Saving 1000 Lives Team Based Working

Effectiveness of team working Sexton / Thomas / Helmreich – Uni. Of Texas – BMJ v320, 18/3/2000

Aston University Work Aston Business School, University of Aston, Birmingham B4 7ET Michael West, professor of organisational psychology. The Effectiveness of Health Care Teams in the National Health Service Report Carol S. Borrill, Jean Carletta, Angela J. Carter, Jeremy F. Dawson, Simon Garrod, Anne Rees, Ann Richards, David Shapiro and Michael A. West

Teamworking is critical to good quality care

What is a team? Beasts of burden yoked together.

What defines a Team? Teams are defined by their task not by the team members. Team members are selected because they have the mix of skills necessary for the task to be completed successfully.

What is a team? The very basics: A group of people who: Have a clear task to perform Need to work together to achieve this task Are able to meet together to review objectives and the way in which the team is performing

What is a team “A team is a group of individuals who work together: – to produce products or deliver services for which they are mutually accountable. –Team members share goals –and are mutually held accountable for meeting them, –they are interdependent in their accomplishment, –and they affect the results through their interactions with one another. –Because the team is held collectively accountable, the work of integrating with one another is included among the responsibilities of each member.” Mohrman, Cohen & Mohrman (1995). Designing Team-Based Organisations. London: Jossey Bass

Teams have the following characteristics: Team members have shared objectives in relation to their work. Team members interact with each other in order to achieve these shared objectives. Team members have more or less well defined roles, some of which are differentiated from each other. Teams have an organisational identity – they have a defined organisational function and are recognised as a team by others outside the team. The team task performance has consequences that affect others inside or outside the organisation. –Developing Team Working in Health Care A Guide for Managers –Carol Borrill and Michael West, Aston University

The woodpecker might have to go!

Do you work as a team in your work place? YES NO DON’T KNOW

% Team working and mental health

Working in teams in the NHS Do you work in a team? If yes … –Does your team have clear objectives? –Do you have to work closely together to achieve these objectives? –Do you meet regularly to review your team effectiveness and how it could be improved?

It is possible to: Not be in a team Be in a pseudo team Be in a real team

Real teams Team Interdependence Team Identity Team Autonomy Team Objectives Team Member Role Clarity Team Reflexivity Clarity of Leadership There is team learning behaviour

Real teams Team Interdependence –Team members have to work closely together to complete the team task Team Identity –It is clear who is in the team and the team is recognised as a team by others in the organisation

Real Teams Team Autonomy –The team has sufficient control and discretion to decide how to carry out team tasks Team Objectives –The team has clear objectives which are agreed by all team members and to which all team members are committed

Real teams Team Member Role Clarity –Each team member is clear about their own role and the roles of others within the team Team Reflexivity –The team meets regularly to review objectives and the ways in which the team is achieving these

Real teams Clarity of Leadership –Everyone is clear about who is the leader of the team and there is no conflict about leadership There is team learning behaviour –Team members share learning which enables the team to adapt and improve performance

Team Based Working Team Based Working is a philosophy or attitude about the way in which organisations work – where decisions are made by teams of people rather than by individuals and at the closest possible point to the client, patient or customer.

Predictors of mortality Sophistication of appraisal Sophistication of training % of staff working in teams Int. J. of Human Resource Management 13:8 December –1310 The link between the management of employees and patient mortality in acute hospitals Michael A. West, Carol Borrill, Jeremy Dawson, Judy Scully, Matthew Carter, Stephen Anelay, Malcolm Patterson and Justin Waring

Carol S. Borrill, Jean Carletta, Angela J. Carter, Jeremy F. Dawson, Simon Garrod, Anne Rees, Ann Richards, David Shapiro and Michael A. West. Aston Business School, University of Aston, Birmingham B4 7ET

LowModerateHigh Team functioning Patient experiences Clarity of objectives Reflexivity Support for innovation Team functioning and patient satisfaction

Those working in well functioning teams report higher levels of organisational commitment and Higher levels of adherence to organisational rules whilst Implementing more innovations in patient care Effective team working is correlated with more effective clinical governance Individual and organisation

Retention and turnover Within healthcare, those working in well functioning teams are more likely to stay working in their current organisation than those working in poorly functioning teams. A stable workforce will tend to report less accidents, errors and work related injuries.

Healthcare Commission Annual Health Check 2007 & extent of team working : Teams and organisational performance

< >3.8 Health care team effectiveness Team Functioning External ratings of innovation

The greater the number of professional groups represented in the team, the higher the levels of innovation in patient care Borrill et al. (2000)

Health care team innovation Innovation in quality of care Professional diversity

Stress In the NHS those not working in teams have much higher stress levels –Carter and West 1999

Benefits of team based working – the research evidence Reduced hospitalisation and associated costs Improved service provision Improved levels of innovation in patient care Enhanced patient satisfaction Increased staff motivation and mental well-being Reduced error rates Reduced violence and aggression Lower patient mortality

A Pseudo Team A group whose members claim to be part of a team but the group does not exhibit the characteristics of a team

“Common behaviours seen in pseudo teams include lack of common purpose, a purpose with which members cannot identify, inability to focus on a goal, poor relationships among members, interpersonal attacks, members whose personal ambition overshadows the common goal, inability or unwillingness to evaluate outcomes, lack of clear responsibility, and unknown or inappropriate levels of responsibility.” –Team-Based Health Care Organizations – Blueprint for success. Jo Manion, William Lorimer, William J Leander. Aspen Publications 1996

Working in teams and job satisfaction

Working in teams and intention to quit

Working in team and errors, stress and injury

Teams, harassment and violence

T eam Working and Health & Safety eTBWePTBW Organisational health and safety % staff suffering injury at work in previous year % staff witnessing potentially harmful errors/near misses in previous month % staff experiencing physical violence in previous year % staff experiencing bullying, harassment or abuse in previous year PCT’s - 145,000 respondents

How many teams do you belong to?

Team community A number of teams that need to work together to achieve a higher goal e.g. a patient pathway Including all those teams or organisations that must provide support or resources to the home team if it is to succeed

Pathway Management Team Trust Board PCT G.P.’s Portering Ward Management Team Theatres Social Workers Radiology Bereavement Counselling Physio

Home team The team whose goals inform your work in all the other teams you may be involved with

Are you accountable for the performance of the teams that you are in? What are you accountable for? What are your responsibilities? Who monitors or audits your teams’ performance? How effective is your team? What could be done to improve team effectiveness What teams do you work in? Who else is in these teams?

Are there tools to assess team working?

Tools for assessing team working: Does your team have clear objectives? Do you have to work closely together to achieve these objectives? Do you meet regularly to review your team effectiveness and how it could be improved?

Real teams Team Interdependence Team Identity Team Autonomy Team Objectives Team Member Role Clarity Team Reflexivity Clarity of Leadership There is team learning behaviour

The Aston Team Performance Inventory (ATPI)

Highly Effective Teams Aston Team Performance Inventory Team task design Effort and skills Organisational support Resources Team Processes Objectives Reflexivity Participation Task focus Team conflict Creativity and innovation Individual satisfaction Attachment Team effectiveness Inter-team relationships Team innovation InputsProcessesOutputs Leadership Leading Managing Coaching