Robin Miller, Senior Fellow and Director of Evaluation

The importance of teams to the successful delivery of health and care services is now well established. There is an overwhelming evidence base that teams of relevant professionals coming together to achieve a shared goal can lead to genuine improvements in patient care.

Many of the new models of care have inter-professional teams at their core and see them as a (if not the) key vehicle to achieve integration between services and professionals. Common examples include those seeking horizontal integration around general practices or nursing homes and vertical integration to ease discharge from hospital. Beyond those based in the frontline there are also a myriad of other teams which need to work successfully if the aspirations of the new models are to be achieved. Project teams to undertake the detailed development and co-ordination of these very complex programmes, commissioning teams to bring together budgets and contract specifications, and strategic teams to oversee the local system and address any clashing priorities and incentives.

Whatever team we are considering, research suggests that there are a number of common elements that must be in place. A shared commitment to clear goals, a healthy team dynamic in which difference of opinions can be constructively discussed, and leadership which encourages both engagement and responsibility of the team members. The contrary also appears to be true, with poorly led and un-collaborative teams having negative impacts for both patients and the staff who are based within them. In many ways it is better to work in isolation than to be part of a mal-functioning team.  There is also a danger that a team may internally feel that it is working well whilst those outside of the team have a less positive view. Some studies show that patients have experience inter-professional teams as ‘closed shops’ in which decisions about their care and treatment are made without them present, and as a result they feel less rather than more control over their lives.

Whilst none of these elements of good team work will be a surprise, achieving them in practice is far from straightforward. In part this is because the picture that we have in our minds of an inter-professional team is one that meets regularly, has time for its members to get to know each other, and is part of overall commitment for the agencies concerned to work together. The reality is sometimes very different. Project teams by their nature can be short term, and around each patient with complex needs can be a unique grouping of professionals responding to their needs. For those which are more established, planned rotations, wider restructurings or competing priorities membership may lead membership to be much more transient. Team members do not always get on as individuals, and teams are as prone as the rest of our services to being dominated by the most powerful professional group amongst its ranks. We are usually members of many teams at the same time and may feel a stronger loyalty to one more than another. Many see their professional grouping as being the team to which they feel the strongest affiliation rather than their operational team.

For the new models to succeed then the partnerships behind them need to be positive about the potential of teams but be realistic about what is required for them to function successfully. As with all aspects of integration, teams will never be a fixed entity that can be taken for granted and instead need to be continually nurtured, reviewed and improved. This includes project management and strategic planning teams, who are just as prone to the professional rivalry and lack of focus of those on the frontline.  Organisational support in the form of a clear purpose, sufficient autonomy, and relevant data are key.  Training and development for all staff on how to be part of a successful team will also have significant benefits at all levels and functions.

Finally, the old ‘maxim’ suggests that there is no ‘I’ in team and that collective goals should take precedent over individual aspirations. This is a worthy sentiment, but in fact successful teams work on the basis of each individual member taking responsibility for their own conduct and contribution. Too easily do we regress to blaming the team leader for not feeling informed, ineffective meetings or poor relationships. A successful team of any description requires each member to turn up, to speak their mind, and to play their part.  It is also each member’s responsibility to build connections with other teams that they are part of and identify opportunities for collaboration. And when the team is dissolved (as no team lives for ever), it is then these individuals who can take forward the learning into the next iteration of teams that will emerge.
After all, integrate begins with an ‘I’ and ends with a ‘team'.

Dr Robin Miller is a Senior Fellow and Director of Evaluation at HSMC. His latest book explores teams working in health and social care. For more details see Jelphs, K., Dickinson, H., and Miller, R. (2016) Working in Teams, Bristol: Policy Press.

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