Comparing Health Care and Business Literature Essay

Abstract
Teams are a significant tool for promoting and managing change. There are shared definitions of teamwork in the literature, and agreement on general benefits and limitations of working in teams. However, the historical development of teamwork differs between health care and the business environments of manufacturing and service industries. The impact of the organisational context on teamwork appears to differ most, when literature from the two environments is compared. As a result, there are specific issues that are unique to the development and implementation of health care teams.Comparing Health Care and Business Literature Essay

This article summarises the unique team structures and the issue of professionalisation in health care teams, while recommending that team members acknowledge their professional differences and focus foremost on meeting patient needs.

Introduction
Currently, quality health care depends on a wide range of skilled professionals collaborating effectively together. Health care professionals need to continually improve the quality and efficiency of patient services in an environment of constant change. Real improvement requires change of the systems in which health care is delivered. Highly skilled clinicians require appropriate and well-designed organisational structures to deliver the best quality care (Klein 1998). Systems change is often perceived as threatening to the status quo, and must therefore be carefully managed to achieve optimum outcomes.Comparing Health Care and Business Literature Essay

Teamwork has become an essential tool of quality management, which links efficient organisational practice with high-quality patient care. Teams are one of the most effective ways of integrating individual patient concerns with the bigger organisational perspective, while maximising the diversity of the health care workforce. Therefore, 179

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teams are important in both managing and promoting change. However the ‘[ability] to work as part of a team within a complex [health care] organisation…is much talked about but little studied’ (Buchan 1998, p S66).

Effective teams have been promoted as an important means of enhancing organisational performance in business management. Often, literature from the business environments of service and manufacturing industry is generalised to health care without taking account of the differences between the organisations. Jayasuria and Sim (1998) who studied strategic planning, advised against extrapolating findings from business to health care. They highlighted the uniqueness of the variety of health care output indicators (as opposed to business profits and growth), the divergent group of stakeholders (trustees, management, government) and the professional hierarchies.Comparing Health Care and Business Literature Essay

This article will compare the development of teams in both business and health care literature to emphasise the instrumental role of the organisational context in shaping health care teams. A consensual definition of teamwork will be offered. Further, a discussion of the benefits and obstacles to teamwork will be discussed broadly before the implications for health care environments are highlighted.

Historical context
The importance of knowledge and service industries has increased in response to a continuing technology and information explosion. The information technology infrastructure has assumed many traditional managerial roles and functions. Therefore, organisations are moving towards flatter and more participative management structures where workers receive sufficient information to make effective decisions about their work (West 1994). Task complexity has increased and challenged traditional methods of work specialisation as more information has become available to each worker (Sundstrom, De Meuse & Futrell 1990). Organisations have enhanced their customer focus to become more responsive within competitive and deregulated markets where there are scarce resources (Syer & Connolly 1996).Comparing Health Care and Business Literature Essay

For these emerging organisations to work well, enhanced communication systems have been required for responsible interdependent decision-making. Generally, teams have accommodated different perspectives and generated workable solutions (Wenzel 1995). Teams have also responded quickly to customer needs and facilitated organisational change (Fanning 1997). As a result, there are increasing recommendations for effective teamwork in most organisations (Lawler 1993; Syer & Connolly 1996).

Development of teams
Over the last three decades, teams have developed to meet the changing and complex nature of organisational activities. Sundstrom, De Meuse and Futrell identified four categories of teams: production/service, advice/involvement, project/development, and action/negotiation.Comparing Health Care and Business Literature Essay

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The organisational context for teamwork

Initially teams were created at the production level to generate products or services, often with little involvement of managers, support or office personnel. Employees decided on their division of labour to meet defined output quotas. These teams were commonly found in commercial airlines, assembly, construction, mining and sales environments. During the 1980s quality circles evolved as an employee initiative, to involve people from different work areas in problem-solving of quality and productivity problems. Although these teams did make decisions and advise management, their success was often limited because they did not have sufficient responsibility to enforce the recommended changes (Pearson 1992). Later, project/development teams of white collar workers collaborated on assigned or original projects.Comparing Health Care and Business Literature Essay

These teams focused on innovation rather than implementation, and maintained a breadth of autonomy and an extended life span (Sundstrom, De Meuse and Futrell 1990). Teams that focused on action/negotiation were commonly composed of highly-skilled and specialised people cooperating in brief performance events. These teams often performed management functions through integrating ideas and activity across different functional areas (Mohrman & Mohrman 1997).

In comparison to the disempowering nature of quality circle teams, self-managed work teams evolved during the 1990s in finance, business and manufacturing environments as perhaps a fifth category of teams (Dumaine 1990). Cohen and Ledford (1994) described a self-managed work team as a group of interdependent individuals with sufficient autonomy and responsibility to manage a substantial but unique task-based component of the whole process. Team-members were multi-skilled, so they could move through all the roles/jobs (Pearce & Ravlin 1987). Participative goal setting and individual and team-based feedback were used to minimise the team’s variance from their goals (Pearson 1992).Comparing Health Care and Business Literature Essay

Health care context
Similar trends have been described within health care environments. Social and economic changes, together with enhanced medico-technical developments have influenced the evolution of health care (Loxley 1997). Health care professionals have been required to integrate resource parameters into clinical decision-making as a consequence of increasing pressure to articulate the rising costs of clinical activity. Resources need to be focused where they add most value to the patient (Hastings 1997). Further, rapid technological advances have led to greater complexity and specialisation of health care. As a result, there are risks of fragmented care with more new services and specialisations and a greater need for collaboration.Comparing Health Care and Business Literature Essay

The collective knowledge and skills of health care professionals needs to be maximised to meet the increasing complexity of patients’ need (Loxley 1997; Headrick, Wilcock & Batalden 1998). Teams therefore need to include the contributions and perspectives of many specialists, in order to enhance the quality of patient care and clinical outcomes (Horwitz 1970; Snyder 1981; Porter-O’Grady 1997; Firth-Cozens 1998; Rissel, Holt & Ward 1998). 181. Comparing Health Care and Business Literature Essay

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Health care teams have traditionally delivered coordinated patient care (Kane 1975; Griffin 1996; Harber & Ashkanasy 1998). For example, Orem (1985) defined a health care team as ‘an organised group of health care workers who have roles related to meeting the health care needs of a patient or a group of patients’ (p 298). Because health care teams focus on the interconnected needs of patients, they coordinate a range of services to meet the specific goals of individual patients (Maple 1987). Patient-focused production/service teams have traditionally dominated health care environments. These teams included diverse professionals who were all essential in performing complex and diagnostic interventions (Orem 1985). However, there are documented differences in levels of commonality, cooperation and coordination within these teams. Most commonly, these differences are explained across the range of teams described as multidisciplinary, interdisciplinary or transdisciplinary. Maple (1987) distinguished different patterns of communication and performance that represent an evolving trend.Comparing Health Care and Business Literature Essay

Multidisciplinary teams have historically been more common as they evolved from the traditional medical model, where medical diagnosis and treatment were the primary focus and the physician was the most important provider (Hastings 1997). Each professional in a multidisciplinary team works in parallel, with clear role definitions, specified tasks, hierarchical lines of authority and high levels of professional autonomy (Ivey et al. 1988). Professionals often consult with patients individually and create their own goals and treatment plans (Griffin 1996). As a result, differing priorities between team members may result in inconsistent or contradictory communication to patients.Comparing Health Care and Business Literature Essay

Interdisciplinary teams are the most common type of team that rehabilitation therapists currently report working in (Mullins et al. 1997). Professionals in an interdisciplinary team meet regularly to coordinate treatment programs to holistically meet patient needs (Maple 1987). Goals are usually set collaboratively and intervention may be conducted jointly (Brandis, Murtagh & Solia 1998). Often, one team member is appointed to coordinate communication between professionals and the patient (Callaly et al. 1998). Interdisciplinary teams are well recognised as beneficial for patients with chronic and complex health problems (Ivey et al. 1988). They most closely reflect the characteristics discussed generally in the literature.Comparing Health Care and Business Literature Essay

In contrast, transdisciplinary teams are not common in health care, although their preferred use is increasing (Mullins et al. 1997). Participation in transdisciplinary teams often cuts across traditional professional boundaries, as in educational teams that meet the learning needs of children with disabilities. All members contribute, via consensual decision-making, to an individualised plan for the patient, and one or two members are designated as primary agents for intervention (Maple 1987). This level of collaborative practice maximises shared expertise while minimising professional autonomy (Ivey et al. 1988).

Referring back to the categories of teams discussed previously, advice/involvement teams have demonstrated improvements in health care quality and productivity through using

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quality circles (Barczak, 1996). While project/development teams are infrequently described in the health care literature, current health management teams could be identified as action/negotiation teams. In these teams, clinicians have focused on delivering quality health care, while administrators concentrated on minimising costs and improving efficiencies, so that together they translated high-quality clinical care into value for money (Wenzel 1995; Adams 1996; Capko 1996). Further, Moss (1996) argued that self-managed work teams are emerging in North America to meet the managed care demands for greater staff utilisation and more streamlined delivery of health care.

Comparison of team categories
Teams appear to be broadly evolving through five stages of production/service, advice/ involvement, project/development, action/negotiation and self-management in business environments. In contrast, teams in health care have traditionally focused on production and service in delivering coordinated patient care. There has also been an evolution within production/service health care teams from a multidisciplinary focus towards an interdisciplinary one. This may reflect the way that health care is expanding to incorporate more holistic patient care.

Different categories of teams are becoming more common in health care environments as the health care context changes. It appears that quality improvement initiatives are fostering both advice/involvement and action/negotiation teams. Therefore, it will be important to monitor the changing nature of teamwork in health care, before too many generalisations are made from business to health care environments. Despite the differences in their evolution, there are common characteristics of teams that span both business and health care literature.Comparing Health Care and Business Literature Essay

Defining a team
Specific definitions of teams abound in the literature. A baseline of definitional consensus is evident across the different types of teams and organisational environments. Katzenbach and Smith (1993, p 45) stated that:

…a team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable.
Similarly, Brill (1976, p 22) defined teams as:
…a group of people each of whom possess particular expertise; each of whom is responsible for making individual decisions; who together hold a common purpose; who meet together to communicate, collaborate and consolidate knowledge, from which plans are made, actions determined and future decisions influenced.