The Effectiveness of Health Care Teams in the National Health Service

care team whose members are dispersed across sites, will find decision making
more difficult and ineffective than a team whose members share the same physical
location.
Organisational Climate
The climate of the organisation - how it is perceived and experienced by those who
work within it - will also influence the effectiveness of teams (Allen, 1996). Where the
climate is one characterised by high control, low autonomy for employees, lack of
concern for employee welfare and limited commitment to training, it is unlikely
teamworking will thrive (Markiewicz & West, 1997).
The extra commitment and effort demanded in team-based organisations requires
organisational commitment to the skill development, well-being and support of
employees (Mohrman, Cohen & Mohrman, 1995). Competition and intrigue can
further undermine team based working in health care, since teamwork depends on
shared objectives, participative safety, constructive controversy and support (West,
1990; West & Anderson, 1996). Ross, Rink and Furne (2000) reported that team
members’ willingness to work in teams was limited by the lack of a common set of
values about the benefits of teamwork. They recommended the need for clear
objectives, leadership, commitment and wide organisational ownership as precursors
for working in teams.
Professional subcultures also influence team effectiveness. Kinnunen (1990) used
an anthropological approach to distinguish different subcultures between medical,
nursing and management staff in a large primary health care organisation in Finland.
These three professional groups described different relationships to formal power
structures, which influenced their group behaviour, leadership style, administrative
orientation, decision-making preferences and patient interactions. In general, doctors
and managers shared basic assumptions about work that were paternalistic,
proactive, dominant and emphasised loyalty to authorities. In contrast, nurses
stressed participation, delegation, traditions and symbiotic harmony in work relations.
Inter-team relationships
In a comprehensive study of team-based organisations involving both questionnaire
and case study methods, Mohrman et. al. (1995) demonstrated that inter-team
competition is a major threat for team-based working. Teams that compete may
develop greater commitment to the team’s success than the organisation’s success.