Working in and between
teams to create positive
cultures in primary care
18th October 2016, The King’s Fund
Dr Rachna Chowla
GP Partner, Albion Street Group Practice
@rachnachowla [email protected]
Contents
Why do culture and team working matter?
PLAT: new research in primary care
Which factors create positive cultures in healthcare?
What are we doing at the Albion Street Group Practice?
Why do culture & team working
matter?
Francis Report 2013 and others
Acute data:
Strong correlation between positive HR policies/practices
& patient mortality
Link between positive climate (e.g. well structured team
environments, support, opportunities to contribute to
improvements) and variety of performance indicators
West et al, 2015
NHS research on team effectiveness
Patient outcomes
Reduced hospitalisations and costs
Reduced error rates
Lower patient mortality
Higher patient satisfaction
Team outcomes
Increased staff engagement
Increased effectiveness and innovation
Increased well-being of team members
Reduced turnover and sickness absence
Inter-disciplinary teams outcomes
Deliver higher quality patient care and implement more
innovations Lyubovnikova, J. & West, M.A. (2013)
Why do culture & team working
matter?
PLAT (practice leadership assessment tool)
Findings:
1) Statistically significant correlations between
2) CQC KLOE inter-correlations: scores on well-led highly
correlated with all other KLOEs and inspection rating
scores, overall
Safe Effective Caring Responsive Well-LedOverall
Rating
Delivery of care ✔
Patient-centred care ✔ ✔ ✔
Team working ✔
Management and leadership ✔
PLAT
CQC domains
Real Teams have:
Clear, shared objectives and they measure their
performance against these objectives
Are mutually dependent on each other/have to
work closely together to achieve their objectives
Meet regularly to review their team’s
effectiveness and discuss and decide how it could
be improved
Teams are more effective
and innovative to the extent
that they routinely take
time out to reflect upon
their objectives, strategies,
processes and environments
and make changes
accordingly.
Reflexivity
Schippers, West & Dawson, 2012
Team effectiveness
Driven teamResilient
team
Dysfunctional team
Complacent team
High task reflexivity
High social reflexivity
Low task reflexivity
Low social reflexivity
• High short-term
task effectiveness
• Poor team member
well being
• Short-term
viability
• Moderate
innovation
• High inter-team
conflict
• Poor task
effectiveness
• Poor team
member well-
being
• Very low team
viability
• Low innovation
• High inter-team
conflict
• High task effectiveness
• Good team member well
being
• Long-term viability
• High innovation
• High inter-team cooperation
• Poor task effectiveness
• Average team member
well being
• Short-term viability
• Low innovation
• Moderate inter-team
cooperation
Key Role of Team Leadership
Agree an inspiring vision and clear direction
Ensure agreed, clear (5 or 6) objectives for the year focused on key issues
Ensure regular, positive and effective team meetings
Encourage positive, supportive relationships
Resolve and prevent intense conflicts
Positive group attitudes towards diversity
Nurture team learning, improvement & innovation
Lead inter-team cooperation
Be attentive and listen carefully to the team – essential for
compassionate leadership
Evidence in practice:
Albion Street Group Practice
What happens now?
Multiple teams, complex tasks, part-time working
We meet a lot!
Daily clinical de-briefs, weekly management/clinical meetings,
monthly PLT, separate team meetings, separate quarterly
partnership meetings
Decision to make cultural assessment part of our due
diligence process
Tool-based assessment ?PLAT
Formal OD work
References
Lyubovnikova, J. & West, M.A. (2013). Why teamwork matters: Enabling health
care team effectiveness for the delivery of high‐quality patient care. In E. Salas
et al. (eds.). Developing and enhancing teamwork in organizations: Evidence
based practice and guidelines. (pp.331‐372). San Francisco: Jossey Bass.
Schippers, M.C., West, M.A. and Dawson, J.F. (2014). Team reflexivity and
innovation: the moderating role of team context. Journal of Management.
West at al, 2016. Practice Leadership Assessment Tool – Evaluation Report. The
Kings Fund/CQC. In press.
West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015)
Leadership and Leadership Development in Healthcare: The Evidence Base.
London, Faculty of Medical Leadership and Management
West, M.A., 2012, Effective Teamwork: Practical lessons from Organizational
Research. London: Wiley
With thanks
Innovation increases as professional
diversity within healthcare teams
Professional diversity
Innovation in
quality of care
in 100 PHC
teams
Healthcare team effectiveness
<3.2 3.2 –
3.4
3.4 –
3.63.6 –
3.8
>3.8
PHC Team Functioning
External
ratings of
innovation
Similar findings in CMH
teams
Teams harassment and violence
1
2.32
2.15
1.28
0.8
1
2.07
2.28
1.45
0.89
1
1.511.46
1.28
11
1.691.6 1.63
1.1
0.7
0.9
1.1
1.3
1.5
1.7
1.9
2.1
2.3
2.5
Not working in ateam
Pseudo III Pseudo II Pseudo I Real team
Harassement from collegues Violence from colleagues
Harassement from patients Violence from patients
www.nhsstaffsurrveys.comTypes of team working
patterns
Odds
rati
o