Multidisciplinary Teamworking: From Theory to Practice

1. Multidisciplinary Teamworking: From Theory to Practice Dr. Michael Byrne Clinical Psychologist

2. 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

3. 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)

4. Types of teamworking (Opie, 1997) • Where ‘members operating out of their disciplinary bases…’: • ‘Work parallel to each other, their primary objective being that of coordination’ (i.e. multidisciplinary teamworking); • ‘Undertake some joint collaborative work (i.e. interdisciplinary teamworking’) Integration

5. 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? Regression?

6. Ways to address teamworking (Coghlan et al., 2003) GoalsTop-down Formal Structures Policies & procedures Culture / Tradition Informal Teamwork experiences Informal relationships Power positions / interactions Attitudes Bottom-up

7. Factors influencing teamworking (Byrne, 2005a) Environmental / Structural Operational Relationships Professional Personal

8. 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)

9. Team configurations (Onyett, 1998) • Profession managed networks • No team leader, meet to discuss communal consumers • Fully-managed teams • ‘Command & control’ style structure • Coordinated teams • Dual accountability: operationally to team coordinator & professionally to line manager • Democratic (or self-directed) teams Structural

10. 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 Structural

11. Team composition instability Negative teamwork experiences Structural Storming Team instability / Service discontinuity Poor retention

12. 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 Operational

13. 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 Operational

14. Referral pathways (Byrne, 2006c) Target service user population Extent of referral net No. of access points Allocation process Disagreement Operational Individual competitiveness

15. 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 Operational

16. Primary leadership challenge (Onyett et al., 1997b) Need to match (or balance) Operational Operational management Professional autonomy Relationship with team members

17. Centralised Team-based Models of clinical responsibility Member 1 Member 2 Member 1 Member 2 Operational (Transactional) leader (Transformational) leader Member 4 Member 3 Member 4 Member 3

18. Centralised responsibility Leader does not ‘grant’ adequate professional autonomy Operational Lack of trust Members socialised for professional autonomy Members ‘assert’ clinical autonomy (e.g. go ‘solo’)

19. Team-based responsibility Leader ‘grants’ professional autonomy Centralised decision-making Operational Partial development of team hierarchy Some members do not accept

20. 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 • Collaborate • Contend: ‘Task’ ‘Relationship’ conflict • Avoid (& build trust by sharing other tasks) Operational

21. 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) Operational

22. 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 Operational

23. 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 Personal

24. 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

25. If you want to know more • Contact me at: michael.byrne2@mailq.hse.ie • 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.

26. ‘Holy grail’ of teamworking