The importance of effective teamwork in general practice
Teamwork is essential if general practices, with their diversity of roles and skills, are to function effectively and deliver high standards of care – and poor team-working can lead to unforeseen and potentially harmful consequences
Having a good team is vital for success in many aspects of life. Sport and business provide many excellent examples of teams working well together while enjoying a culture of success. With this in mind, how can effective teamwork translate into general practice where established attitudes about autonomy and co-operation add to the complexity of providing care?
Other industries, such as aviation, have improved their reliability by applying innovative concepts to interpersonal relationships and hierarchical structures. A similar approach may assist general practices, which often employ many members of staff to work together as a team, in order to attend to the needs of their patients and provide them with the best service possible. The importance of teamwork and its impact on effective outcomes may therefore be even more prominent in the health care sector than in other sectors.1
ELEMENTS OF TEAMWORK
In 2012, the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) jointly outlined how high-quality, safe patient care not only involves teamwork, but also good communication, leadership and adopting a culture where healthcare professionals can discuss patient safety openly amongst the team and with the patients themselves.2 In order to achieve this, a positive approach to teamwork is required.
Multidisciplinary teamwork in healthcare and its influence on creating a safety culture in an organisation has also been emphasised in numerous reports most notably in the recent Francis report into the care failings at Mid Staffordshire Hospital between 2005 and 2008.3
CHALLENGES
Practice nurse teams are diversifying and, as a result, communication and teamwork is becoming increasingly challenging. This is particularly evident in large teams that encompass a wide variety of very different individual roles. Practice nursing has evolved over recent years with the introduction of new roles and responsibilities, such as nurse practitioners, and nurses are therefore undertaking triage as well as more traditional duties. While this makes teamwork and communication difficult, never has it been more important to get right.
TEAM MEETINGS
One crucial factor for effective teamwork is team meetings. Regular team meetings have been linked with greater levels of innovation and effective teamwork.4 Similarly, failure to set time aside for team meetings is believed to have a negative impact on team building and communication.5 Given that many staff work part time, team meetings are also particularly important for the dissemination of information.
Despite this, setting time aside for a multidisciplinary team meeting on a regular basis is inconsistent throughout general practice in the UK. General practice is under constant pressure and time is often stated as the reason why teams do not have the opportunity to have team meetings.
The Medical Protection Society (MPS) undertook 153 risk assessments of general practices in the UK in 2013. Risks were identified and given a risk rating, which was added up to produce an overall risk score for the practice. Interestingly, a distinct correlation was found between practices that had a very high risk score and a lack of regular multidisciplinary team meetings. On the other hand, it was found that of the practices that had a low risk score, the majority (94.2%) were undertaking regular multidisciplinary team meetings. The practices that had the lowest risk score also had better systems in place for communication within the team. The value and benefits of regular team meetings are therefore apparent from these figures.
BENEFITS
Staff who feel that they have organisational support generally have a greater sense of commitment to their role. Organisational support and reward is important for team members to feel valued and motivated, and a strong sense of team spirit can also greatly enhance job satisfaction. In turn, this increases staff retention, which is particularly important in general practices where many now struggle to recruit experienced nurses.
OVERCOMING BARRIERS
In general practice, one of the barriers to developing a cohesive team is a perceived hierarchical structure. Therefore, barriers between professional groups such as doctors, nurses and receptionists can have an influence on teamwork. This can often inhibit some team members from participating in decision-making and providing open input in team meetings. Having regular meetings leads to breaking down inhibitions, promotes positive interpersonal relations and encourages involvement for some of the more junior members of the team, who are often less likely to contribute.
Given the current climate in healthcare, where litigation against healthcare professionals is rising, safety is paramount. Healthcare professionals and general practice teams are more aware of the importance of clinical risk management and the need for a positive safety culture. The implementation of regular team meetings not only improves the culture of the organisation and teamwork, but it also has a positive impact on patient safety and improves communication within the multidisciplinary team.
REFERENCES
1. Richter AW, Dawson JF, West MA. The effectiveness of teams in organisations: a meta-analysis. The International Journal of Human Resource Management 2011;22(13):2747-2769.
2. Nursing and Midwifery Council and General Medical Council (2012) Joint statement on professional values
3. The Mid Staffordshire Foundation Trust Public enquiry, Chaired by Sir Robert Francis QC. (2013) London. The Stationary Office.
4. Borrill C, Shapiro D, West M, Rees A.
Team working and effectiveness in healthcare. British Journal of Healthcare Management 2000;6 (8):364-371
5. Field R, West M. Teamwork in primary health care: 2 perspectives from practices. Journal of interprofessional care. 1995;9(2):123-130.
6. Department of Health (2011) Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance
