The Effectiveness of Health Care Teams in the National Health Service

Teams that have to make complex decisions report that planning enhances their
performance (Hackman, Brousseau & Weiss, 1976; Smith, Locke & Barry, 1990).
However, when the environment becomes more uncertain, problem identification is
more difficult (Hedburg, Nystrom & Starbuck, 1976; Kiesler & Sproull, 1982).
Ineffective teams tend to deny, distort or hide problems (Stein, 1996). In some
teams, the identification of problems is discouraged as problems are regarded as
threats to morale, or a source of conflict (Janis, 1982; Miceli & Near, 1985; Smircich,
1983).
Thus far we have reviewed the benefits (and potential difficulties) of teamworking in
health care organisations - but the fact that teamworking takes place within
organisations is often ignored in the zeal to promote team effectiveness.
Accordingly, we now turn to address what is currently known about the influence of
their organisations upon teams.
Organisational context
Recent research suggests the broader context within which teams work has an
influence on their performance. Indeed the major change in emphasis in research on
teams in the last 15 years has been the shift from discussion of intrateam processes
to the impact of organisational context on teams. The organisation within which a
health care team functions can influence team effectiveness in a variety of powerful
ways. Researchers, such as Hackman (1990) and Tannenbaum, Beard and Salas
(1992) have suggested that the following are among the contextual factors that
influence team effectiveness:
• Team and organisational rewards
• Team objectives and performance feedback
• Training and technical assistance
• Physical work conditions
• Organisational climate
• Inter-team relationships
• Contracts and management structures
• Team size
These factors will be discussed further, in turn.