Steve Onyett.

Introduction to team effectiveness

Steve Onyett.

Our Health Our Care Our Say

“By 2008 we expect all PCTs and local authorities to have established joint health and social care managed networks and/or teams to support those people with long-term conditions who have the most complex needs”.

Steve Onyett.

The Challenge of Commissioning- Promoting using practice based commissioning creatively,

so that practice teams can work with patients, families and carers to design care packages better suited to their needs.

How radical is this new approach to teamworking?

Models for this can already be seen in mental health and intermediate care teams.

BUT HAVE WE LEARNED THE LESSONS?.

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What is a Team?What is a Team?

A group of people who depend on each other to get a specific job done well.

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Benefits of Effective Team WorkingBenefits of Effective Team Working

PerformanceStaff well-being

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The 2006 NHS National Staff Survey

89% responded positively when asked: “Do you work in a team?”

However this shrunk to 41% when the survey explored whether the team in question fulfilled criteria for a well structured team

Findings consistent since 2003!

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Real teams Shared objectives Members who work closely together to achieve the

objectives of the team Members who have different and defined roles within the

team Less than 7-8 members Opportunities to review the performance of the team and

how it could be improved A team identity, in that others can recognise it as a team

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Effective teams have….. Clear and shared objectives – but when

combining hierarchies also need to be clear about where NOT collaborating

The means to deliver in terms of resources, authority and autonomy

The minimum number of team members required to get the job done.

Clear, differentiated, and diverse roles

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Effective teams have….. A need among members to work together to

achieve team objectives Participation in decision making Norms for excellence Rhetorical and practical and support for

innovation Defended time out to review what it is trying to

achieve, how it is going about it and what needs to change

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The evidence on CMHT effectivenessBorrill et al, (2000) examined 113 CMHTsExternal ratings of innovation and

effectiveness associated with • team clarity of and commitment to objectives, • higher levels of participation, • a stronger commitment to quality, and • practical support for innovation.

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Vision that isbased on explicit and shared valuesclear, negotiated, shared, motivating and attainable

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Participative safety A climate in which team members feel free to

participate and share ideas, even if those ideas are a little “half-baked”.

Associated with • Less resistance to change and a greater likelihood

of innovation• Constructive controversy in pursuit of excellence. • A collaborative, and participative leadership style. • Appropriate exchange of information for collective

decision-making and as a way of achieving good decisions and role clarity.

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Climate for excellenceTeam commitment to achieving excellent

performance through modifying practices and implementing improved methods of working.

Look for commitment to giving users real power in shaping practices, openness to critical evaluation, and time and resources devoted to planning and implementing evaluation.

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Support for innovation

The teams expectation, approval and support of attempts to introduce new and improved way of doing things.

May be verbal approval or offers of co‑operation, time and resources.

Support needs to be demonstrated in practice.

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A typical effective CMHT had

few part-time workers, relatively low stress levels.

clear leadership

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Poor functioningUnclear team objectives were the

biggest contributor to poor functioning. This was associated with the absence

of a clear team leader or co-ordinator or where there was conflict about leadership.

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The mental health of team members

Those working in teams have much better mental health than those working in looser groups or working individually.

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Mental Health

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 organisational climate and conflict.

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The better the functioning of teams the better the mental health of team members across all domains of health care.

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Communication and regular meetings• are associated with higher levels

of effectiveness and innovation in Primary Health Care and CMHTs

• yet the quality of meetings is often poor

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Barriers to effective teamworking1. Teams without tasks 2. Teams without freedom and responsibility3. Unwieldy teams with the wrong members4. Organisations deeply structured around

individual work5. Team processes are neglected rather than

developed 6. Strong teams in conflict

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Obstacles to Effective TeamworkObstacles to Effective Teamwork

Professional divisions, exacerbated by gender issues

Team members belong to different organisations

The lack of professional mutual role understanding and respect

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Obstacles to Effective TeamworkObstacles to Effective Teamwork Lack of understanding of organisational context Lack of pre-qualification team working training Lack of clear team objectives and feedback on

performance Poor or non-existent team meetings, and team

reviews of strategies, processes and objectives The unmet need to base practice and teamwork on

the assessed needs of local populations

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Organisational Supports for TeamsOrganisational Supports for Teams

Clear goalsResourcesCommunication and information systemsEducation and training systemsFeedback systemsLiaison and integration with other parts

of the system

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Organisational Supports for TeamsOrganisational Supports for Teams

Support with the process of teamworking

Reward systemsAppraisal processesRecruitment and selection policies