Interdisciplinary teamwork doesn’t just have a place in clinical teams, it can be rolled out across the whole practice
The daily challenges facing practice managers are not only clinical, but increasingly organisational in their nature. NHS staff are under pressure to provide high quality care in an era of increasing demands, conflicting priorities, and endemic change. Interdisciplinary teamwork has been widely hailed as the optimal work design for achieving quality and safety in healthcare. This involves close collaboration between two or more healthcare professionals who work interdependently to deliver integrated healthcare and make joint decisions around patient-centred goals.
It has been argued that the functional diversity inherent in such teams enables better decision-making, which can improve outcomes for patients, staff, and the wider organisation. Indeed, research has found that teamworking in primary healthcare is associated with lower hospitalisation rates. However, effective teamwork is easier said than done. Here we offer some insights from the discipline of industrial/organisational psychology to help practice managers get the best out of the diverse teams of GPs, nurses, and receptionists they manage. These insights are based on our extensive research, with hundreds of teams across the NHS, and are organised around five themes; effective leadership, team direction, regular reflexivity, creative problem solving, and positive emotion.
Our research with primary healthcare teams (PHCTs) shows that leadership clarity is related to higher levels of participation, clearer team objectives, support for innovation, as well as commitment to excellence. Conversely, lack of clear leadership is associated with poor team processes and worsened mental health of team members. Practice managers must therefore ensure the leadership is absolutely clear, and there is no conflict over who occupies a leadership role in the team. Further, leadership should not only be clear, but also effective.
A leadership style characterised by self-awareness, relational transparency, balanced information processing, and an ethical and moral perspective, termed in the literature as ‘authentic leadership,’ has been shown to engender team member development and a positive organisational climate.1 Authentic leaders are aware of their own strengths and weaknesses, consider all sides of a problem, and draw upon the expertise of their team members make decisions. In doing so, they clearly communicate the rationale behind decisions, ensuring that team members feel that they have a voice. Authentic leaders also prioritise concern for others (including both patients and staff) over their own self-interest, which in turn builds a climate in which trust, integrity and high ethical standards become a priority - all of which are crucial in the work of PHCTs.
Teams are fundamentally defined by their shared purpose, as reflected by the vision and objectives of the team. Theories on goal setting suggest that specific and challenging team goals regulate collective action and incentivise team members to work collaboratively. Research confirms that PHCTs with clear goals perform better on patient-perceived quality, patient satisfaction, and manager-rated team effectiveness than those without.
Practice managers must ensure that their team is defined by a small number of clear and specific objectives (five or six maximum) that are ultimately derived from the organisation’s vision. In order to successfully achieve team objectives, it is crucial to clarify the skills, roles and responsibilities of each team member and establish how these are related to one another. Although team members come from different functional backgrounds, they will each be dependent on each other for information and expertise. Practice managers should therefore clearly understand the unique knowledge, skills and abilities (KSAs) of each individual and ensure that clear communication channels are in place between team members. While having excellent functional skills, some team members may also lack KSAs for teamwork, and training may therefore be necessary in soft skills such as collaboration, conflict management and communication.
Beyond establishing the team’s objectives, a PHCT must take regular time out to review its objectives, strategies and processes and make changes accordingly. This process is referred to as reflexivity, and our research evidence shows teams that engage in regular reflexivity function more effectively than those which do not. Reflexive teams are self-aware, monitor both their successes and failures, learn from their mistakes and constantly review the relevance of their objectives. This means that they are far more likely to recognise gaps and problem areas and implement necessary improvements. Learning from errors is particularly pivotal in healthcare where patient needs are complex and the stakes for errors are high. One of the practical challenges for practice managers is to put aside regular meetings for team reflexivity (at least once a month). Research suggests that healthcare team members often only meet each other if there is a specific problem to be resolved. However, without regular meetings, there is a risk that PHCTs could be pursuing objectives that are no longer relevant to the organisation, or do not put patient needs at the core of the team.
PHCTs are faced with an array of challenges on a daily basis, including the utilisation of limited resources, managing patient expectations, managing inter-professional disputes, and navigating complex care pathways with other teams. However, by their very composition, PHCTs have a diverse pool of KSAs which provides a source of creativity and innovation. Team members also come from different clinical and non-clinical backgrounds with different levels of experience. However, this can often create tension and conflict in the team. Status differences may leave lower-level team members prone to conforming to group decisions, rather than speaking up and having a voice.
By enacting authentic leadership behaviours discussed above practice managers can therefore encourage a climate of participative safety in the team, whereby people are more likely to actively contribute to decision making, share information and viewpoints openly, and invest in the outcomes of those decisions. If a team climate is supportive and non-threatening, people are more willing to take positive risks on behalf of the team and put forward novel ideas and solutions to problems without fear of embarrassment or rejection from the team.2
Practice managers should also manage conflict effectively. If conflict is interpersonal in nature, and concerned with relationship difficulties, this will always have a negative impact on the performance of a team, and should therefore be resolved quickly. However, constructive conflict which is task-oriented can have a positive impact on the teams working in complex environments, as it facilitates more creative solutions to problems. Again, this sort of healthy conflict must play out in a climate of participative safety, in which team members do not take disagreements personally, but prioritise the shared objectives of the team.
Human relationships can be a potent source of both elation and despair. As social creatures, we are predisposed to form close nurturing attachments with one another, including the people we work with. We often prefer to work on tasks that require meaningful interpersonal interactions with others, rather than working on our own. Theories on attachment suggest that members of PHCTs, just like in any other team, will have a preference for supportive, secure, reciprocal relationships in the workplace and will likely develop a shared social identity with their colleagues. This is what fosters team synergy, optimism and commitment.
Healthy team relationships are characterised by warm accepting interpersonal interactions, in which team members treat one another with the same amount of respect and care that they show their patients. In order to develop such positive emotion, practice managers should ensure that the team has an inspiring vision to work towards, which motivates team members to be optimistic about what can be achieved. Team successes should be celebrated and individuals acknowledged for their good work. Teams should also learn from mistakes through the process of reflexivity, and move forward without dwelling on failures or casting blame on.
Taken together, these tips will facilitate effective team dynamics and enable practice managers to get the best out of their PHCTs. Effective leadership, team direction, regular reflexivity, creative problem solving, and positive emotion will not only lead to heightened team performance, productivity and innovation, but will also create a more positive, nurturing and engaging work environment for PHCT members.
1. Walumbwa FO, et al. Authentic leadership: Development and validation of a theory-based measure. Journal of Management 2008;34(1):89-126.
2. Edmondson AC. Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly 1999;44(2):350.
Joanne Lyubovnikova is a lecturer in work and organisational psychology at Aston Business School.
Michael West is a professor at the centre for performance-led HR at Lancaster University Management School.