The Effectiveness of Health Care Teams in the National Health Service

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Leadership There is considerable research evidence that leaders affect team performance (e.g. Brewer, Wilson & Beck 1994; Komaki, Desselles & Bowman, 1989) and evidence of the relationship between leadership style and team effectiveness. Eden (1990) examined the effects of platoon leaders’ expectations on team performance. His work with the Israeli Defence Forces showed that those platoons which trained under leaders with high expectations, performed better on physical and cognitive tests. Podsakoff and Todor (1985) investigated the relationship between team members’ perceptions of leader reward and punishment behaviours and team cohesiveness, drive and productivity. Results showed that both leader contingent reward and punishment were positively related to team drive and productivity. Leader contingent reward was also related to cohesiveness, while leader noncontingent punishment behaviour was negatively related to team drive. Jacob and Singell (1993) examined the effects of managers on the won-lost record of professional baseball teams over two decades and found that leaders did influence team performance by exercising tactical skills and improving the performance of team members. George and Bettenhausen (1990) studied teams of sales associates reporting to a store manager and found that the favourability of leader’s moods was negatively related to related to employee turnover. Primary health care team members in England rated their effectiveness more highly when they had strong leadership and high involvement of all team members (Ross, Rink & Furne, 2000). In nursing care teams, Dreachslin, Hunt and Sprainer (2000) concluded that leadership mitigated the influence of race in self-perceived communication effectiveness. Participants’ comments supported the theme that team leaders who encouraged discussion about differences enhanced perceived team effectiveness. They suggested that leaders provided a unifying force through validating the alternative realities and appreciating the different perspectives of team members, thus moderating the potentially negative effects of racial diversity on team processes. Developing Teams in Organisations To what extent is it possible to develop team working to ensure higher levels of effectiveness? Tannenbaum, Salas, & Cannon-Bowers (1996) have reviewed research in this area and related results to a comprehensive model of team which
integrates interventions (Tannenbaum, Beard and Salas, 1992). They describe a number of intervention types include team member selection and teambuilding: Team member selection Although organisations tend to use quite sophisticated methods for selecting employees for individual jobs, they rarely use systematic methods for selecting for teams. But systematic selection methods can help identify people with greater skill levels. There is strong evidence that a team composed of skilled and motivated people will be more effective than other teams (Tziner, 1988). Selection interventions could improve team effectiveness by increasing the professional or skill diversity of health care team members, thereby increasing the range of competencies in the team. Teambuilding Some teambuilding interventions focus on role clarification, some on interpersonal relationships or conflict resolution issues, while others take more of a general problem-solving approach (Tannenbaum, Salas & Cannon-Bowers, 1996). Team norms, attitudes, climate and power distribution can be affected by teambuilding approaches. Many team processes, including communication, decision-making and mutual role understanding, are often direct targets of team building interventions. Weldon and Weingart (1993) describe the importance of planning in teams for achieving team goals, and suggest that team members are characteristically slow to respond to changes in their tasks or their environments that make their strategies ineffective or their goals obsolete. They propose five ways of supporting team work. Goals should be set for all dimensions of performance that contribute to the overall effectiveness of the team; feedback should be provided on the team's progress towards its goal; the physical environment of the team should remove barriers to effective interaction (consider the difficulties faced by members of a dispersed health care team); team members should be encouraged to plan carefully how their contributions can be identified and co-ordinated to achieve the team goal; and team members should be helped to manage failure, which can damage the subsequent effectiveness of the team.
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 and 10: Index, Dr Foster; deaths within 30
Page 11 and 12: Chapter 1 Teamwork, Communication a
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: Thus the health care team may focus
Page 31 and 32: to provide shared direction and ena
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
Page 50 and 51: Figure 2.13: An example of the layo
Page 52 and 53: stakeholders was sufficiently compr
Page 54 and 55: enefit to all aspects of primary he
Page 56 and 57: Introduction The data analysis expl
Page 58 and 59: those which might ultimately predic
Page 60 and 61: Figure 3.4: Relationship between te
Page 62 and 63: It seems that professional diversit
Page 64 and 65: Bearing in mind that a larger score
Page 66 and 67: Figure 3.15: Clarity of Leadership
Page 68 and 69: Summary of Findings Chapter 4 Quali
Page 70 and 71: of the workshops and consultations
Page 72 and 73: Chronic disease management • effe
Page 74 and 75: Accountability • meeting NHS care
Page 76 and 77: Checklist of activities which contr
Page 78 and 79:
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
Page 239 and 240:
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
Page 247 and 248:
In traditional organisations, power
Page 249 and 250:
Team processes When TBW is introduc
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Appendix I Measures Used Primary He
Page 253 and 254:
Accessibility of the service to use
Page 255 and 256:
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
Page 265 and 266:
Rational Goal Objectives Example In
Page 267 and 268:
Human Relations Objectives Example
Page 269 and 270:
contingencies for each indicator, t
Page 271 and 272:
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......
Page 279 and 280:
Relevance To what extent...... Are
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∗ If the measures suggest that th
Page 283 and 284:
Measure 4 - Patient access to consu
Page 285 and 286:
Next steps • Compare the average
Page 287 and 288:
whether steps could be taken to ens
Page 289 and 290:
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:
Page 295 and 296:
Measure 11 - Patients/clients who d
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Measure 12 - Efficient use of admin
Page 299 and 300:
Objective: Continuous personal and
Page 301 and 302:
Measure 16 - Team members use each
Page 303 and 304:
Objective: Responsiveness to client
Page 305 and 306:
Measure 19 - Patients’ experience
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5. The last two times that you aske
Page 309 and 310:
18. In the last month: How many mor
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___________________________________
Page 313 and 314:
Letters were sent to all the primar
Page 315 and 316:
(ii) The principles of effective te
Page 317 and 318:
• Which aspects of the PHCT servi
Page 319 and 320:
the person’s environment such as
Page 321 and 322:
Handout 3 Practical tips and guidel
Page 323 and 324:
‘The best and most cost-effective
Page 325 and 326:
feedback on performance against tho
Page 327 and 328:
Handout 6 Practical tips and guidel
Page 329 and 330:
Teamworking Mechanisms for reviewin
Page 331 and 332:
Efficient use of resources Of no Ve
Page 333 and 334:
Handout 10 Practical tips and guide
Page 335 and 336:
Page 338 and 339:
Handout 14 Measuring Quality of Car
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
Page 350 and 351:
Berger, J., Fisek, M.H., Norman, R.
Page 352 and 353:
Department of Health (1990). The Ca
Page 354 and 355:
Guzzo, R.A. & Shea, G.P. (1992). Gr
Page 356 and 357:
King, N. (1990). Innovation at work
Page 358 and 359:
Myer, C. (1993). How to Align Purpo
Page 360 and 361:
Schober, M.F., & Clark, H.H. (1989)
Page 362 and 363:
groups. Academy of Management Journ
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