Two articles in the HSJ (16/6/2016) about teams in two different Trusts refer to difficult relationships in teams and suggest that “patients could come to harm”. That poor team relationships can negatively affect patients has been well researched and documented – see Mazocco et al, 2009 as just one example, and read Joshua’s Story about Morecombe Bay as another. This series of blogs will take as its focus team working and team working behaviour.
There are many possible causes of poor team relationships – some related to the way the teams are structured; others related to poor leadership; and, others to lack of organisational interest and attention. These systemic and structural issues are important contextual contributions to the culture and climate in teams. The NHS also has (in my experience) highly diverse teams in terms of national culture and ethnicity – I have come across teams where each team member belongs to a different national culture – navigating your way through this complexity takes some skill.
Yet many of the difficulties are related to personalities and interpersonal interactions. To some of us team working and collaboration comes naturally. We feel enriched by the views of our team mates and safer knowing that we are all in it together. Medical training however has traditionally encouraged autonomy and independence.
Michael West, a highly respected researcher and writer about teams in healthcare highlights four conditions for effective teams:
- Having a real team – bounded, stable, interdependent with a real team task
- Having a clear team purpose; challenging and consequential with clear objectives
- Making the right choices about who should be on the team – skills and roles, enablers not ‘derailers’
- Developing through reflexivity and regular self-coaching
A group of consultants from the same specialty providing a particular service seem to me to be bounded, stable and interdependent even if at times they are working separately. They share responsibility for the quality of care provided by the team; they share the workload; they consult and learn from and with one another; and, they are likely to be teaching and training junior doctors. Their primary purpose is patient care and they will have objectives to meet. Although it is clear that the team does its best to recruit people who have the right skills, the consultant recruitment process in many instances tends to focus on recruiting for skills rather than seeking to understand what candidates could bring to the team and the organisation in addition to their clinical skills. The more difficult aspects to assess are behaviour and attitudes which are then likely to impact, positively or negatively, on team working and interpersonal interactions. Taking time out to reflect on how the team is working together is West’s fourth condition for success and reflexivity will be the focus of the next blog.
by Dr. Megan Joffe