1 multidisciplinary teamworking: from theory to practice dr. michael byrne clinical psychologist

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…’:

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

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?

Reg

ress

ion?

6

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

7

PersonalPersonal

OperationalOperational

ProfessionalProfessional

Environmental / Structural

Environmental / Structural

RelationshipsRelationships

Factors influencing teamworking (Byrne, 2005a)

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)

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

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

Str

uctu

ral

11

Team composition instability

Negative teamwork experiences

Poor retentionTeam instability / Service discontinuityS

truc

tura

l

Storming

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

Ope

rati

onal

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

Ope

rati

ona

l

14

Referral pathways (Byrne, 2006c)

Target service user population

Extent of referral net

No. of access points

Allocation process

Disagreement

Individual competitivenessO

pera

tion

al

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

Ope

rati

ona

l

16

Operational management Professional autonomy

Primary leadership challenge (Onyett et al., 1997b)

Relationship with team members

Need to match (or balance)

Ope

rati

ona

l

17

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

18

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

19

Team-based responsibility

Leader ‘grants’ professional autonomy

Partial development of team hierarchy

Some members do not accept

Centralised decision-making

Ope

rati

onal

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

1. Collaborate

2. Contend: ‘Task’ ‘Relationship’ conflict

3. Avoid (& build trust by sharing other tasks)

Ope

rati

ona

l

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)

Ope

rati

onal

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

Ope

rati

ona

l

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

Per

sona

l

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