1 multidisciplinary teamworking: from theory to practice dr. michael byrne clinical psychologist
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Multidisciplinary Teamworking: From Theory to Practice
Dr. Michael Byrne
Clinical Psychologist
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Introduction
Who am I? Just completed M.Sc. research thesis on Community Mental Health Team working
Purpose? To increase awareness of factors that need consideration when trying to achieve teamworking in multidisciplinary teams
Not here to champion teamworking or to provide a formula for it
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What is a team?
‘A group of animals harnessed together to draw some vehicle’ (Old English)
Teams need to have (West, 2005): – Shared objectives (or purpose)
– Members who work closely together to achieve these team objectives
– Members who have different and defined roles
– Opportunities to review team performance
– A team identity (i.e. ‘we-ness’ or solidarity)
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Types of teamworking (Opie, 1997)
Where ‘members operating out of their disciplinary bases…’:
1.‘Work parallel to each other, their primary
objective being that of coordination’ (i.e. multidisciplinary teamworking);
2.‘Undertake some joint collaborative work (i.e. interdisciplinary teamworking’)
Inte
grat
ion
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Stages of team development (Tuckman, 1965)
Forming
Storming
Norming
Performing
Increasing (external)
focus on service user
via
(1) Organic
growth?
vs.
(2) Make it
happen?
Reg
ress
ion?
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Ways to address teamworking (Coghlan et al., 2003)
Goals Top-down
Formal Structures
Policies & procedures
Culture / Tradition
Informal Teamwork experiences
Informal relationships
Power positions / interactions
Attitudes Bottom-up
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PersonalPersonal
OperationalOperational
ProfessionalProfessional
Environmental / Structural
Environmental / Structural
RelationshipsRelationships
Factors influencing teamworking (Byrne, 2005a)
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Environmental / Structural
Historical service provision practices Legislation, reports, consumerism, media Management support (e.g. team training) Greater availability of ‘maturing’ disciplines Team configuration Resources (e.g. physical, team composition,
supervision)
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Team configurations (Onyett, 1998)
1. Profession managed networks– No team leader, meet to discuss communal consumers
2. Fully-managed teams– ‘Command & control’ style structure
3. Coordinated teams– Dual accountability: operationally to team coordinator &
professionally to line manager
4. Democratic (or self-directed) teams
Str
uctu
ral
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Team composition
Skill-mix reflects task at hand?
Service users as staff members?
Numerical balance of disciplines
Optimum no. of members (e.g. West, 2005)
Similar grades / Similar pay scales: shared perception of egalitarianism
Instability vs. excessive solidarity
Str
uctu
ral
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Team composition instability
Negative teamwork experiences
Poor retentionTeam instability / Service discontinuityS
truc
tura
l
Storming
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Shared model of teamworking Agreement on task team is engaged in?
– Is the focus on the service user?
Agreement on who does what? – Team composition?– Who leads (vs. dispersed throughout team)?– Role clarity?
Agreement on processes to achieve goals?– Decision-making processes (e.g. referral pathway)– Conflict resolution strategy
Ope
rati
onal
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Role clarity (Brown et al., 2000)
Clarity re. behavioural requirements of role
Interdisciplinary teamworking may require some ‘generic’ working & result in:– Fear of dilution of professional identity– Feel like an ‘endangered species’
An increase in professional boundaries
Ope
rati
ona
l
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Referral pathways (Byrne, 2006c)
Target service user population
Extent of referral net
No. of access points
Allocation process
Disagreement
Individual competitivenessO
pera
tion
al
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Leadership types (Bass, 1990)
Transactional– Use of power (i.e. traditional ‘command & control’)
Transformational– Seeks to inspire / influence
– Requirement for effective transactional leadership?
Laissez-faire– Uninvolved, disinterested
Ope
rati
ona
l
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Operational management Professional autonomy
Primary leadership challenge (Onyett et al., 1997b)
Relationship with team members
Need to match (or balance)
Ope
rati
ona
l
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Models of clinical responsibility
Centralised Team-based
(Transactional)
leader
Member 1
Member 4
Member 2
Member 3
(Transformational)
leader
Member 1 Member 2
Member 4 Member 3
Ope
rati
onal
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Centralised responsibilityLeader does not ‘grant’ adequate
professional autonomy
Members ‘assert’ clinical autonomy (e.g. go ‘solo’)
Members socialised for professional autonomy
Lack of trust
Ope
rati
ona
l
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Team-based responsibility
Leader ‘grants’ professional autonomy
Partial development of team hierarchy
Some members do not accept
Centralised decision-making
Ope
rati
onal
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Other leadership challenges
Ensure ‘psychologically safe’ communication– Balance between formal, informal & written – Promote shared records – Prioritise goal-directed meetings– Encourage ‘constructive controversy’– Manage ‘expected’ resistance
1. Collaborate
2. Contend: ‘Task’ ‘Relationship’ conflict
3. Avoid (& build trust by sharing other tasks)
Ope
rati
ona
l
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Other leadership challenges Promote procedural transparency
Promote a broad model of mental health
– Distinct occupational cultures (& tribal loyalty)– Increasing polarities re. treatment options
Openly address power dynamics
Engage peripheral members & external stakeholders
Reward efficiencies (vs. waiting lists)
Ope
rati
onal
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Reflective practice
Ring fence time to discuss:– How are we doing?– Are we a performing unit?– How can we improve outcomes for service users?
Performance management (Byrne, 2006a)– Constituency-generated evaluation criteria
Ope
rati
ona
l
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Personal factors Too much emphasis on personality
Teamwork knowledge & training
Loss of faith in system vs. willingness to ‘graft’
Willingness to participate & accept responsibility
Openness to learning & overcoming biases
Self-audit
Per
sona
l
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Summary
Teamworking needs to be nurtured
Purely ‘top-down’ approaches addressing predominantly ‘formal’ factors are ‘necessary but not sufficient’ for improving teamworking
Intra-team relationships are fundamental to teamworking
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If you want to know more
Contact me at:
Read:Byrne, M. (2006c). A response to the Mental Health Commission’s Discussion paper ‘Multidisciplinary Teamworking: From Theory to Practice. The Irish Psychologist, 32(12), 323-339.
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‘Holy grail’ of teamworking