Saving 1000 Lives Team Based Working

Saving 1000 LivesTeam Based Working

Effectiveness of team working

Sexton / Thomas / Helmreich – Uni. Of Texas – BMJ v320, 18/3/2000

Aston University Work

• Aston Business School, University of Aston, Birmingham B4 7ET

• Michael West, professor of organisational psychology.

• The Effectiveness of Health Care Teams in the National Health Service Report

• Carol S. Borrill, Jean Carletta, Angela J. Carter, Jeremy F. Dawson, Simon Garrod, Anne Rees, Ann Richards, David Shapiro and Michael A. West

Teamworking is critical to good quality care

What is a team?

•Beasts of burden yoked together.

What defines a Team?• Teams are defined by their task not by

the team members.• Team members are selected because

they have the mix of skills necessary for the task to be completed successfully.

What is a team?The very basics:

A group of people who:• Have a clear task to perform• Need to work together to achieve this

task• Are able to meet together to review

objectives and the way in which the team is performing

What is a team• “A team is a group of individuals who work

together:– to produce products or deliver services for which they

are mutually accountable. – Team members share goals – and are mutually held accountable for meeting them, – they are interdependent in their accomplishment,– and they affect the results through their interactions

with one another. – Because the team is held collectively accountable, the

work of integrating with one another is included among the responsibilities of each member.”

Mohrman, Cohen & Mohrman (1995). Designing Team-Based Organisations. London: Jossey Bass

Teams have the following characteristics:• Team members have shared objectives in relation to their work.

• Team members interact with each other in order to achieve these shared objectives.

• Team members have more or less well defined roles, some of which are differentiated from each other.

• Teams have an organisational identity – they have a defined organisational function and are recognised as a team by others outside the team.

• The team task performance has consequences that affect others inside or outside the organisation.– Developing Team Working in Health Care A Guide for Managers

– Carol Borrill and Michael West, Aston University

The woodpecker might have to go!

Do you work as a team in your work place?• YES

• NO

• DON’T KNOW

0

5

10

15

20

25

30

35

Not in a team Pseudo team Work in a team

%

Team working and mental health

Working in teams in the NHS• Do you work in a team?

• If yes …– Does your team have clear objectives?– Do you have to work closely together to

achieve these objectives?– Do you meet regularly to review your team

effectiveness and how it could be improved?

It is possible to:• Not be in a team

• Be in a pseudo team

• Be in a real team

Real teams• Team Interdependence

• Team Identity

• Team Autonomy

• Team Objectives

• Team Member Role Clarity

• Team Reflexivity

• Clarity of Leadership

• There is team learning behaviour


– Team members have to work closely together to complete the team task

• Team Identity

– It is clear who is in the team and the team is recognised as a team by others in the organisation

Real Teams

• Team Autonomy

– The team has sufficient control and discretion to decide how to carry out team tasks

• Team Objectives

– The team has clear objectives which are agreed by all team members and to which all team members are committed

Real teams


– Each team member is clear about their own role and the roles of others within the team


– The team meets regularly to review objectives and the ways in which the team is achieving these

Real teams


– Everyone is clear about who is the leader of the team and there is no conflict about leadership


– Team members share learning which enables the team to adapt and improve performance

Team Based Working

• Team Based Working is a philosophy or attitude about the way in which organisations work –

• where decisions are made by teams of people rather than by individuals and

• at the closest possible point to the client, patient or customer.

Predictors of mortality

• Sophistication of appraisal

• Sophistication of training

• % of staff working in teamsInt. J. of Human Resource Management 13:8 December 2002

1299–1310The link between the management ofemployees and patient mortality in acutehospitalsMichael A. West, Carol Borrill, Jeremy Dawson, Judy Scully,Matthew Carter, Stephen Anelay, Malcolm Patterson andJustin Waring

% staff working in teams

100%80-99%60-79%40-59%< 40%

Me

an

Mo

rta

lity

ind

ex

108

106

104

102

100

98

96

94

92

Carol S. Borrill, Jean Carletta, Angela J. Carter, Jeremy F. Dawson, Simon Garrod, Anne Rees, Ann Richards, David Shapiro and Michael A. West. Aston Business School, University of Aston, Birmingham B4 7ET

2.7

2.8

2.9

3

3.1

3.2

3.3

Low Moderate High

Team functioning

Pa

tie

nt

ex

pe

rie

nc

es

Clarity of objectives

Reflexivity

Support for innovation

Team functioning and patient satisfaction

• Those working in well functioning teams report higher levels of organisational commitment

and• Higher levels of adherence to organisational

ruleswhilst• Implementing more innovations in patient care• Effective team working is correlated with more

effective clinical governance

Individual and organisation

Retention and turnover• Within healthcare, those working in well

functioning teams are more likely to stay working in their current organisation than those working in poorly functioning teams.

• A stable workforce will tend to report less accidents, errors and work related injuries.

• Healthcare Commission Annual Health Check 2007 &

extent of team working:

1

1.5

2

2.5

3

Use of resources Quality of care

Rat

ing

Low team working

Medium team working

High team working

Teams and organisational performance

1

1.5

2

2.5

3

3.5

<3.2 3.2 - 3.4 3.4 - 3.6 3.6 - 3.8 >3.8

Health care team effectiveness

Team Functioning

External ratings of innovation

The greater the number of professional groups represented in the team, the higher the levels of innovation in patient care

Borrill et al. (2000)

Health care team innovation

0.5

1.5

2.5

3.5

4.5

5.5

5 7 8 9 10 11 12

Innovation in quality of care

Professional diversity

Stress

• In the NHS those not working in teams have much higher stress levels

–Carter and West 1999

Benefits of team based working – the research evidence• Reduced hospitalisation and associated costs• Improved service provision• Improved levels of innovation in patient care• Enhanced patient satisfaction• Increased staff motivation and mental

well-being• Reduced error rates• Reduced violence and aggression• Lower patient mortality

A Pseudo Team

A group whose members claim to be part of a team but the group does not exhibit the characteristics of a team

“Common behaviours seen in pseudo teams include• lack of common purpose,• a purpose with which members cannot identify, • inability to focus on a goal,• poor relationships among members,• interpersonal attacks,• members whose personal ambition overshadows the

common goal,• inability or unwillingness to evaluate outcomes,• lack of clear responsibility, and unknown or inappropriate

levels of responsibility.” – Team-Based Health Care Organizations – Blueprint for success. Jo

Manion, William Lorimer, William J Leander. Aspen Publications 1996

Working in teams and job satisfaction

www.nhsstaffsurveys.com

3.24 (0.68)

3.34 (0.72)

2.76 (0.73)

2.93 (0.74)

3.63 (0.64)

2.50

2.70

2.90

3.10

3.30

3.50

3.70

3.90

Not Working inTeam

Pseudo III Pseudo II Pseudo I Real team

Types of Team Working Patterns

Job S

atis

fact

ion

http://www.nhsstaffsurveys.com/

Working in teams and intention to quit


2.47 (1.01)

2.80 (1.07)

3.13 (1.12)

2.64 (1.05)

3.29 (1.12)

2.20

2.40

2.60

2.80

3.00

3.20

3.40

3.60

Not Working inTeam



Inte

ntio

n to

Lea

ve



Working in team and errors, stress and injury

1.00

1.57

1.26

1.00

1.91 1.88

1.00

1.70 1.69

1.501.61

0.91

1.31

0.870.90

0.70

0.90

1.10

1.30

1.50

1.70

1.90

Not Workingin Team



Odd

s R

atio

ErrorsStressInjury


Teams, harassment and violence

1.00

2.32

2.15

1.28

1.00

2.07

2.28

1.45

1.00

1.511.46

1.35

1.00

1.691.60 1.63

1.10

0.80

0.89

1.00

0.70

0.90

1.10

1.30

1.50

1.70

1.90

2.10

2.30

2.50

Not Working inTeam



Odd

s R

atio

Harassmentfromcolleagues

Violencefromcolleagues

Harassmentfrompatients

Violencefrompatients

Team Working and Health & Safety

eTBW ePTBW

Organisational health and safety .41 -.43

% staff suffering injury at work in previous year -.30 .36

% staff witnessing potentially harmful errors/near misses in previous month

-.32 .30

% staff experiencing physical violence in previous year -.36 .34

% staff experiencing bullying, harassment or abuse in previous year

-.29 .30

284 PCT’s - 145,000 respondents

How many teams do you belong to?

Team community

• A number of teams that need to work together to achieve a higher goal e.g. a patient pathway

• Including all those teams or organisations that must provide support or resources to the home team if it is to succeed

Pathway Management T

eam

Trust Board

PCT

G.P.’s

Portering

Ward Management Team

Theatres

Social Workers

Radiology

BereavementCounselling

Physio

Home team• The team whose goals

inform your work in all the other teams you may be involved with

• Are you accountable for the performance of the teams that you are in?

• What are you accountable for? What are your responsibilities?

• Who monitors or audits your teams’ performance?

• How effective is your team?• What could be done to improve team

effectiveness

What teams do you work in? Who else is in these teams?

Are there tools to assess team working?

Tools for assessing team working:• Does your team have clear objectives?• Do you have to work closely together

to achieve these objectives?• Do you meet regularly to review your

team effectiveness and how it could be improved?


• Team Identity

• Team Autonomy

• Team Objectives





The Aston Real Team Profile

Please circle the rating that best represents your view of the situation that exists currently in the team in which you work using the following rating scale:

1 - not at all descriptive of my team 2 - a little descriptive of my team 3 - somewhat descriptive of my team 4 - quite descriptive of my team 5 - reasonably descriptive of my team 6 - very descriptive of my team

Overall ‘real team’ assessment - add all circled scores and divide by 8

Areas which require improvement (scores of 5 or lower):

• The Aston Team Performance Inventory

• (ATPI)

Highly Effective Teams

Aston Team Performance Inventory

•Team task design•Effort and skills•Organisational support•Resources

Team Processes•Objectives•Reflexivity•Participation •Task focus•Team conflict•Creativity and innovation

•Individual satisfaction•Attachment•Team effectiveness•Inter-team relationships•Team innovation

Inputs ProcessesOutputs

Leadership•Leading•Managing•Coaching

Documents

Saving 1000 Lives Team Based Working