2 - Team Working and Effectiveness of Healthcare
2 - Team Working and Effectiveness of Healthcare
2 - Team Working and Effectiveness of Healthcare
The research programme was carried out over a three-year period. Information on
team working was gathered from some 400 health care teams using the methods
described in Box 2. This involved consulting over 7000 NHS personnel and a large
number of NHS clients. Five national workshops were held with key representatives
from primary and community mental health care. A wide range of research methods
were used, including questionnaire surveys, telephone interviews, in-depth interviews,
observation, focus groups and video and audio tape recordings of team meetings.
The research was carried out in two stages: quantitative data collection from 100
primary health care teams (PHCTs), 113 community health care teams (CMHTs) and 193
secondary health care teams (SHCTs), and in-depth work with a sub-sample of teams.
Sample size
Survey data
Additional
questionnaires/
Telephone interviews
External ratings
PHCT
100 teams
1156 respondents
Team composition
Team functioning
Team effectiveness
Team innovation
Member well-being
Team meetings
Team management
Decision making
Team effectiveness
Team innovation
CMHT
113 teams
1443 respondents
Team composition
Team functioning
Team effectiveness
Team innovation
Member well-being
Team composition
Team meetings
Team management
Decision-making
Team effectiveness
Team innovation
Type of team
Team membership
Team member
turnover
Box 2:
SHCT
Sample 1:
193 teams
1233 respondents
Sample 2:
2263 respondents
Team composition
Team functioning
Well-being
Team viability
Team membership
Member well-being
Work role
What is a team?
A team is a group of individuals who work together to produce products or deliver
services for which they are mutually accountable. Team members share goals and
are mutually held accountable for meeting them, they are interdependent in their
accomplishment, and they affect the results through their interactions with one
another. Because the team is held collectively accountable, the work of integrating
with one another is included among the responsibilities of each member1
Team processes -
Team outputs -
INPUTS
TEAM PROCESSES
OUTPUTS
Domain
Leadership
Health Care
Environment
Clarity of objectives
Effectiveness - self
and externally rated
Organisational
context
Task orientation
Clinical
outcomes/quality of
health care
Team task
Support for
innovation
Reflexivity
Cost effectiveness
Decision making
Team composition
Participation
Communication/
Integration
Team member
turnover
Innovation
Figure 2:
Team
effectiveness
Figure 1:
Team working
Team working
Figure 3:
Stress
higher scores
indicate
higher levels
of stress
Figure 4:
Stress
higher scores
indicate
higher levels
of stress
Team working
Figure 5:
Stress
higher scores
indicate
higher levels
of stress
Proportion of Managers
Figure 6:
Innovation
Figure 7:
Innovation
Figure 8:
Figure 9:
Team
working
Figure 10:
Stress
higher scores
indicate
higher levels
of stress
Figure 11:
Conclusions
Health care teams that have clear objectives, high levels of participation, emphasis on quality
and support for innovation, provide high quality patient care. Such teams also introduce
innovations in patient care.
Members of teams that work well together have relatively low levels of stress.
In primary health care teams particularly, a diverse range of professional groups working
together, is associated with higher levels of innovation in patient care.
The quality of meetings, communication and integration processes in health care teams,
contributes to the introduction of new and improved ways of delivering patient care.
Clear leadership contributes to effective team processes, to high quality patient care, and to
innovation.
The findings deliver an important message to those concerned with health care organisation and
delivery; good teamwork makes a critical contribution to effectiveness and innovation in health care
delivery, and also contributes to team members well-being.
Whether there are clear team objectives and feedback to the team on its performance.
The necessary technical assistance and resources to support the team in its work.
HRM systems geared towards teams, including selecting for and appraising teams
and providing assistance for teams.
Leadership in teams.
A report giving full details of the research methods and findings can be obtained from Aston
Centre for Health Service Organisation Research - 0121 359 3611 extn 5045.
Two practical workbooks have been produced to help with the implementation of team
working:
References
1. Mohrman, S.A.,Cohen, S.G. and Mohrman, A.M.Jr (1995). Designing Team-Based
Organisations. San Francisco: Jossey-Bass.
2. The NHS Plan: A plan for investment, a plan for reform. HMSO 2000
3. National Health Service Management Executive (1993). Nursing in Primary Care - new
world, new opportunities. Leeds: NHSME.
4. Haward, B., Amir, Z., Borrill, C.S., Dawson, J., Sainsbury, R., Scully, J. and West, M.A. Do
breast cancer teams work? The impact of constitution, new cancer workload, and methods
of operation on effectiveness. University of Leeds. 2001.
5. West, M.A., Borrill, C.S., Dawson, J., Scully, J. and Patterson, M. The link between
management of employees and patient mortality in acute hospitals. Aston University, 2001.
6. West, M.A. and Slater, J.A. (1996). The Effectiveness of Team Working in Primary Health Care.
London: Health Education Authority.
7. Audit Commission (1992). Homeward Bound: A New Course for Community Health.
London: HMSO.