Defining Diverse Work - Literature review Example

1 CONCEPTS Primary Work Teams In a team based organization, the basic unit is the primary work team. These are also referred to as self-directed work teams. In an organization which is team based, primary work teams are dominant and all the basic work in the organization is carried out by the primary work team. This primary work team is made up of members who because of their particular skills and talents help the team to undertake and carry out its work. In this team the members work together as a unit over a long period of time. Members of a primary work team should have a common purpose, a similar method of working, skills which complement yet overlap each other and the members should be mutually accountable to each other. The members of these teams also need to be multiskilled, so as to help and take over from an individual team member as and when the need arises. Some of the examples of primary work teams in the hospitals are patient care teams, specialty team in operation theatres and trauma team in the emergency department. (http://books.google.com/books?id=QESsW4TaEDAC&pg=PA111&lpg=PA111&dq=primary+work+teams+health&source=web&ots=AJkgeF5uH8&sig=9Tyafb_Ox5vWY-O8hf3ZIWzcodM#PPA111,M1) Extended Teams In Health services the extended team is being touted as a way of achieving good quality and well co-coordinated health care outside of hospitals. This team however has 2 no legal or organizational standing. Despite this, the role played by such a team is of invaluable assistance to a patient and hence should be made to work despite all the problems encountered. This team is made up of not just the general practitioners and practice nurses but of community nurses, palliative nurses, midwives and therapists like occupational, speech, physio etc. Here the general practitioner plays the dominant role in diagnosis but care and support is delivered by the nurses and therapists who are in a majority in the team. Extended teams help in the care of patients with advanced disease or in supporting children at risk. Hence there has to be a lot of co-operation between team members and also sharing of information. (http://www.bmj.com/cgi/reprint/317/7158/579.pdf) Defining Diverse Work Teams perform best, when their work includes entire processes or functions. Hence a team’s work should include all the necessary activities and responsibilities, and not just a small part, such that the entire work process belongs to the team. To achieve this each team must perform a diverse set of activities which goes beyond the confines of a single department. This allows the team to have greater autonomy and control as the team does not have to rely on an outsider. Diverse work within a team allows it to perform better as there is increased job satisfaction. Hence ensuring that each team has a diverse pool of work, enables it to work 3 to its full capacity and consistently. (http://books.google.com/books?id=QESsW4TaEDAC&pg=PA111&lpg=PA111)&dq=primary+work+teams+health&source=web&ots=AJkgeF5uH8&sig=9Tyafb_Ox5vWY-O8hf3ZIWzcodM#PPA111,M1) Buckets of Work To design an effective team it is essential to designate responsibility. It is important to figure out what the work is and then how it will be done and by whom, from the teams working pool. Once the work has been characterized it is put into categories, best explained by ‘buckets of work’. Depending on competency restrictions there are separate buckets for each distinct restriction. A nursing team could thus have three buckets, one for work which only an RN can perform, one for work which any prepared licensed individual can undertake and the last for responsibilities that can be undertaken by any trained care giver. The most competent team designs have very few buckets and the maximum percentage of work is in the bucket which is marked for any trained care giver, i.e. which any competent trained individual can undertake. If there are too many buckets and the work load in the buckets is high, then the pool of work is too narrowly defined and could lead to bottlenecks in the working of the team. (http://books.google.com/books?id=QESsW4TaEDAC&pg=PA42&lpg=PA42&dq=uckets+of+work&source=web&ots=AJkgfw3pC-&sig=LbtBjccOBnAG-2JOVkNdkVvFPIs#PPA42,M1) 4 Team Dynamics Group and team dynamics is the study of groups and group processes with a focus on self-directed or primary work teams. It involves understanding the basic nature of groups and how they develop. (http://www.nickroy.com/) To understand team dynamics of Primary Health Care it is important to know who the team comprises of. The core members of the team are generally the general practitioner, practice manager, practice nurse, health care assistants, health visitors, counselors and the administrative and clerical staff. The extended members of this team are Community nurses, midwives, emergency care practitioners, community pharmacists and allied health professionals like dieticians and therapists. For effective team dynamics, it is essential that skills of every team member are equally respected. Also, communication within team members is extremely vital. For a team to work efficiently patients and colleagues should be made aware of the role and responsibility of each team member and also which member is responsible for each aspect of patient care. Regular reviews of the team’s performance and remediation of any problem in the same can only improve the functioning of the team. Multidisciplinary training of team members would help members understand the roles played by various health professionals who are a part of their team in contributing towards better health care. (http://www.rcgp.org.uk/PDF/ISS_INFO_21_FEB07.pdf) 5 Mutual Accountability Mutual accountability helps safeguard the patient from incompetent and unethical medical practice. Mutual accountability fosters collaboration between the different members of the team. Judgment and professional accountability of every member of the team can be questioned by another with a view to improve the quality of treatment given to a patient. Mutual accountability can be achieved only when roles and responsibilities of team members are defined. Medical practitioners are accountable for the duties they delegate to the rest of their team members, while the team members are accountable for not just performing the delegated functions but also accepting them. Mutual accountability can work only in an atmosphere that fosters trust, support and shared decision making. All team members should feel equally empowered, and each ones autonomous judgment should be equally respected. It is also important for communication channels among all team members to be constantly open. (http://www.cma.ca/index.cfm/ci_id/37131/la_id/1.htm) Key Leadership Elements For a team to function effectively it is extremely important to have a strong, visionary and proactive person at its helm. This leader has to be committed to the success of his team. Leaders need to lead by example. There are six key leadership elements as elucidated by Manion, J.; Leander, W.J. and Lorimer, W. (http://books.google.com/books?id=QESsW4TaEDAC&pg=PA148&lpg=PA148&dq=ke 6 y+leadership+elements+in+teams&source=web&ots=AJkgfx2sE6&sig=0U_8a_qBVukmxWqHlnfU_vQquD8#PPA148,M1) are i) Modeling change, ii) establishing trust, iii) setting the pace, iv) creating the vision, v) focusing the organization, and vi) building commitment. The team leader has to play an important role in formulating and communicating the team structure to team members. He is instrumental in coaching and guiding the team members into forming a cohesive and effective team. A true leader coaches, mentors, enables, empowers, teaches, develops and encourages his team members into performing their best within the team. Modeling Change Previously health care tradition was one of an independent, practitioner serving his patient. Then came the era when physicians were in charge of their patients and the nurses played a supporting role in looking after them. (http://www.health.nsw.gov.au/amwac/amwac/pdf/10_frank.pdf) Today for more effective patient care, work teams are being modeled and planned. It is suggested that planned changes to structural and functional integration of the existing models, i.e. changes to the primary health care staffing and development of teamwork could improve productivity, patient satisfaction, clinical quality and employee morale in the health care sector. (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12545513&dopt=AbstractPlus) 7 One of the models suggested which takes into account the basic and extended work teams in health care is the Interdisciplinary Teamwork System Model. (http://dcahec.gwumc.edu/education/session3/models.html) While developing this model, team members would need to plan out their goals, tasks and roles, leadership, communication, conflict resolution and other such factors. Also training of health care givers in interdisciplinary teams would ensure that this new model in health care would be successful. Leading Positive Change A leader’s crucial role is to initiate a change in the workplace and minimize its impact. To bring about a positive change in the system a leader has to help others to overcome their resistance to change. The leader has to lead discussions on how best to implement these changes and to foster trust and teamwork within his team. Change has to be brought about in a manner such that it has minimal negative effects on the morale of individuals, processes and productivity. (http://www.ddiworld.com/learninglinks/default.asp?fuseaction=module&wbt=no&id=54) In a healthcare system it is important for a leader to mobilize others into acting by taking a catalyst approach. He should ensure that the lines of communication are open between all team members such that there is mutual accountability and feedback. The team members’ personal and practical needs should be met such that they are committed to achieving the best results. If a leader is capable of this he could bring about a positive change in the health care system. 8 Ubiquitous and Escalating Change Frameworks It is a known fact that our world is forever changing. Nothing remains static. The world we live in is dynamic and chaotic. Things in today’s world are changing extremely fast. Nobody can dare to predict what will happen in the next few years. The mapping of the human genome is a good example, of one of the major sources of change. It has brought about new organ development and physiological regulation, in the span of a very few years and this will bring about a major change in the lifestyles of millions of individuals. One cannot predict how this change will affect people in the years to come. (http://cte.rockhurst.edu/FileUploads/Whetten_CH10.pdf) Thus one cannot predict what changes are going to occur and when they will occur. As one can see with the events unfolding around us that change is not only constant and ubiquitous but that it is escalating exponentially. However, when things are changing constantly and fast, it is not possible for anyone to adapt to the change. Frameworks are theories which provide a fixed point of reference. These in turn help to provide stability and order in the midst of all this change. For leaders these frameworks provide a reference point, with the aide of which complex situations can be resolved. A good leader has frameworks which try to limit change wherever and whenever possible, so as not to overwhelm team members. 9 Tendencies towards Stability Teams are created to provide stability, steadiness and predictable conditions, where each member knows his job, does it well and does not let a crisis situation arise. Teams specify what its members are expected to do, the procedures to be used, the rules etc. This reduces the problems that can crop up in changing situations. For stability to be maintained in a team it is essential to stay a course in the middle range, i.e. not be too perfect as this would make other team members uncomfortable, and at the same time not be too badly behaved as this would cause irritation among the other team members. Hence it is essential for most members of a team to stay in the middle range, for the team to be effective. A good team leader, however, would instill in all team members a change towards the positive side. This could however lead to team stability being lost unless the leader is capable of leading positive change in all members. (http://cte.rockhurst.edu/FileUploads/Whetten_CH10.pdf) Establishing a Climate of Positivity To bring about constant, positive change in a team it is extremely essential to establish a climate of positivity. Change in most establishments is constant and most leaders of a team focus on the negative or problem creating aspects of change. A good leader would however focus on the positive aspects of change and this would prove valuable for his team. 10 Negative phenomena are seen to create more of an impact on people, than positive phenomena and this is true in the case of most leaders too. Thus they focus more on the negative than the positive. Hence, leaders need to consciously choose to pay attention to positive phenomena that take place due to the constantly changing dynamics in a team. To establish a climate of positivity, leaders need to focus on positive energy networks, foster a climate of compassion, forgiveness and gratitude and pay attention to the team members’ strengths. (http://cte.rockhurst.edu/FileUploads/Whetten_CH10.pdf) Create Positive Energy Networks Individuals who create and strengthen happy feelings and liveliness among others are said to be positive energizers. These individuals are seen to be high performers in the work environment and they enable people around them to perform better too. A positive energizer is found to be a person who is sensitive in all relationships, trustworthy, supportive, flexible, tolerant and unselfish. To create positive energy networks, place the positive energizers in places where others can interact with them and be influenced by them. The team leader should try and foster qualities that would make him\her a positive energizer. Positive energizers should be recognized and rewarded. The work atmosphere should be such that it would provide opportunities for people to form friendships, as this too would act as a positive energy network. (http://cte.rockhurst.edu/FileUploads/Whetten_CH10.pdf) 11 Build Human Capital Positive change can take root, only if the entire team and not just the leader develops the capability to carry out positive change and to work on their own initiative. When all team members develop this capability, the company or the team is said to have built a well developed human capital. In layman terms this would mean that the team or company has skillful and capable team members or employees. It has been shown that Human Capital is the key to long term success and most forward thinking organizations will do their best to develop this resource. Human Capital can be built when all team members are given developmental opportunities, so that they can further themselves. This then acts as an investment towards the future and towards the success of the team. (http://cte.rockhurst.edu/FileUploads/Whetten_CH10.pdf) REFERENCES 1. Manion,J., Laeander,WJ, Lorimer,W . Team based Health Care Organisations: Blueprint for success. Published in1996. 29th July 2007 2. Rigby, M.; Roberts, R.; Williams, J., et al. Integrated Record Keeping as an essential aspect of a primary care led health Service. BMJ 1998; 317; 579-582 29th July 2007. 29th July 2007. 12 3. Nick. About Group and Team Dynamics. Group and Team Dynamics. 2nd June 2007. 29th July 2007. 4. RCGP Information Sheet. The Primary Care Practice and its Team. Royal College of General Practitioners. Feb 2007. 29th July 2007. 5. Northwest Territories Medical Association, Northwest Territories Registered Nurses Association. The Provision of Healthcare in the Northwestern Territories: A Joint Statement of Healthcare Reform. CJRM 2000; 5(1):12 Winter2000. 29th July 2007. 6. Frank, JR. Medical Leadership and Effective Interprofessional Healthcare teams: A Competency based approach. IMWC 2007. 29th July2007 7. Interdisciplinary Healthcare Teams. Models of Team Practice. Program Office of the District of Columbia Area Health education Centre. 1999. 29th July 2007. 8. Leading Staff through Change. Learning and Assessment Links. 29th July 2007. 9. Leading Positive Change. Skill Learning. 3rd December 2004 29th July 2007. Read More