle problems calmly. Shapers: Their function is to generate positive action and they spark life into the team. They are good at working under pressure and do not mind making unpopular decisions. Monitor Evaluators: Their function is to analyse and evaluate ideas and suggestions. They are good at weighing up the strengths and weaknesses of propositions and coming to carefully thought through decisions. Team workers: Their function is to prevent interpersonal problems within the team and allow all members to contribute effectively. They are good at diplomacy and at maintaining morale and co-operation. Implementers: their function is to provide good organisational skills and competency in undertaking all necessary tasks. They are good at applying solutions to problems and are very reliable. Completer Finishers: Their function is to foster a sense of urgency within the team and to promote the meeting of schedules. They are good at detail and follow through, and aspire to high standards at all times. Page 3 of 8
Specialists: Their function is to provide the rare skill upon which the organisation is based. They know more about their subject than anyone else and can be called upon to make decisions based on in-depth experience. Belbin's role descriptors suggest three orientations: a. Action Oriented Roles: in which the Shaper Challenges the team to improve. The implementer who puts ideas into action and the Completer Finisher who ensures thorough, timely completion. b. People Oriented Roles: in which the Coordinator acts as a chairperson. The team worker who encourages cooperation and the resource investigator who explores outside opportunities. c. Thought Oriented Roles: in which the plant presents new ideas and approaches. The monitor-evaluator who analyzes the options and the specialist who provides specialized skills. You might like to consider whether the result of your team role inventory revealed that you to tend towards action; people or thought orientated roles and whether this met how you saw yourself in team situations. You might also want to reflect on whether the roles you tend to take change according to the team or context you are in. Although Belbin s role descriptors all have positive attributes that contribute to effective team working, he also warned that these roles have to have a balance within the team. No role is more important than another, all have equal value to good team working but too many of one sort at the expense of others could hinder team effectiveness. It was also observed that there could be clashes of management style played out in role types, for example Co-ordinators more democratic style could contrast with Shapers more directive approaches and that Shapers might have a tendency to overrule or minimise the contributions of Plants (Belbin, 1981). How we behave as individuals within teams will affect how it functions. Gaining insight into the roles we tend to adopt helps us recognize the contributions we can make and also to be aware of how our roles might interact with those of other's. 4. Interprofessional teams Are interprofessional teams different to other teams? Whittington (2009) has described an interprofessional team as one made up of two or more professions who work together co-operatively to improve both people's experience of the services they use and the outcomes achieved. Page 4 of 8
It seems then, that the only difference between an interprofessional team and any other team is that its members, working closely together, are from more than one discipline. This diversity can add complexity in terms of defining and agreeing working terms, conditions, philosophies values, vision, aims and objectives but essentially the fundamental aspects of effective team working remain the same. Where this diversity is handled well, differences are valued for the richness and variety brought to working in the complexity of health and social care (Haigh, 2004). This notion of valuing the contributions of others is underlined by The Royal Colleges of Radiographers and Radiologists in a shared publication (2007) in which they state that mutual respect for each other s competency, skill and knowledge is an important factor in making the best use of each team member and thus successful teams. 5. Conditions for effective team working Rex Haigh, a consultant psychiatrist, defines five qualities of a therapeutic environment, and suggests how these might relate to effective team working. Haigh s work is within the mental health context but can be easily transferred to any team, interprofessional or uni-professional, working in any setting. Attachment - Refers to the basic need of infants for the nurturant and emotional bond forged between the baby and primary caregivers in order for that child to become a healthy human being. In terms of team effectiveness within a working environment, this basic need (or right) can be understood as that of each member feeling they belong and are valued within the team. In effective teams all staff members are encouraged to feel part of things and in this way they can contribute to their full potential. Haigh particularly refers to this aspect when students join teams to gain practice experience. He suggests time taken to induct students and new junior members of staff is well spent in terms of their being able to make useful contributions within a short timescale. Containment - Is about the promotion of a culture of safety, in which staff members feel sufficiently looked after by those in leadership or management positions. Trusting and respectful relationships between staff members develops a network within which everyone supports each other and reflective practice is the norm. Communication - Reflective practice also plays a part in the communication strategies of effective teams. This doesn t just relate to having defined channels of communication and referral, although these are important. Openness and reflection, where difficulties and conflicts can be voiced constructively promotes a culture in which team relationships are enhanced and supportive with the aim of ensuring care is safe. Involvement - Feeling included and paid attention to is an important part of developing the individual s identity in the team. We mentioned before that interprofessional teams can carry an Page 5 of 8
enhanced sense of diversity; this can carry a risk of isolation that threatens team effort if individuals do not feel fully involved in what is going on. Effective teams have members who appreciate each other s contributions and involvement is constantly promoted. Agency - Refers to a culture of empowerment. Team members share responsibility based on mutual trust and understanding of what all contribute. Model of team effectiveness The factors Rex Haigh describes relate to the conditions that teams might need in order to work effectively. This has taken a psychological perspective, although clearly effective team functioning is also subject to a number of other factors. Borrell and her colleagues derived a simple model to account for these in which inputs and team processes result in outputs, although synergy can be clearly found with Haigh s work. Inputs concern the environment being conducive, the organisation and its processes and systems being supportive, the team task being achievable and the team composition being favourable to complete the task. Team processes include the need for leadership and decision making; clarity of objectives; participation by all members; task orientation; communication and support for innovation. The outputs include effectiveness ; good clinical outcomes and quality of care; innovation; cost effectiveness; team members mental health and favourable staff turnover. 6. Why conflicts might occur Jelphs and Dickinson (2008) assert that conflicts occur because people see the world differently. The way these perceptions show themselves in behaviour are at times seen negatively by others resulting in conflict. Stapely (2002) on the other hand sees conflict or aggression (p75) as arising when one person s desires are not satisfied at the expense of another s. Stapely is writing in the context of football where it could be argued that conflicts are more acceptably played out as aggression than in the normal health and social care team. However, in the health and social care context it can be seen that one team member s desire for a certain course of action might be in conflict with another s. An example can be in discharge planning for a service user from acute hospital care back into the community. Some members of the team might consider the service user ready for discharge from their perspective, but others be concerned that from their perspective the service user is far from ready and conflict arises as some team members push for discharge and others resist. Added to this, community teams including social services may feel they need more time to arrange appropriate services or home adjustments or that the service user has been discharged without adequate information being communicated, again giving rise to conflict. To go back to Jelph and Dickinson s notion that conflicts occur because of different ways of perceiving the world, it could be argued that the more diverse the team, for instance in interprofessional teams, Page 6 of 8
the more likely it is to experience conflict, as in the example above. As mentioned before, interprofessional teams may have to work harder at reaching shared understandings and mutual settings of goals and agreement of how to achieve them, and as such may be more exposed to the risk of conflict. This can be very stressful and disturbing to team members. 7. How effective teams use conflict positively However, conflict should not be viewed as universally negative. It can be challenging and uncomfortable, but effective teams are healthy enough to use conflict positively. A number of decades ago Janis (1972) identified the concept of group think in which, because of the desire to avoid dealing with conflict within the team, poor group decisions are made. This has resulted in tragedy in some notable cases. An example he gives is the NASA spaceship Challenger disaster in which seven astronauts lost their lives following an explosion occurring 73 seconds after takeoff. The resulting investigation revealed that poor decision making processes due to unwillingness to address and deal with conflicts were major contributors to the disaster (Rogers Commission Report, 1986). Jelphs and Dickinson (2008) argue that if teams are able to capitalise on the differences across the team membership that this enables the use of the rich resource within them. This suggests that positive views of any situation can be used to drive action forward balanced by any negative views that can identify pitfalls and risks that need to be managed. Also many different viewpoints can drive creative solutions for the benefit of the service user not forgetting that the service user and his/her carers are also a source of creative solutions tailored to his or her individual situation. Effective teams use conflict or differences of opinion within the team positively. These teams are expert in open and honest communication, and do not reject, trivialise or take for granted its importance. They take care to ensure all members are able to contribute in discussions; they value these contributions and take steps to ensure everyone fully understands each other. They recognise that critical opinions are useful in helping to avoid mistakes and at the same time can sensitively challenge opinions that seem out of step with the aims of the team. They can acknowledge and tolerate anger or irritation and build bridges when conflict occurs. 8. Conclusions Conclusions to be drawn from this e-lecture are: Teams are small groups of people working with a shared vision, towards common goals and objectives. The team roles that individuals play are of equal importance and value, but understanding how these need to be balanced promotes effectiveness. Page 7 of 8
Effective teams work interdependently, understanding, respecting and valuing each other s contributions with the service user at the heart of the team s interest. Interprofessional teams carry the same characteristics of other effective teams and whilst their diversity can carry the risk of increased conflict, their richness offers creative and flexible approaches to care. The service user and his/her carers are also valuable team members. Effective teams rely on positive working conditions for healthy functioning. Effective teams use conflict positively. Page 8 of 8