Following on from the first blog in this series on teams and team working behaviour, this blog focuses on West’s fourth condition for effective team working, which is that the team develops through reflexivity and regular coaching. We learn that “Teams are more effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly.” (Schippers, West & Dawson, 2012).

The difference between reflexivity and reflection is an interesting one. Reflection has become a process all doctors, starting early in their training, are expected to do in a formal way and to provide evidence of having done so. Hibbert, a University of St Andrews academic, makes the point that reflection is concerned with thoughtful questions about something you want to understand by using your “mental tools” to build your understanding or solve a problem (for example, exploring why something went wrong in an SUI; why a certain decision was made). The result is increased understanding about a problem or puzzle. Reflexivity, on the other hand, is concerned with thoughtful questions about yourself (or about the team) – for example, why do I or we see X as a problem or a puzzle and why do I or we choose to do things in a particular way – what are my/our underlying assumptions that result in this particular formulation of the problem or puzzle.

The processes are similar but technically (some might say pedantically) different in terms of the outcome. Reflection results in learning (increased understanding and possible behaviour change) and reflexivity results in learning and leaves the learner changed as a result. Hibbert talks about reflexivity as reflection + self-change.

Does your team take regular time out (e.g.10 minutes at the end of each consultant meeting, half an hour after every 4 meetings, or a day out every 6 to 8 months or even once a year) to reflect on how the team works together and what impact this has on the service they deliver and on patient care? This is more than team building – it is questioning our basic assumptions about the way we work; how we work together; how it is that we have ‘allowed’ the situation to get the point that it is a problem. What is it about us as a team, our collective attitudes and behaviour that have in some way ‘colluded’ to allow this to happen? When we are able to explore these, surface our underlying assumptions and understand how they get in the way of effective team working, we can actually start to change the way we work.

by Dr. Megan Joffe