Year: 2008
Type: book
Abstract: The purpose of the project was to examine how we can create the conditions in NHS organisations that ensure the effectiveness of work teams in providing the best quality care for patients and improving the working lives of NHS staff.The project examines possible barriers to, and facilitators of, effective team-based working in NHS organisations, and aims to provide practical guidelines for NHS organisations on how to implement effective team-based working.Why focus on team-based work?Over the previous twenty years the importance of team working in health care has been emphasised in numerous NHS reports and policy documents, and most recently High Quality Care for All -NHS Next Stage Review described team-based working as an imperative from the inception of the NHS.Teams are increasingly the unit of performance in many organisations (Lawler, Mohrman & Ledford, 1992) and as organisations grow in size and become more complex, groups of people are required to work together in co-ordinated ways to achieve objectives that contribute to the overall effectiveness of their organisation.Team-based working provides the flexibility needed to respond effectively to the constantly changing demands in the organisation's environment, and provides a mechanism for bringing together the range of expertise, skills and knowledge required to complete complex work tasks.There is an increasing body of research in organisations that have shown links between team-based working and organisational effectiveness (see Chapter One for a detailed review).In the research presented here, we focus on how to build organisations that are structured around teams, thus enabling effective team working.This is because, in contrast with the wealth of advice on teambuilding and team working, there is little guidance or advice to managers on how to build team-based organisations.However, emerging evidence suggests that it is the organisational context rather than team processes that determines the effectiveness of team-based IV working within and across organisations (West, Tjosvold, & Smith, 2003; West & Markiewicz, 2003).Given the body of evidence about the benefits of effective team working in health care, we need to discover what factors promote effective team-based working in NHS organisations.The overall challenge and the aim of this research was to answer the question how can we build NHS organisations that ensure the effectiveness of work teams in providing the best quality patient care?We also had a number of research objectives: 1.To determine whether, and which aspects of, team-based working predicts Trust performance, patient satisfaction and staff well-being.2. To determine whether an increase in the level of team-based working predicts Trust performance, patient satisfaction and staff well-being.3. To determine whether leadership, culture and HR support systems influence levels of team-based working in the NHS.4. To determine whether team-based working interacts with HR support, culture and leadership to predict Trust performance, patient satisfaction and staff well-being. 5. To evaluate the effects of interventions in NHS Trusts that seek to promote teambased working upon patient care and delivery of services to patients.6.To identify the barriers to, and facilitators of, implementing team-based working in NHS Trusts.7. To determine which aspects of interventions to develop team-based working most influence the success of the interventions.8. To determine what strategies the most well developed team-based organisations pursued in order to effectively implement team-based working.9. To develop practical guidelines for NHS Trusts for how to implement team-based working successfully.V MAIN FINDINGS To answer the central research question, and research objectives one to five, we used quantitative data collected from the National NHS Staff Survey to examine whether well-structured 'real' team-based working in NHS Trusts was associated with employee well-being, patient satisfaction and measures of Trust performance.This was supplemented by data collected from interviews with senior managers and focus groups with staff in fourteen NHS trusts which displayed 'high', 'increasing' and 'low' levels of 'well-structured' team-based working.To answer objectives six to eight we collected data from interviews with senior managers and focus groups with staff in eight NHS trusts that have recently introduced interventions designed to promote team-based working with the aim of examining the barriers to, and facilitators of, team-based working, and also the impact on staff members and the delivery of patient care.Quantitative analysis of the National NHS Staff Survey data was used to address research objectives one and two.Research objective one was to determine whether, and which aspects of, team-based working predicts Trust performance, patient satisfaction and staff well-being and research objective two was to determine whether an increase in the level of team-based working predicts Trust performance, patientsatisfaction and staff well-being.Our analysis showed a strong association between staff members who reported working in 'real teams' and more positive outcomes, where staff members who worked in a 'real team' were:• Less likely to have suffered work related injuries or stress• Less likely to have witnessed errors and incidents• Less likely to have experienced physical violence, harassment, bullying or abuse from patients or work colleagues• More likely to report they were satisfied with their job VI Our analysis would also indicate that there are different types of 'pseudo teams'; respondents working in a 'pseudo team' where:• team members work closely with each other, but where the team does not have clear team objectives or meet regularly, was associated with higher levels workrelated injuries and stress, errors and near misses, and violence and harassment• team members do not meet regularly (but do work closely together and with clear objectives) was associated with higher levels of work-related injuries and violence and harassment from patients This analysis of the National NHS Staff Survey data was supplemented by interviews and focus groups conducted with staff and managers, which identified the following points:• Marked differences across NHS Trusts regarding the extent to which team members were clear about their own roles and responsibilities and those of other team members.• Lack of clarity over roles and responsibilities often manifested itself in poor communication and lack of citizenship between team members, which could ultimately have an impact on the delivery of healthcare to patients.• Team-based working was embedded across all NHS Trusts by virtue of the tasks completed, and working interpedently in multi-and uni-disciplinary teams was essential to ensure the delivery of healthcare to patients.• Finally, we found universal problems of practical difficulties and resourcing issues preventing team members from meeting together in one place at the same time, and as a result teams not having sufficient opportunities to reflect on past performance.Quantitative analysis of the National NHS Staff Survey data also indicated that there were significant implications for NHS Trusts at a corporate level of having high number of staff working in 'pseudo teams'.NHS Trusts which had a higher proportion of staff working in well structured 'real' teams (and thus a lower proportion of staff in poorly structured teams) reported significantly better Trust level outcomes.The data also showed that NHS Trusts which displayed an increase year-on-year of staff working in VII well structured 'real' teams also performed better on Trust level outcomes.Specifically, these trusts were rated as being more effective on measures of financial management, and at meeting the Department of Health's core standards, existing national standards and new national targets.Research objective three was to determine whether leadership, culture and HR support systems influence levels of team-based working in the NHS.Quantitative analysis of the National NHS Staff Survey data identified that, across NHS Trusts, respondents were more likely to work in well structured teams where the prevailing organisational climate of the trust was positive and supportive, managers were supportive of staff and jobs were well designed.Research objective four was to determine whether team-based working interacts with HR support, culture and leadership to predict Trust performance, patient satisfaction and staff well-being.Quantitative analysis of the National NHS Staff Survey data identified that, across NHS Trusts a combination of: • managerial support for work-life balance and good team-based working was associated with shorter patient waiting times • jobs which were well designed and good team-based working was associated with shorter patient waiting times • a positive and supportive organisational climate and good team-based working was associated with lower patient mortality and shorter patient waiting times Research objective five was to evaluate the effects of inventions in NHS organisations that seek to promote team-based working upon patient care and delivery of services to patients.Qualitative data collected with interviews and focus groups with staff and managers in NHS Trusts which had implemented interventions aimed at prompting team-based working identified: • Patient outcomes, such as waiting times and length of stay, are improved as a result of team-based working and patients experience a more uniform and coordinated care pathway VIII • Team-based working interventions encourage all members of a team to participate in setting the team's goals and objectives • Better understanding and communication within the team and with other teams as a result of team-based working improves morale and service delivery • Team-based working interventions helped identify team members roles and r
Institution: Aston University
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
Funder: Aston University
OpenAlex ID: W373821032