Brendan McCormack Teamwork Issues effectiveness and importance

Teamwork:
issues,
effectiveness
and importance
Professor Brendan McCormack
Director, Institute of Nursing & Health Research and Head of
the Person-centred Practice Research Centre, University of
Ulster.
Professor II, Buskerud University College, Drammen, Norway;
Adjunct Professor of Nursing, University of Technology, Sydney;
Adjunct Professor of Nursing, Monash University, Melbourne;
Visiting Professor, School of Medicine & Dentistry, University of Aberdeen.

Presentation Focus
• Clinical and Therapeutic effectiveness
• Key issues in team functioning
• Human Flourishing
• Workplace Culture

Clinical Effectiveness
“the extent to which clinical interventions
when deployed in the field for a
particular patient or population do what
they are intended to do, that is, maintain
and improve health and secure the
greatest possible health gain from
available resources”
[DoH, 1996]

‘doing the thing right’ whilst
doing the thing right whilst
‘doing the right thing’

Therapeutic Effectiveness
Therapeutic reciprocity it is a fundamental
support system to sustain and develop
peoples’ therapeutic effectiveness. It relies
on a team culture that encourages
practitioners to be sensitive to their
practice, open to meaningful challenge
about practice, where there is access to
support and development and a
commitment to reflection on practice.

Practice Context
• Highly political & unsettling
Requires:
spaces that provide opportunities for creative problem
solving and the determining of practical, context specific
solutions and that create sufficient psychological safety
(Brown & McCormack 2010)

Psychologically Unsafe Environments:
characterised by …
• Misuse of power and lack of autonomy
• Horizontal violence and oppressed
behaviours
• Transactional leadership
(Brown & McCormack 2010)

Twenty years as a nurse
Moving through the ranks knowing
who I am
Knowing me
Becoming a manager, being a manager
Managing
Discovering the joys of personcentredness
Unfurling the challenges of being a
person-centred leader
Self growth
Discovery
Transformation
The winds of change blow from the west
Person-centred leadership devalued
Targets
Bullying
Devaluing
I am an ‘It’
Stats mean good care
Shared experiences mean coercion
Get out get out get out
Stay safe
Shut down
Hide
But I need to keep listening to the
But I need to keep listening to the
patients

What is a team
• “a group in which the individuals have a
common aim and in which the jobs and skills of
each member fit in with those of others, as ... in
a jigsaw puzzle pieces fit together without
distortion and together produce some overall
pattern”.
• “an effective team may be defined as one that
achieves its aim in the most efficient way and is
then ready to take on more challenging tasks if
so required”. [Adair, 1986]

What is a team
•The task
•The individual
•The group

The Task
• common sense of purpose
• clearly defined task(s)
• clarity about roles to match the task(s)
• balance of tasks with services
• knowledge, skills and expertise required
for effective task completion

The Individual
id

Human
Flourishing
Human flourishing
occurs when a
person is
concurrently doing
what he [sic] ought
to do and doing
what he wants to do
(Aristotle)

The Four
Elements of
Flourishing
• Challenge
• Connectivity
• Autonomy
• Using your
valued
competencies
(Gaffney, 2011)

Emotional Survival
• Depends on …
– Feeling psychologically og ca y safe
– Feeling good about oneself
– Feeling close and respected in relationships
and groups that are important
(Gaffney 2011)

• Motivated t to act
Helping individuals to
Flourish in the Workplace
• Respect from others and self-respect
• Fulfilment of potential for growth
• Satisfaction and security
• Reward for effort

The Group
• team philosophy
• a shared agenda
• shared decision-making processes
• effective use of resources
• effective co-ordination
• communication, i feedback & evaluation
• collaborative, inclusive & participative
p

The need for leadership that is shared,
distributed and adaptive
• Person-centred Situational Leadership
(Lynch et al 2011)
• Clarity of leadership vs management
functions and roles (Dewing &
McCormack, in progress)
• Shared governance models

mmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmm Developing effective
mmmmmmmmmmmmmmmmmmmm workplace cultures for
mmmmmmmmmmmmmmmmmmmm team/therapeutic
mmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmm
effectiveness requires
mmmmmmmmmmmmmmmmmmmm the changing gof
mmmm
patterns

Patterns are often ignored or go unchallenged despite
changes to structures and processes (Plsek 2001; Ill 2005).
This is because patterns are associated with distinctive
behavioural norms that manifest specific values, beliefs and
assumptions within a workplace. These aspects together by
definition are termed ‘culture’ (Schein, 2004) where implicit
importance is placed on how things are done and what
counts as important. To bring about fundamental change in
complex systems requires the recognition of patterns that
drive thinking and behaviour (Plsek 2001).

Patterns describe problems that occur over
and over again in a team and they describe
the core of a solution to that problem in
such a way that it can be used a million
times over – without t ever doing it the same
way twice. As such, patterns can be very
generalised at a conceptual level l while they
are absolutely unique at a local
implementation ti level. l

EFFECTIVE WORKPLACE CULTURE
concept analysis
(Manley et al 2012)
Enabling Factors Essential Attributes Consequences
INDIVIDUAL:
•Transformational
leadership
•Skilled facilitation
•Role clarification
ORGANISATIONAL:
•Flattened &
transparent
management
•Organisational
readiness
•Human resource
management support
1. Specific values promoted in the workplace,
namely:
m1
• Person-centredness
• Lifelong learning
• Support and challenge
• Leadership development
• Involvement & participation i by stakeholders
• Evidence-use and development
• Positive attitude to change
• Open communication
• Teamwork
2. All the above values are realised in practice,
there is a shared vision & mission and, individual
& collective responsibility
3. Adaptability, innovation & creativity maintain
workplace effectiveness
4. Appropriate change is driven by the needs of
patients/users/communities
5. Formal systems exist to continuously enable and
evaluate learning, performance and shared
governance 3 :
•Continuous evidence
that:
‣Patients, users,
communities needs are
met in a person-centred
way
‣Staff are empowered &
committed
‣Standards & goals are
met (individual, team,
organisational
effectiveness, includes
safety)
‣Knowledge/evidence is
developed, used &
shared
‣Human flourishing
•Influence on other
idiocultures

Slide 23
m1 manleyk, 2005/04/06

Developing Effective Workplace
Cultures through Emancipatory
Practice Development
A Case Study of the Belfast Health
and Social Care Trust
Professor Tanya McCance, Ms Bernadette
Gribben, Ms Elizabeth Mitchell, and Professor
Brendan McCormack
(McCance et al, in press; McCormack & McCance, in press)

Project Aims
• demonstrate a greater knowledge and
understanding of the principles of person
centredness
• demonstrate an understanding of the
emerging challenges to providing person
centred care
• identify outcomes for staff and patients as a
result of practice change

Participating Acute Hospital sites
• Cancer Inpatient Unit
• Mental Health Inpatient Unit
• Brain Injury Unit
• Specialist and General Medical Inpatient Wards
- Chest Medicine
- Cardiology Intervention
- Medicine/ Respiratory
- Medical/ Hepatology
- Neurology
• Eyes and ENT Theatre Department

Programme Facilitation & Management
• The programme was implemented over a period of 18
months.
• High level Steering Group
• Implementation Team comprising of Ward Managers,
Nursing Development Leaders and Service Managers
from each of the participating sites.
• Internal/external facilitation
• Service user involvement e was obtained through
involvement in programme activities e.g. patient stories
and observations of practice.

Development Themes
• Theme 1:
• Theme 2:
• Theme 3:
• Theme 4:
Promoting an awareness and
understanding of person-
centredness
Developing a shared vision
Determining the existing quality
of the user experience
Developing practice

Data Collected
• Patient stories
• Implementation team 1: interviews
• Implementation team focus groups
• Key stakeholder focus group
• Reflective accounts (participants)
• Stakeholder Evaluation (Claims, Concerns
and Issues [Guba & Lincoln 1989])
• Practice changes specific evaluations (e.g.
improvements in patient flow)

Summary of Key Findings
Enabling Conflicting Living Person-
Engagement Pi Prioritiesiti
Centred Care
• Ways of working
• Building
relationships
• Maintaining
momentum
• Feeling
pressurised
• Staffing
resources
• Evolving context
• Embracing
person-centred
values
• Being confident
and competent

“meaningful critically reflective
conversations that lead to
support for, and engagement
with, the changes that teams
initiate as a result of the
learning"

Coming together is a beginning.
Keeping together th is progress.
Working together is success.
(Henry Ford)