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What sort of team working do we need for future models of care?

Christine HamiltonReflections on multi-disciplinary and partnership working from the 2016 IHM conference hosted by the Scottish Institute of Health Management

by Christine Hamilton

21 November 2016


As ever, October’s IHM Conference was both thought-provoking and stimulating. Again and again IHM speakers repeated the critical need for improved multi-disciplinary and inter-organisational working. It seems effective team working is a prerequisite for success in both areas.

Scotland’s Chief Medical Officer, Dr Catherine Calderwood, spoke compellingly about Realistic Medicine – an aspiration for truly person-centred care where the patient is fully part of the decision making processes about their treatment. This model will result in less variation, harm and waste whilst increasing innovation and improving management of risk.

Does truly person-centred care change the traditional view
of the patient as a customer of the service?

lucas-and-nacerThis prompted me to reconsider who needs to be in the teams which provide such care, their range of professions and where the patient fits into the team. Does this change the traditional view of the patient as a customer of the service? In this model the patient surely needs to be a full member of the ‘design team’ that creates the most appropriate package of care.

Professor Sir Lewis Ritchie provided an engaging summary of the National Review of Primary Care Out-of-Hours Services. Again the evidence from this review points to the critical role of multi-disciplinary and inter-organisational teams in providing the necessary flexibility of provision to provide high quality, safe and effective urgent care. The right mix of knowledge and skills is needed during out-of-hours periods as well as in core working time.

The concept of ‘teaming’ seems to be helpful in both the above scenarios. It provides a model for those teams that need to be continuously forming and reforming to work flexibly across disciplines and address different situations. The way in which organisations support action teams within more complex communities of service teams is also valuable.

On the second day of the conference two presentations pointed the way forward to addressing some of the challenges raised by Dr Calderwood and Professor Ritchie on day one…

Professor Michael West described ways in which we can create cultures which support the provision of high quality, compassionate, improving care. He touched on research showing the importance of drawing on the full range of expertise in the multi-disciplinary team. This is vital in successfully addressing the unexpected or novel combination of conditions and circumstances that require an innovative multi-professional solution.


In her session Multi-disciplinary working – teams or committees? Lynn Markiewicz showed us how to develop the sort of team working we need to support these future models of care. I would echo Lynn’s caution that developing truly effective multi-disciplinary and inter-organisational team working is not a quick or easy ‘fix’. There are a number of barriers but with the right structure and processes in place we can influence behaviour in teams (see Aston Team Journey).

barriers-to-effective-inter-professional-workingIn summary, teams which are trained on how to work together effectively and to be inventive and creative in the service of good, holistic healthcare are essential to achieving the aspirations of Realistic Medicine and safe, high quality, sustainable Out-of-Hours Care.

Like Lynn, I remain optimistic that, with the right intention and support, Scottish health and social care organisations can develop the levels of effective team working that will bring success.

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