Date post: | 12-Jan-2016 |
Category: |
Documents |
Upload: | benjamin-thompson |
View: | 212 times |
Download: | 0 times |
Teamwork and Patient Care in Health Services
Office of Health Care ManagementDublin
19th September 2003
Professor Michael WestProfessor Michael West
Aston Business SchoolAston Business School
Attracting and retainingAttracting and retaining
Information overloadInformation overloadCooperative working Cooperative working
Involvement Involvement Building trust Building trust
Innovation and changeInnovation and change
LeadershipLeadership
Job Satisfaction and Stress in Britain
In the ten years of the 1990s, job satisfaction In the ten years of the 1990s, job satisfaction of workers fell and stress increasedof workers fell and stress increased
Levels of satisfaction fell particularly in the Levels of satisfaction fell particularly in the public sector (but generally higher levels of public sector (but generally higher levels of satisfaction). satisfaction).
People in smaller organisations and women People in smaller organisations and women are more satisfied with their jobs.are more satisfied with their jobs.
www.oswald.co.ukwww.oswald.co.uk
Research Question
What is the link between people What is the link between people management practices and patient management practices and patient care in hospitals?care in hospitals?
Interviews and questionnaires: 61 trusts
TrainingTraining
Appraisal: % in formal teams
Controls: size & health profile; Controls: size & health profile; number of doctors; mortalitynumber of doctors; mortality
Research Methods
Methods
size of training budget size of training budget spend over statutory requirements spend over statutory requirements access to tailored, formal training policy for each access to tailored, formal training policy for each
occupational group occupational group percentages of each occupational group having 3 percentages of each occupational group having 3
days formal off-the-job training in previous year days formal off-the-job training in previous year frequency of training needs analysis for each frequency of training needs analysis for each
occupational group occupational group percentages doing NVQspercentages doing NVQs
TrainingTraining
Methods
priority attached to appraisalpriority attached to appraisal % of staff in each group received % of staff in each group received
appraisals in last yearappraisals in last year frequencyfrequency % of appraisers receiving training% of appraisers receiving training methods used to evaluate appraisals and methods used to evaluate appraisals and
systems of appraisalsystems of appraisal
Appraisal:
Methods
hospital sizehospital size number of doctors per bednumber of doctors per bed local health profile from Health Authority local health profile from Health Authority
data:data:– deaths (all causes) 15-64 standardiseddeaths (all causes) 15-64 standardised– deaths from cancerdeaths from cancer– deaths from circulatory diseasedeaths from circulatory disease– emergency re-admissionsemergency re-admissions– emergency admissionsemergency admissions
Controls: size & health profile; Controls: size & health profile; number of doctors; mortalitynumber of doctors; mortality
Methods
Does the team have clear overall objectives?Does the team have clear overall objectives? Do team members have to work interdependently Do team members have to work interdependently
to achieve these objectives?to achieve these objectives? Do team members have clear roles within the Do team members have clear roles within the
team?team? Do others in the organization see the team as a Do others in the organization see the team as a
team?team?
Percentage of staff working in formal Percentage of staff working in formal teamsteams
Results
HR accounts HR accounts for 33% of hospitalfor 33% of hospitalvariance in mortalityvariance in mortality
1. Appraisal
2. Training2. Training
3. Staff in formal teams
7.5
8.0
8.5
9.0
9.5
10.0
10.5
11.0
low moderate high
% d
eath
s af
ter
adm
issi
on f
or h
ip f
ract
ures
Sophistication of appraisal system
92
94
96
98
100
102
104
106
108
<40% 40-59% 60-79% 80-99% 100%
Mea
n m
orta
lity
inde
x
%staff working in teams
Implications
A significant improvement in appraisal is A significant improvement in appraisal is associated with a reduction of 12.3% of associated with a reduction of 12.3% of the number of deaths after hip fracture the number of deaths after hip fracture
25% more staff working in teams is 25% more staff working in teams is associated with 275 fewer deaths per associated with 275 fewer deaths per 100,000 following emergency surgery or 100,000 following emergency surgery or 7.1% of the total number of deaths 7.1% of the total number of deaths following emergency surgery following emergency surgery
Additional Control Variables
GP Facilities per 100,000
NHS facilities per 100, 000NHS facilities per 100, 000
Income
Prior mortality 72%Prior mortality 72%
Doctors/Doctors/100 beds100 beds
No controlsNo controlssignificantsignificant
HR directorHR director
VotingVoting
HRM overallHRM overall
Case studiesCase studiessupportsupport Implications …Implications …
Change inChange inmortalitymortality
Results …
AppraisalAppraisal
A Comparison of GHQ-12 Findings from the BHPS1 and the NHS Sample
SourceSource StatusStatus Sample SizeSample Size Percent Percent CaseCase
BHPSBHPS EmployedEmployed 5,001 5,001 17.8%17.8%
NHSNHS EmployedEmployed 11,291 11,291 26.8%26.8%
1. British Household Panel Survey, 3rd Wave data, 1993-19941. British Household Panel Survey, 3rd Wave data, 1993-1994
0
5
10
15
20
25
30
35
Not in a team Pseudo team Work in a team
%
Team working and stress
Benefits due to:
Buffered from organisation
Social support
Role clarity
Humans in groups
Clear shared Clear shared objectivesobjectives
Support for innovationSupport for innovation
Participation Participation
Emphasis on quality of patient Emphasis on quality of patient carecare
Health Care Team Effectiveness
3.4
3.6
3.8
4
4.2
4.4
Exte
rnal
Ra
tings
of
Effe
ctiv
enes
s
<3.2 3.2 - 3.4 3.4 - 3.6 3.6 - 3.8 >3.8
PHC Team Functioning
Similar findings in CMH teams
Health Care Team Effectiveness
1
1.5
2
2.5
3
3.5
External Ratings of Innovation
<3.2 3.2 - 3.4 3.4 - 3.6 3.6 - 3.8 >3.8
PHC Team Functioning
Similar findings in CMH teams
Health Care Team Innovation
0.5
1.5
2.5
3.5
4.5
5.5
Innovationin Quality of
Care
5 7 8 9 10 11 12
Professional Diversity
Health Care Team Effectiveness
Within health care, those working in Within health care, those working in well functioning teams are more well functioning teams are more likely to stay working in their settings likely to stay working in their settings than those working in poorly than those working in poorly functioning teamsfunctioning teams
Retention and turnoverRetention and turnover
Why Team-based Working?
PerformancePerformance Involvement
Change andChange andinnovationinnovation
Well-being
CooperationCooperationacrossacrossteamsteams
AutonomyAutonomyandand
responsibilityresponsibility
The tasks The tasks for teamsfor teams
BuildingBuildingteamteam
organizationsorganizations
Failures of team-based working
How to promote effectiveness and
innovation in teams ...
1. Select people with diverse experience and knowledge to
form the team
2. A team task and one that challenges the team
3. Clear leadership
4. Dance together constantly to pass the 20
second test
5. Encourage constructive conflict and dissent – agreeing to disagree
6. Regularly check that the team is functioning well
(role of leadership)
7. Value errors and problems
8. Emphasise team creativity not just
productivity … and stop work.
Reflexivity and Team EffectivenessReflexivity and Team Effectiveness
Teams will be more effective and Teams will be more effective and innovative to the extent that they reflect innovative to the extent that they reflect upon their objectives, strategies, upon their objectives, strategies, processes and environments and adapt processes and environments and adapt these aspects of their task worlds these aspects of their task worlds accordingly.accordingly.
9. Bonding and bridging – inter-team relationships
Train to work in teams
Knowledge, skills and attitudes for customer teamwork
KSAs for teamwork:KSAs for teamwork: communication communication
KSAs for teamwork:KSAs for teamwork: goal setting and performance goal setting and performance management management
KSAs for teamwork:KSAs for teamwork: planning and co-ordination planning and co-ordination
KSAs for teamwork:KSAs for teamwork: collaborative problem-solving collaborative problem-solving
KSAs for teamwork:KSAs for teamwork: conflict resolution conflict resolution
Audit of organisational structures and culture
Audit of business environment
Identification of types and locations of teams
Implementation of support systems
Implementation of team management and leadership systems
Implementation of team based working
Evaluation and maintenance systems
Introducing team-based working
Organizational Supports for TeamsOrganizational Supports for Teams
Setting clear objectives for teams and theSetting clear objectives for teams and the
organization with a primary focus on patient careorganization with a primary focus on patient care
Communication and information systemsCommunication and information systems
Education and training systemsEducation and training systems
Feedback systemsFeedback systems
Liaison and integrationLiaison and integration
Process assistanceProcess assistance
Recruitment, appraisal and selection policies.Recruitment, appraisal and selection policies.
Team-organizational Relationships
Negotiate versus comply with Negotiate versus comply with organizational demandsorganizational demands
Challenge versus accept organizational Challenge versus accept organizational limitationslimitations
Challenge versus accept organizational Challenge versus accept organizational incompetenceincompetence
Communicate independence versus Communicate independence versus dependencedependence
Rely appropriately versus heavily on Rely appropriately versus heavily on organizational directionorganizational direction
Revolutionary Teams
Have a clear visionHave a clear vision Form small team of committed colleaguesForm small team of committed colleagues Develop a clear, consistent and coherent Develop a clear, consistent and coherent
message linked to patient caremessage linked to patient care Repeat, repeat, repeat the messageRepeat, repeat, repeat the message Listen openly to the views of othersListen openly to the views of others Be persistent whatever the obstacleBe persistent whatever the obstacle Ensure participationEnsure participation Be prepared for conflictBe prepared for conflict
Rwanda
Race
FootballViolence
MiddleEast
Customers?
BosniaKashmir
NorthernIreland
IntergroupPrejudice
The Human Pathology
What words?What words?
Who are they?Who are they?
Their threat?Their threat?Feelings?Feelings?
Your Out Groups
Circle of Trust
open
Comm
altruism
Sharedfate
+conflict
respect
risk
values
LeadershipKindness
Courage
Identity
Externalrelationships
Reflexivity
Relationships
Optimism
Vision