The Effectiveness of Health Care Teams in the National Health Service

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Innovation Quality of teamworking is powerfully related to innovation of health care teams: • The clearer the team's objectives • The higher the level of participation in the team • The higher the level of commitment to quality • The higher the level of support of innovation ….. the more innovative are health care teams across virtually all domains of functioning Mental Health Those working in teams have much better mental health than those working in looser groups or working individually. The benefits appear to be due to: • Greater role clarity • Better peer support Those working in teams are also buffered from the negative effects of organizational climate and conflict. The better the functioning of team with respect to… • Clarity of objectives • Levels of participation • Commitment to quality • Support for innovation … the better the mental health of team members across all domains of health care. Organisational performance There is a significant and negative relationship between the percentage of staff working in teams and the mortality in these hospitals, taking account of both local health needs and hospital size. Where more employees work in teams the death rate is significantly lower (calculated on the basis of the Sunday Times Mortality
Index, Dr Foster; deaths within 30 days of emergency surgery and deaths after admission for hip fracture) 1 . Retention and turnover Within health care, those working in well functioning teams are more likely to stay working in their settings than those working in poorly functioning teams. Leadership In Community Mental Health and Primary Health Care, where there is no clear leader/co-ordinator or where there is conflict over leadership team objectives are unclear, and there are…. � Low levels of participation � Low commitment to quality � Low support for innovation � Poor team member mental health � Low levels of effectiveness and innovation Communication Communication, integration and regular meetings in PHC and CMC health care teams are associated with higher levels of effectiveness and innovation, yet the quality of meetings (particularly in Primary Health Care) is often poor. Professional diversity Diversity of professional groups in Primary Health Care is clearly linked to levels of team innovation. In newly formed Community Mental Health Teams, this relationship does not appear. The same findings emerged from research carried out with 85 breast cancer care teams 2 . 1 This finding is based on research recently completed by the research team at the Aston Centre for Health Services Organisation Research (further details available from West or Borrill). 2 This finding is based on research recently completed by the research team at the Aston Centre for Health Services Organisational Research (further details available from West or Borrill).
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: The objectives of the research were
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 and 28: Thus the health care team may focus
Page 29 and 30: integrates interventions (Tannenbau
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
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those which might ultimately predic
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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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Page 338 and 339:
Handout 14 Measuring Quality of Car
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Page 344 and 345:
Page 346 and 347:
Page 348 and 349:
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Berger, J., Fisek, M.H., Norman, R.
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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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The Effectiveness of Health Care Teams in the National Health Service

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