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Working in and between teams to create positive cultures in primary care 18 th October 2016, The King’s Fund Dr Rachna Chowla GP Partner, Albion Street Group Practice @rachnachowla [email protected]
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Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Apr 23, 2018

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Page 1: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Working in and between

teams to create positive

cultures in primary care

18th October 2016, The King’s Fund

Dr Rachna Chowla

GP Partner, Albion Street Group Practice

@rachnachowla [email protected]

Page 2: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Contents

Why do culture and team working matter?

PLAT: new research in primary care

Which factors create positive cultures in healthcare?

What are we doing at the Albion Street Group Practice?

Page 3: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Why do culture & team working

matter?

Francis Report 2013 and others

Acute data:

Strong correlation between positive HR policies/practices

& patient mortality

Link between positive climate (e.g. well structured team

environments, support, opportunities to contribute to

improvements) and variety of performance indicators

West et al, 2015

Page 4: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

NHS research on team effectiveness

Patient outcomes

Reduced hospitalisations and costs

Reduced error rates

Lower patient mortality

Higher patient satisfaction

Team outcomes

Increased staff engagement

Increased effectiveness and innovation

Increased well-being of team members

Reduced turnover and sickness absence

Inter-disciplinary teams outcomes

Deliver higher quality patient care and implement more

innovations Lyubovnikova, J. & West, M.A. (2013)

Why do culture & team working

matter?

Page 5: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

PLAT (practice leadership assessment tool)

Findings:

1) Statistically significant correlations between

2) CQC KLOE inter-correlations: scores on well-led highly

correlated with all other KLOEs and inspection rating

scores, overall

Safe Effective Caring Responsive Well-LedOverall

Rating

Delivery of care ✔

Patient-centred care ✔ ✔ ✔

Team working ✔

Management and leadership ✔

PLAT

CQC domains

Page 6: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Real Teams have:

Clear, shared objectives and they measure their

performance against these objectives

Are mutually dependent on each other/have to

work closely together to achieve their objectives

Meet regularly to review their team’s

effectiveness and discuss and decide how it could

be improved

Page 7: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Teams are more effective

and innovative to the extent

that they routinely take

time out to reflect upon

their objectives, strategies,

processes and environments

and make changes

accordingly.

Reflexivity

Schippers, West & Dawson, 2012

Page 8: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Team effectiveness

Driven teamResilient

team

Dysfunctional team

Complacent team

High task reflexivity

High social reflexivity

Low task reflexivity

Low social reflexivity

• High short-term

task effectiveness

• Poor team member

well being

• Short-term

viability

• Moderate

innovation

• High inter-team

conflict

• Poor task

effectiveness

• Poor team

member well-

being

• Very low team

viability

• Low innovation

• High inter-team

conflict

• High task effectiveness

• Good team member well

being

• Long-term viability

• High innovation

• High inter-team cooperation

• Poor task effectiveness

• Average team member

well being

• Short-term viability

• Low innovation

• Moderate inter-team

cooperation

Page 9: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Key Role of Team Leadership

Agree an inspiring vision and clear direction

Ensure agreed, clear (5 or 6) objectives for the year focused on key issues

Ensure regular, positive and effective team meetings

Encourage positive, supportive relationships

Resolve and prevent intense conflicts

Positive group attitudes towards diversity

Nurture team learning, improvement & innovation

Lead inter-team cooperation

Be attentive and listen carefully to the team – essential for

compassionate leadership

Page 10: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Evidence in practice:

Albion Street Group Practice

What happens now?

Multiple teams, complex tasks, part-time working

We meet a lot!

Daily clinical de-briefs, weekly management/clinical meetings,

monthly PLT, separate team meetings, separate quarterly

partnership meetings

Decision to make cultural assessment part of our due

diligence process

Tool-based assessment ?PLAT

Formal OD work

Page 11: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

References

Lyubovnikova, J. & West, M.A. (2013). Why teamwork matters: Enabling health

care team effectiveness for the delivery of high‐quality patient care. In E. Salas

et al. (eds.). Developing and enhancing teamwork in organizations: Evidence

based practice and guidelines. (pp.331‐372). San Francisco: Jossey Bass.

Schippers, M.C., West, M.A. and Dawson, J.F. (2014). Team reflexivity and

innovation: the moderating role of team context. Journal of Management.

West at al, 2016. Practice Leadership Assessment Tool – Evaluation Report. The

Kings Fund/CQC. In press.

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015)

Leadership and Leadership Development in Healthcare: The Evidence Base.

London, Faculty of Medical Leadership and Management

West, M.A., 2012, Effective Teamwork: Practical lessons from Organizational

Research. London: Wiley

With thanks

[email protected]

Page 12: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Back-up slides

Page 13: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Team functioning and patient

satisfaction

Page 14: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Innovation increases as professional

diversity within healthcare teams

Professional diversity

Innovation in

quality of care

in 100 PHC

teams

Page 15: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Healthcare team effectiveness

<3.2 3.2 –

3.4

3.4 –

3.63.6 –

3.8

>3.8

PHC Team Functioning

External

ratings of

innovation

Similar findings in CMH

teams

Page 16: Working in and between teams to create positive in and between teams to create positive cultures in primary care 18th October , The King’s Fund Dr Rachna Chowla GP Partner, Albion

Teams harassment and violence

1

2.32

2.15

1.28

0.8

1

2.07

2.28

1.45

0.89

1

1.511.46

1.28

11

1.691.6 1.63

1.1

0.7

0.9

1.1

1.3

1.5

1.7

1.9

2.1

2.3

2.5

Not working in ateam

Pseudo III Pseudo II Pseudo I Real team

Harassement from collegues Violence from colleagues

Harassement from patients Violence from patients

www.nhsstaffsurrveys.comTypes of team working

patterns

Odds

rati

o