Various teams exist within primary and secondary care and their structure and function is dependent upon a number of elements, including the organizational structure, the client group and the care setting. A number of team structures can be identified within healthcare including multiprofessional teams, multidisciplinary teams and interprofessional teams. Scholes and Vaughan (2002) clarify the dif- ference between these teams, highlighting that the multiprofessional team comes from different health and social care backgrounds, but may not act together. The primary healthcare team is a good example of this. The multidisciplinary team has members who share the same professional background but practise within different specialities or branches – for example, district nurse, respiratory specialist nurse, in- tensive care nurse. Finally, ‘interprofessional’ refers to interactions between team members. Scholes and Vaughan also highlight that within government policy these terms are used interchangeably. Team working is the means by which teams inter- act in order to achieve their common goal. In order to be effective, teams need to be developed. They not only need a common goal to work towards but also require a clear function, need to be organized, to have good communication strategies and policies and guidelines in place. Due to the increasingly complex healthcare needs of patients, teams are expanding to include a range of healthcare professionals and as such will need to recognize the contribution of each team member in order to remain effective.
Reflection point
Think about the team you are currently placed with.
r What healthcare professionals make up your team?
r Can you identify who belongs to the multidisciplinary team and who belongs to the multiprofessional team?
Senior management teams may have no direct contact with patients but will be required to provide the resources to deliver services to those patients (Boaden and Leaviss 2000). These may be described as ‘indirect teams’ because of the lack of front-line patient contact, whereas teams delivering patient care are seen as ‘direct teams’. In contemporary healthcare there are a variety of different teams, including
‘project teams’, which may be set up to improve the quality of a service or to develop a new service. ‘Care delivery teams’ may be further divided into client- specific groups such as children, care of the elderly or learning disability teams.
‘Disease-specific teams’ include respiratory, cardiac, stroke and neurological disease teams (CHSRF 2006). These teams may be multiprofessional – that is, composed of professionals from different health and social care backgrounds – or ‘uniprofes- sional’, as in specialist nurse teams. In addition, teams are recognized on the basis of where care is delivered, such as primary care, secondary care and long-term care.
Øvretveit (1993) identifies three further types of team:
r The client team is formed by a group of professionals from different backgrounds who come together specifically to provide care for an individual patient. They may not meet face to face but do communicate. This team is transient and disbands when the care episode has ended or the patient’s needs have changed.
r The network association team comprises volunteers who act as a vessel for making referrals to other professionals.
r Formal teams are multidisciplinary and are governed by policy, with an identified team leader – for example, the primary healthcare team.
Pre-registration students will become part of a number of teams and will need to recognize that the nature of the team will reflect the task/goal they are required to achieve. The composition of the team will vary depending on the task/goal. The more complex the task, the more complex the group. In the case of Pearl, the team caring for her is best reflected in the client team: the team did meet, but disbanded when Pearl was discharged.
Vignette Pearl’s discharge planning meeting
Nurse: If I may start, Pearl has now been on the ward for a week.
She has been assessed under the Mental Capacity Act and has capacity to make her own decisions. She has refused the insertion of a PEG and understands the consequences of this decision. She would like to go home to die.
Doctor: I agree with Pearl’s decision. The procedure would have been very difficult and the risks are high, as Pearl has com- plex health problems. As long as Pearl and her family are aware that she is going home for end of life care, then we can plan for her discharge as soon as possible.
Community matron:
I’m happy for Pearl to be discharged, but I do have con- cerns about how Mr White will manage as he has his own health problems. He’s deaf and sleeps upstairs. He won’t hear Pearl if she’s choking.
Social worker: We can arrange a package of care. I have fast-tracked con- tinuing healthcare under the palliative care criteria and the package will be in place by the end of the week. This will include a night sit.
Dietician: I’m happy for Pearl to go home, but I will need time to prepare the family and carers to ensure Pearl’s dietary needs are met. I have discussed this with the speech and language therapist and we have agreed a consistency of food appropriate to Pearl’s needs.
Occupational therapist:
I’ll contact the family to undertake a home visit. I need to assess access for a profiling bed and mattress. Pearl refuses to be hoisted so carers must use sliding sheets to move Pearl. I’ll prepare a manual handling plan.
Social worker: I’ll contact the care agency and hospital at home to ensure that they are aware of Pearl’s care plan.
Doctor: As everyone is in agreement that Pearl should go home, we can start discharge planning today.
The discharge planning meeting outlined above epitomizes good teamwork among healthcare professionals. However, one aspect in which it is lacking is that the patient and/or their representative were not present at the meeting and so were unable to offer their perspective. However, it did demonstrate that there was no hierarchy among the healthcare professionals; there is evidence of open com- munication and shared decision-making, questions are asked and all avenues are explored in order to facilitate a successful discharge.
Patient perspective
Later, Mr White commented: ‘I am sorry I could not attend your meeting but it is nice that the staff have asked our views about Pearl coming home and how I would manage. I know Pearl wants to come home, but at my age I need to be considered as well.’
Activity
r Access a discharge planning meeting in as many of your clinical placements as possible.
r Reflect on the meeting and try to identify which healthcare professional played which of Belbin’s team roles. For example, who would you say was the ‘plant’ and why?
r What elements can you identify that would lead you to believe that this was a good example of an effective team?
r How did the team members demonstrate that they had a good understanding of their own role and those of the rest of the team?
r Do you feel that the team showed mutual respect, and if so how?