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Teamworking In a care oriented environment, to achieve any worthwhile results, one must work as part of a team. Great practice is a fine thing but unless it is part of a communicative, dynamic team then it falls down as soon as the practitioner finishes their shift. As Adrian Ward in 1 993 puts it “Teamwork should never be regarded as an optional extra in this sort of work, it is the heart of the matter. ” Good teamwork starts with the organisational culture. In my place of work there is a fairly straight forward organisation with a simple hierarchical makeup.

A chain of command runs from the directors, ia the manager and deputy manager to the qualified nursing staff and then to senior carers and carers. There are offshoots to this in the form of a residents committee which includes residents and relatives. Also, there are the cleaning, laundry and kitchen staff who are off to one side to make up the care team. This works well under most conditions and usually it is the qualified staff who make the day to day management decisions in collaboration with the residents and families. Some theories of teamwork rely on a certain amount of conflict in the team to generate an effective result.

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Others look to foster a cohesive atmosphere in a team. Mike Woodcock defined the nine characteristics of a mature team which will give a harmonious collective working together towards a mutual goal. The nine characteristics are clear objectives and agreed goals, openness and confrontation, support and trust, cooperation and conflict, sound procedures, appropriate leadership, regular review, individual development and sound inter-group relations. When all these are present to a certain extent then a smooth and well rounded team should result. According to Bell and Hart, there are eight major causes of conflict in teams.

These are conflicting resources, conflicting styles, conflicting perceptions, conflicting goals, conflicting pressures, conflicting roles, personal values and unpredictable policies. Although conflict and change may cause some problems, in a team a certain edge to the dynamic is not necessarily a bad thing. It can help bring a lot of knowledge, experience, insight and innovation from the different perspectives involved. Belbins team roles are useful to identify who does what in a team and are helpful to analyse the team and find gaps in expertise. They can be divided into four categories. Leading is the place for a oordinator or shaper.

To make things happen, a team needs an implementer and a finisher. To stimulate ideas one needs a monitor, plant and a specialist. In addition an investigator and a team worker is needed. Although these are all identified roles in the team, they do not have to be separate people. We all have many facets to our personality and many of us are able to combine or more Of these roles in one person. Once a good, cohesive team has been put together the next big challenge, particularly in today’s multi disciplinary health care system, is for that team to be able to work in a collaborative way with other teams.

This is helpful as often a goal will involve input from more than one agency or team. In addition, collaboration is an excellent way to improve standards and drive down costs. This philosophy is very clearly voiced in the 1998 white paper, Modernising Social Services, which said that people do not fit into neat service categories, and if partner agencies are not working together it is the user who suffers. Whether it is interprofesional or inter-agency collaboration, there is a clearly recognised premium for the service user both in quality of care and in outcomes when good practise is followed by all teams involved.

Also there is a bonus in that it does make for a nicer working environment and that is always helpful when trying to achieve something. To be an effective leader requires a complex mix of attributes, behaviours and skills but most of all it requires an ability to reflect upon and evaluate yourself. A good leader should teach, inspire and empower their people. A good leader does not necessarily have to be a formal manager, although usually this is the case, but can be a self empowered worker taking up the role where a vacuum exists in the management Structure. One of the most influential models of leadership is

Adair’s Action-centred Leadership. From this one gets the idea that if one person can do something, then others are able to learn how to do it and that leaders can be made. In fact, that we are all capable of leadership. According to Adair, the three elements required are understanding the task, understanding the people in the group and understanding the group as an entity. The leader has to keep the needs from all three balanced. A truly effective leader will attend to all three elements. Frederick Taylor in his Theory of Scientific Management postulated the following. Workers do not enjoy work so need to be supervised closely.

Managers should break down a job into a series of small tasks. If workers are paid according to the amount of work done then they will be motivated to work hard and maximise productivity. This is a model advocated by Henry Ford and used by many high intensity production environments today. Maslow however takes a different approach more focused on meeting the psychological needs of workers. These can be structured into a hierarchy and once the base level needs are met (wages) then other needs can be factored in such as security of employment, a social aspect to work, recognition and status in the workplace.

As with all forms of Maslows Hierarchy of Needs, the lower levels need to be satisfied before the higher levels can be met. Also not all workers are motivated in the same way so some may jump around the hierarchy a little whereas others might progress smoothly in an upwards trajectory. Good communication is an absolute requirement for a leader. Florence Nightingale put it very well in 1860 when she said “Let whoever is in charge keep this simple question in their head (not how can i do this thing right myself, but) how can i provide for this right thing to always be done. A good leader will ot only communicate the teams goals and methods to the members but will involve them in the whole process.

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