Researching team-based practice and learning in health care
Research into the team-based practice and learning dimensions of health care has to date focused on the behavioural dimensions of care coordination. Here, the questions that are asked of team-based practice centre on how healthcare professionals negotiate care decisions with one another, the degree to which decisions are reached collaboratively or unilaterally, and whether the outcomes of these negotiations serve to consolidate and further patients' care trajectories safely, effectively and appropriately (Reeves and Lewin 2004).
The general judgment about healthcare teams is that rather than evidencing stable networks of collaboration, these teams at best achieve what Engeström referred to as 'knotworking' (Engeström 2008). Knotworking is a modality of collaboration that involves limited co-presence, high people turn-over, mediated (rather than co-present) communication (phones, charts, notes), and various other means that serve to make up for a lack of focused and shared coordination of work tasks and roles. Reeves and Lewin (2004) refer to healthcare teams as interprofessional groups because, for them, the term 'team' overstates the collaborative aspect of healthcare professional practice.
More recent research has promoted resilience as a lens on behaviour to highlight its generative and creative aspects. Healthcare professionals' resilience is seen as ensuring the safety and continuity of patients' care in the face of emergent problems and unforeseen obstacles. Resilience tends to be defined as a hidden, emergent potential. It is deemed to reside in both healthcare professionals and in the systems they inhabit. The practical features of resilience become manifest when standard routines fall short and resilience kicks in to overcome problems and generate innovative ways forward (Bowers et al 2017).
At King's Centre for Team-Based Practice and Learning in Healthcare, we engage with healthcare professional groups and teams by focusing on in situ interaction. We take into account not just dynamic and emergent formations and interactions, but also the more systematic and habituated dimensions of 'collaborative' work. In addition to this, we practise an important research innovation. Rather than studying healthcare 'teamness' as static object that can be measured and subjected to expert judgment, we work with healthcare professionals and patients to elicit their views on, feelings about and experiences of healthcare collaboration. In doing so, we mobilise video feedback to assist participants with the task of articulating dimensions of their work that tend to fall prey to habituation, normalisation, and 'learned forgetting' (Iedema et al forthcoming 2018).
By bringing practitioners, patients and researchers together in these ways, we practise what we preach and prioritise how we study in what we study: stakeholders in health care deliberating and collaborating to optimise care processes and outcomes for patients and families.
Bowers, C., Kreutzer, C., Cannon-Bowers, J., & Lamb, J. (2017). Team Resilience as a Second-Order Emergent State: A Theoretical Model and Research Directions. Frontiers in Psychology, 8(August 2017). doi:10.3389/fpsyg.2017.01360
Engeström, Y. (2008). From teams to knots: Activity-theoretical studies of collaboration and learning at work. Cambridge/New York: Cambridge University Press.
Iedema et al (forthcoming 2018) Video Reflexive Ethnography in Health Research and Healthcare Improvement. Oxford: Taylor & Francis.
Reeves, S., & Lewin, S. (2004). Interprofessional collaboration in the hospital: Strategies and meanings. Journal of health Services Research & Policy, 9(4), 218-225.