As suggested earlier, teamworking is a diverse field, and the potential literature that may be drawn on is significant and increasing in both breadth and depth. Space means that we cannot talk in detail about all areas that may be important in the future, such as geographically dispersed teams, self-managed teams and team coaching. Changes in the ways we commission and provide services is creating teams that are geographically dispersed away from the main organisational hub, not just across local borders, but in other parts of the country. This provides a range of challenges regarding the support for these teams and their alignment with the host organisation. Self-managed teams come in and out of fashion, but cuts to management layers, a greater understanding of how people engage with services, the need for people to take responsibility for their actions, and decisions being made as close to service users as possible, are again driving an interest in self-managed teams. There is much written about coaching as an intervention for individuals. The art of real team coaching is about enabling teams to improve performance, functioning, wellbeing and engagement (Hawkins, 2014), and it is being recognised as an intervention that can have a tangible impact and accelerate the learning and development of a team.
In this chapter we have chosen to concentrate on three key areas that are most salient to health and social care teams, and will likely remain central regardless of the rapidly shifting context in which we find ourselves:
Throughout this book we have tried to convey the message that just concentrating on supporting individual teams is not enough in the complex world of health and social care delivery. It’s a bit like baking a cake – you may have the very best quality ingredients, but it is how they interact together that is the predicator of a cake that is well baked and delicious to eat. Historically, significant effort has gone into developing single teams, while not perhaps recognising or paying enough attention to the environment that teams operate within. In this revised edition we also focus on the individual’s responsibility for being a team member. How we show up as individuals and contribute (or not) on a day-to-day basis has an impact on both the culture (how we do things around here) and climate (how it feels) of the team and its relationships with other teams.
This chapter is structured around four interdependent levels that need to work together if teams are to ultimately succeed: individual, team, organisation and partnership. We introduce a range of models, frameworks and tools that have been successfully tried and tested in teamworking in and across a variety of organisational settings. It was difficult to choose which models and frameworks to include as there are literally hundreds (this has involved robust debate and negotiation, as in all the best teams!). Models and frameworks are sometimes perceived as only having academic relevance, but they are a way of representing the reality of the world, and can help in making sense of what sometimes seem overwhelmingly complex situations and issues (while acknowledging that models are not inevitably direct reflections of the world we live in).
As we saw in the last chapter, various claims have been made concerning the impacts that effective teamworking may have on both individuals and organisations, but similarly there are several reports where these assumed benefits have not always been fully realised. As Salas et al (2000, p 340) note, ‘many organisations have, in the past, assumed that a team is a mere collection of individuals and, as such, assumed that merely putting members together would result in effective performance, but this is not true.’ While there is a range of potential mitigating factors that might blunt the impact of teamworking, some commentators have also questioned the degree to which these presumed benefits have been demonstrated within a health and social care context. Zwarenstein and Reeves (2000, p 1022) describe this context as replete with rhetoric about the value of teamworking, but a lack of evidence to support the notion that it is necessarily a ‘good thing’ – hence their conclusion, ‘what’s so great about collaboration?’
In this chapter we consider the extent to which the aspirations of teamworking set out in Chapter 1 are reflected in the research evidence. As well as considering the findings of teams in health and social care in general, we focus in particular on the research evidence regarding teams in which professionals and practitioners from different disciplines and/or organisations work together. Increasingly professionals and practitioners are formally situated within teams that require interdisciplinary collaboration, and indeed, for many (for example, surgical teams), this has traditionally been the case.
Teams are an important component of everyday life. If you are employed it is likely that you sit in some form of team; if you are studying you will at some point engage in teamwork for a particular project or activity; and in your leisure time you may play in a sports team or support at least one team. Teamworking is an activity that most of us engage in on a regular basis without even consciously thinking about it. Teams can be incredibly important to us on a human level and contribute to our identity, wellbeing, sense of belonging and community. Similarly, in the context of public services, teams are thought to be important in terms of driving organisational and system performance.
At present, local health and social care communities are under significant pressure as challenges arising from the impacts of austerity measures combine with greater citizen expectations, the vestiges of repeated reorganisations of different government agencies and functions and changes to balances of professional power. Government and non-government organisations alike are tasked with achieving the holy trinity of doing more with fewer resources and in a more joined-up and user-centric way. Dealing with complex and cross-cutting issues while there is such turbulence in the system is no easy thing to achieve, and many individuals and organisations have sought to identify the means through which to improve the performance of their organisations and also the broader systems in which they are embedded.
At least part of the answer to this challenge is effective teamwork. As Glasby and Dickinson argue in the introductory book in this series (see Partnership working in health and social care, 2014a), it is not easy to make partnerships work.
Ultimately, the evidence, questions, summaries, learning and frameworks set out in this book lead us to make a series of practical recommendations and potential warnings, both for policy and for practice.
There is a need to consider the implications for existing teams and services when they exhort new teams or style of working. Creating new teams in any area will affect existing teams, their working practices and relationships, and may hinder the development of practice as people struggle to differentiate roles and boundaries.
Measures of teams in organisations are sometimes only built around their existence, not around their effectiveness; this perhaps adds to cynicism around rhetoric, as opposed to commitment, to teamworking.
Although teamworking may be helpful in a number of ways, it is not a default position that will solve all difficulties. Teams need real tasks and a real need to work together in order to be effective. Simply ordering more of certain types of teams will not overcome the difficulties that health and social care communities face.
National policy needs to send out stronger messages about how organisations need to make investments in enhancing and sustaining teamworking, rather than just one-off training.
There is a real need to have some stability in the system. Improvement in services is about doing something differently. To do this, people need to take risks and they will not feel safe to do so until there is a climate of mutual trust and respect, which takes time to develop.