The Effectiveness of Health Care Teams in the National Health Service

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Conclusions • Systematic and revolutionary organizational change is necessary if the positive results of this research are to be implemented in practice. • NHS organizations have to developed as team-based, rather than hierarchical. • Structure, culture, work design, HRM and management have to accommodate and enable rather than impede team-based working. • NHS employees should be trained in the KSAs for working in teams. • NHS managers should be trained to manage team-based organizations.
Chapter 1 Teamwork, Communication and Effectiveness in Health Care: A Review The challenges of organising health care in the modern United Kingdom context are considerable. There are continual improvements in medical technologies, greater levels of knowledge and awareness amongst patient populations and increasing demands for the variety of sources of health care available within the National Health Service. The provision of free health care at the point of delivery to the population has become one of the most important issues in the national political agenda in the early part of the twenty-first century. At the same time the National Health Service has become a massively complex institution characterised by large organisations, repeated restructurings, and subject to a wide range of political and economic pressures. The response of the government has been to promise a huge increase in spending on the NHS; a key question to be answered in relation to this political agenda is how can we organise health care and achieve good, fair and cost effective services for the whole population. This report focuses on determining whether, and if so, how teamworking can help. In this first chapter we review the research evidence about the potential benefits of teamworking and the factors that influence the effectiveness of teams, focusing particularly upon their use in health care settings. We draw on empirical evidence from research conducted in the United Kingdom, mainland Europe, North America and Australia. The literature on team composition and the processes which influence team performance is briefly reviewed with particular emphasis on communication, decision-making and problem-solving. We then explore the influences of organisational context and leadership, before presenting the theoretical model which guided the research programme described in this report. First we consider what a ‘team’ means. The activity of a group of people working co-operatively to achieve shared goals is basic to our species (Baumeister & Leary, 1995). The current enthusiasm for teamworking in health care reflects a deeper,
Page 1 and 2: The Effectiveness of Health Care Te
Page 3 and 4: Appendix II Knowing the way: Effect
Page 5 and 6: Christine Carmichael June 1997 - Fe
Page 7 and 8: The objectives of the research were
Page 9: Index, Dr Foster; deaths within 30
Page 13 and 14: • Flat organisations can be monit
Page 15 and 16: audit of the case managers' records
Page 17 and 18: Specifically, West and Wallace (199
Page 19 and 20: There is some evidence that team me
Page 21 and 22: circumstances efficient teamwork re
Page 23 and 24: selected the best option. Following
Page 25 and 26: Team and organisational rewards It
Page 27 and 28: Thus the health care team may focus
Page 29 and 30: integrates interventions (Tannenbau
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Page 33 and 34: Inputs Teams work within a domain s
Page 35 and 36: Chapter 2 Primary Health Care Team
Page 37 and 38: midwives); 33.5% administrative sta
Page 39 and 40: External ratings - team effectivene
Page 42 and 43: Location Four location categories w
Page 44 and 45: functioning, issues of team process
Page 46 and 47: Organisational Context Figure 2.11
Page 48 and 49: Figure 2.12: Consultation and Quali
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Page 56 and 57: Introduction The data analysis expl
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Figure 3.4: Relationship between te
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It seems that professional diversit
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Bearing in mind that a larger score
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Figure 3.15: Clarity of Leadership
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Summary of Findings Chapter 4 Quali
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of the workshops and consultations
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Chronic disease management • effe
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Accountability • meeting NHS care
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Checklist of activities which contr
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Objective 1 - Promote, maintain and
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Objective 5 - High team member comm
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Measure 2 - Young People’s Sexual
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Percentage of team members who repo
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determined the percentage of patien
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test their generalisability for pri
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Introduction Chapter 5 Community Me
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As the Health Team Effectiveness re
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CMHTs managed. The main reasons for
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Section 4: Biographical information
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Number of members % of women 35 30
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Figure 5.4: CMHT occupational group
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CMHT response to emergency referral
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number of teams 50 40 30 20 10 0 Tu
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Team average tenure Average job ten
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� Team processes: team processes
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made about the running of the team.
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single evaluative or morale factor.
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turn, team characteristics were ent
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• Teams using integrated client c
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Team Inputs Information about the t
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Results The method of analysis was
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Figure 6.4: Impact of team processe
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4.5 4.0 3.5 3.0 2.5 2.0 -.2 0.0 .2
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external rating of team innovation
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meetings), beta = -.20, t = -2.20,
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Two factors, acting independently o
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that the majority of such training
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In relation to recruitment and rete
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Chapter 7 Community Mental Health T
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Figure 7.1: Process and effectivene
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Figure 7.2: Client caseload profile
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Figure 7.3: Summary of selected cli
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83 per cent of selected clients wer
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Figure 7.5: Summary of health econo
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Team I 39 26 33 Team J 45 39 13 TOT
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Figure 7.11: Costs and clinical tar
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Overall costs Overall cost per clie
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Referrals pooled in the team/number
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12 months. Of course, some of these
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We were also forcibly reminded of t
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Section 1: Biographical information
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comprised of six items with five in
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• Does your team have relatively
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The mean caseness of teams was 23.3
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Response Fifty-seven teams particip
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health care areas. For example, a b
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The Coronary Care Unit This team is
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specialities. The clinicians are in
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Summary of Findings Chapter 9 Secon
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Analysis of variance within and bet
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Role Conflict 148.16 1,2147
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etween team membership types in str
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237 team members (752 nurses, 114 d
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Multiple Team Membership Most peopl
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higher level unit (organisation, th
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Team size and type of Trust are ass
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Introduction Chapter 10 Meetings an
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Even in relatively small groups, ac
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did not code finer timing informati
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Figure 10.2: Communication in a pri
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Figure 10.4: Communication in a com
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Summary of Findings Chapter 11 Anal
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team's size (unrelated t-tests, all
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meetings, we will return to why thi
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taken up by "any other business" ra
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attendance to GPs and the practice
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(See Figure 11.8). The graph includ
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members in other ways. From the con
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equal responsibility subset (for eq
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Types of Meetings The number of dif
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Figure 12.2: Four Categories of Pra
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Teams which are commissioned by hea
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Although the meetings fell into the
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Figure 12.5: Duration of meetings i
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chairing meetings, such cases illus
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Attendance at meetings The CMHT mee
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describe the overall nature of CMHT
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Chapter 13 Conclusions and Recommen
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� Leadership also emerges as crit
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care teams must therefore be traine
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3. Team composition Today’s healt
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always be to move as quickly as pos
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customer satisfaction with retail o
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In traditional organisations, power
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Team processes When TBW is introduc
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Appendix I Measures Used Primary He
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Accessibility of the service to use
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Introduction The World Health Organ
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From this conceptual, background Po
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Com peting Values M odel Internal H
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care and of taking into considerati
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derived from 100 teams, examining t
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Rational Goal Objectives Example In
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Human Relations Objectives Example
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contingencies for each indicator, t
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Centre Steven Campbell Research Ass
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Appendix III Effectiveness Measures
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Objective: Promote, maintain and im
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Effectiveness To what extent......
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Relevance To what extent...... Are
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∗ If the measures suggest that th
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Measure 4 - Patient access to consu
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Next steps • Compare the average
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whether steps could be taken to ens
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Measure 8 - Patients have access to
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Objective: Efficient Use of Resourc
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Date: Day of week: Name: Job title:
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Measure 11 - Patients/clients who d
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Measure 12 - Efficient use of admin
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Objective: Continuous personal and
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Measure 16 - Team members use each
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Objective: Responsiveness to client
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Measure 19 - Patients’ experience
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5. The last two times that you aske
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18. In the last month: How many mor
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___________________________________
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Letters were sent to all the primar
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(ii) The principles of effective te
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• Which aspects of the PHCT servi
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the person’s environment such as
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Handout 3 Practical tips and guidel
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‘The best and most cost-effective
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feedback on performance against tho
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Handout 6 Practical tips and guidel
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Teamworking Mechanisms for reviewin
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Efficient use of resources Of no Ve
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Handout 10 Practical tips and guide
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Handout 14 Measuring Quality of Car
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Berger, J., Fisek, M.H., Norman, R.
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Department of Health (1990). The Ca
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Guzzo, R.A. & Shea, G.P. (1992). Gr
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King, N. (1990). Innovation at work
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Myer, C. (1993). How to Align Purpo
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Schober, M.F., & Clark, H.H. (1989)
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groups. Academy of Management Journ
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