When is a team not a team?

Local health and social care communities are facing a raft of challenges such as the need to become more dynamic and diverse while facing pressure to become more efficient, and are increasingly required to work in new ways across networks and boundaries.

Effective teamworking has been seen as a potential solution to all these difficulties and more. One particular area where teamworking appears to hold potential is where health and social care communities are confronted by complex, cross-cutting issues, but are constrained by the structural, pro­cedural and cultural barriers which are associated with a welfare system largely designed along functional organisational lines.

In other words, it has been suggested that several of the difficulties which health and social care organisations are forced to face when trying to work together are, to an extent, a product of the design of these systems. More effective teamworking is seen as one way in which we might overcome these problems and provide more seamless services.

Effective teams cannot be formed by ­simply grouping individuals together – although this is often what happens in practice in health and social care. Just as terms such as “partnership” have become buzzwords like “community” or “empowerment” did in the 1980s, “teams” and “teamworking” have become buzzwords within the fields of management and organisational behaviour. Consequently, it has been suggested that teams have become the (unspoken) core building blocks of many of the so-called “fads” of modern management (for example, empowerment, business process re-engineering, quality services and management and the learning organisation).

Positive impacts

However, just because something is called a team it does not mean that the predicted benefits will automatically flow from this arrangement of people or, indeed, that teamworking is the best way to bring about particular changes.

Evidence suggests that working in teams can positively impact on: organisational performance safety costs service user satisfaction access to services and innovation.

Working in teams has also been demonstrated to have significant impacts on staff members. An NHS study found that those individuals working in clearly defined secondary care teams had lower levels of stress than those not working in teams or working in loose groupings. It is suggested that teamworking provides more social support to individuals and role clarity than those not working within teams or who are only quasi-members.

However, there is a caveat these impacts were only shown where there were real interdependencies and social support between team members. The NHS national staff survey demonstrates that working in a “team” actually predicts higher level of staff injuries and stress. However, working in a well-structured team predicted lower levels of injuries and illness among staff and also lower levels of errors and near misses witnessed by staff.

In order to gain the full range of benefits which are associated with teamworking, relationships must be forged between team members, and between teams and the wider organisational environment. Research evidence shows a range of ways in which this process might be enhanced, as well as offering lessons about what might hinder it.

It is likely that a number of the mechanisms for more effective teamworking will be recognisable and seem, to an extent, intuitive to many of us. However, within the busy day-to-day world of service delivery, these basic building blocks are often overlooked.

The terms team and teamworking will no doubt be familiar to most of us. Teams are ubiquitous in modern life and we refer to any number of entities as teams. Indeed, this might be part of the problem with the team concept.

As we earlier outlined, some commentators have suggested that team and teamworking have recently become buzzwords, and this may in part result from the fact that teams are recognisable to all of us. A consequence of this is that when we talk about teams it is important that we define precisely what it is we are referring to.

So what then do we mean by a “true team”? The precise definition might seem like an academic point and to some degree it is, but it has real implications in practice.

Teams differ depending on their structures, purpose, tasks, settings and team members. What is considered a team within a hospital is likely to differ to that in a primary care, mental health or respite care setting.

Whether teams are temporary or permanent, where their members are from, ­whether membership is voluntary, what tasks the team is supposed to achieve and the level of specialised skills the team requires are all important markers of distinction between teams.

Defining teams

Not all teams are equal and it has been suggested that the failure to differentiate between different forms of teamworking is partly why research has found the effects of teamworking to be inconsistent. Just as it is important for researchers to make sure that they are comparing the same things when talking about teams, a key issue for students and frontline workers when using the terms team and teamworking is to check that all partners understand the same thing by these terms.

Without being specific about what we actually mean by teamworking (or indeed partnership) there is a risk that their ­widespread use will fuel cynicism about these concepts and frontline practitioners will be reluctant to engage with these agendas.

The key issues and principles to be drawn from definitions of teams are outlined in the panel (above).

Although teamworking may be helpful in several ways, it is not a default position which will solve all difficulties. Teams need real tasks and a real need to work together in order to be effective. Simply ordering more of certain types of teams will not overcome the difficulties which health and social care communities face.

There are no great secrets about teamworking, but different knowledge levels, skills, intuition and experiences make it a contested area.

It is not a panacea for all situations, but an area that needs real commitment, investment and curiosity.

Helen Dickinson and Jon Glasby, Health Services Management Centre, University of Birmingham, are the editors of the new Better Partnership Working series. Further information

● This article is based on material from Kim Jelph’s and Helen Dickinson’s Working in teams, the fourth book in a new series focused on Better Partnership Working. Published by Policy Press in association with Community Care, the five books seek to provide a series of accessible ‘how to’ guides. These books summarise current policy and research in a detailed but accessible manner, offering practical support to those working with other agencies and professions and provide some helpful frameworks with which to make sense of the complexity which partnership working entails.

● This article is published in the 14 August issue of Community Care magazine under the heaidng When is a team not a team?

● The previous articles in this series were published in the 15 May edition,19 June edition, and 24 July edition of Community Care