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Health policy in New Zealand, as elsewhere, has articulated the notion of partnership to be achieved through developing policies and practices aiming to empower users and their families. The involvement of users, family, and significant others in decisions about users' health care points to a realignment of traditional power relations through its de-centring of professionals in some domains of health care. It is suggested that family meetings to discuss users' progress and discharge plans could constitute an important mode of empowerment on the individual plane. Working within Michel Foucault's concept of discourse, this article discusses the practices of multidisciplinary teams to empower users on the structural and individual plane. Achieving significant changes in practice will likely require health professionals' attention to how their discourses position users, and the development of a reflexive and analytical response to their work points to the need for training in teamwork focusing on these dimensions. Such work requires organizational support.

The use of multi-disciplinary health care teams is an increasingly common aspect of service delivery in health care in Western countries. While the literature rehearses the putative benefits to practitioners and clients of such teams, there appears to be an absence of extensive evidence-based research on team practices to substantiate such claims. What evidence there is suggests that team work is in different ways problematic. This article is a progress report on a qualitative research project into the operation of health teams with responsibility for clients in hospitals and the community in New Zealand. The first part of the article presents some of the main themes in current research on health care teams. The second part argues that effective team work requires giving attention to a hitherto marginalised dimension of teamwork -the team's reflexive and representational practices. Attention to these practices appears to be particularly important in complex cases or when the team believes that its work with the client is not progressing as well as it might. The article concludes by highlighting the sociological significance of representational issues in team work and by drawing some inferences about factors affecting effective teamwork.

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