Thinking teams thinking clients: issues of discourse and representation in the work of health care teams

Abstract

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.

Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork

“…9,10 Explanations for poor interprofessional relationships include the lack of explicit, appropriate task and role definitions; the absence of clear leadership; insufficient time for team building; the "us-and-them" effects of professional socialization; frustration created by power and status differentials; and the vertical management structures for each profession. [11][12][13][14] As this evidence of error and quality problems accumulates, it is accompanied by a growing belief among policymakers that interprofessional relationships are important and must be improved. For reasons that remain unclear, policymakers are choosing to intervene in this relationship using one of two generic approaches.…”

Client-centred practices and work in inpatient rehabilitation teams: results from four case studies

“…Working as a team is influenced by individual characteristics of team members (gender, age, or ethnicity, years of service); professional affiliations; roles, norms and values; and interprofessional perceptions of team processes [25,33,[41][42][43][44][45]. In our attempt to articulate the dimensions that participant HCPs mentioned regarding work in teams and CC, we turned to a new theory by Gittell et al because it [30] highlights the interdependence and interconnectivity of healthcare workers to providing effective and quality care.…”

Narrative in interprofessional education and practice: implications for professional identity, provider–patient communication and teamwork

“…For example, research by McClelland and Sands (1993) found that a missing team member who was in a position of supplying a critical piece of information or perspective on a patient (the professional "voice") at a team meeting resulted in a negative effect on patient care. Opie (1997) similarly argues that the ways in which differing representations are made by different team members have a powerful effect on the team's options for action.…”