Team Work in Neurorehab

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Team Work in Neurorehab

Transcript of Team Work in Neurorehab

72 Physiotherapy Research International

Physiother. Res. Int. 11(2) 7283 (2006) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pri.325

Therapists experiences and perceptions of teamwork in neurological rehabilitation: reasoning behind the team approach, structure and composition of the team and teamworking processesKITTY MARIA SUDDICK University of Brighton, UK LORRAINE DE SOUZA Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, UK ABSTRACT Background and Purpose. Teamwork and the interdisciplinary team approach have been strongly advocated for use in the provision of neurological rehabilitation services. However, whether teamwork has been adopted, and in what form, has yet to be established. The present study investigated therapists experiences and perceptions of the reasoning behind the team approach in neurological rehabilitation, the structure and composition of the team within which they worked and the teamworking process Method. This article reports part of an exploratory qualitative study. Five occupational therapists and five physiotherapists from three teams: a rehabilitation centre; a community team; and a stroke unit based within the UK. Semi-structured interviews were undertaken with each participant and then transcribed. Content and thematic analysis of the qualitative interview data was carried out, with respondents validating both the transcription and analysis stages. Results. Perceived composition and structure of the neurological rehabilitation team was variable across teams and between individual team members. There was disparity as to whether patients were included within the neurological team; the interdisciplinary team approach had not been consistently adopted and there were sub-teams and other team memberships in existence. Reasoning behind the team approach supported the perceived benefits of teamwork from a number of perspectives, and the activities reported as part of the team process were diverse. Conclusions. Different teams may choose to use different strategies depending on the aims and context of the team effort. In some instances interdisciplinary teamwork and patient-centred approaches were not adopted consistently and the process of teamwork itself is both complex and diverse. Copyright 2006 John Wiley & Sons, Ltd. Key words: neurological rehabilitation, team, team process, teamwork Copyright 2006 John Wiley & Sons, Ltd Physiother. Res. Int. 11: 7283 (2006) DOI: 10.1002/pri

Therapists experiences of teamwork in neurological rehabilitation 73 INTRODUCTION Teamwork has developed within the UK as a key component in healthcare delivery within the National Health Service (NHS). It has also been hailed as the cornerstone of rehabilitation (Diller, 1990) and has been supported by governmental directives (DoH, 2000) and professional bodies (Chartered Society of Physiotherapy, 2002; College of Occupational Therapists, 2000). Within the provision of neurological rehabilitation services, teamwork has been reported to have a number of benefits: to provide comprehensive co-ordinated care to the neurologically impaired (LaRocca and Kalb, 1992; McGrath and Davis, 1992) to promote problem solving and goaldirected activity within the team (Feiger and Schmitt 1979) to improve the outcome of the intervention (Melvin, 1980) to promote motivation, generalization and a patient-centred service (McGrath and Davis, 1992). Although these benefits have been presented within the literature they have not been substantiated. Nor have the potential disadvantages, such as the resource and cost implications, been explored. There also remains a lack of transparency concerning the defining characteristics of the main teamwork models: multidisciplinary and inter disciplinary (Nieuwenhuis, 1993). A team whose members utilize more traditional methods of working in the confines of their own professional knowledge base whilst still co-operating is considered to be operating under a multidisciplinary framework (Diller, 1990; Barr, 1997). Interdisciplinary teamwork requires greater collaboration and has Copyright 2006 John Wiley & Sons, Ltd

been defined as a model of care delivery and group interaction that will improve the outcome of the intervention far and beyond that of the summative effort of team members working in isolation (Melvin, 1980). The broadly defined characteristics of an interdisciplinary team which have been supported by the relevant literature include: an emphasis on social- or handicap-related goals (role assumption) (McGrath and Davis, 1992); shared responsibility for goals across professional disciplines (McGrath and Davis, 1992; Schut and Stam, 1994); commitment to shared working practices (collaboration) (Barr, 1997) and joint decision-making (Coopman, 2001); and an integrative clientcentred service (Halstead et al., 1986; Davis et al., 1992). However, there have been no clear guidelines or substantive research that has clearly defined or characterized the differences between the two. Despite a number of individually reported team cases from the UK (Davis et al., 1992; McGrath et al., 1995; Stead and Leonard, 1995; Newall et al., 1997) and the USA (Halstead et al., 1986), whether teamwork models have been adopted as a working framework for neurological rehabilitation teams has not been fully established. Questions also remain about the specific composition and structure of neurological rehabilitation teams in all varieties of setting. Each team has individual functions, characteristics and membership as well as environmental influences, and they can be geographically and organizationally diverse (Boaden and Leaviss, 2000). Adding to the complex nature of teamwork in neurological rehabilitation is the teamworking process: the functions and activities which a team carries out together, formal and informal, structured or nonstructured, and the factors that influence these processes. To investigate teamwork inPhysiother. Res. Int. 11: 7283 (2006) DOI: 10.1002/pri

74 Suddick and De Souza practice, researchers have explored the key activities that a team must carry out to optimize its effectiveness and the characteristics of effective or ineffective teams. The literature has covered healthcare teams across a number of specialist areas. However, research which has focused on the neurological rehabilitation teamwork process has been minimal, and has concentrated on a particular aspect of the process, that is, communication at ward meetings, role overlap (Booth and Hewison, 2002), the effect of using team notes and care pathways (Gibbon et al., 2002) or on a particular team in isolation (Halstead et al., 1986; Davis et al., 1992; McGrath et al., 1995; Stead and Leonard 1995; Dawson and Bartlett, 1996). Research has not attempted to explore the teamworking process in its entirety, although some research on stroke units has attempted indirectly to support the contribution of teamwork to the stroke unit benefits reported in the literature (functional ability, survival and patients placement on discharge) (Stroke Unit Triallists Collaboration, 1997; Indredavik et al., 1999), it has not provided conclusive supporting evidence, and there has been limited discussion in the literature on the distinction between the different but related aspects of neurological rehabilitation team outcomes. Effectiveness can be considered from the perspective of clients and from management and professional perspectives (Curry and Herbert, 1998); it may focus on the rehabilitation outcome, or on other factors such as the levels of satisfaction between the members of the neurological team and other quality of care indicators. Evaluating team effectiveness is the subject of another paper which is currently under review. The aim of the present study was to explore the perceptions of occupational therapists and physiotherapists towards the Copyright 2006 John Wiley & Sons, Ltd

teams within which they worked. This exploration included the structure, composition and membership of the team, the reasoning behind the use of the teamwork approach in neurological rehabilitation and the types of activities that were carried out within the teams as part of the teamworking process. METHOD The physiotherapy and occupational therapy managers of 13 neurological rehabilitation teams were approached to ascertain whether they wished to participate in the study. The teams approached included stroke units, specialist inpatient or outpatient neurological services, specialist neurological rehabilitation centres and community neurological rehabilitation teams based in the Thames region. Four responses, from the occupational therapy and physiotherapy staff from two stroke units, one rehabilitation centre and one community team, were received. The first three teams which responded were selected to continue. Ethical approval for the study was then obtained from the relevant local research ethics committees. The research procedure consisted of nine stages (Figure 1). Using a topic guide, semi-structured interviews were carried out involving five occupational therapists and five physiotherapists working within three teams involved with the neurological rehabilitation of adults. The three teams were: a team at a neurological rehabilitation centre (Team A); a community neurorehabilitation team (Team B); and a specialist stroke unit team (Team C). The sample was purposive, and occupational therapists and physiotherapists with less than one months experience of working within the teams were excluded. Interviewees 16 were occupational therapists and physiotherapists from Team A; interviewees 7 and 8 were from Team B; andPhysiother. Res. Int. 11: 7283 (2006) DOI: 10.1002/pri

Therapists experiences of teamwork in neurological rehabilitation 75Stage 1 Interview Stage 2

Interview transcribed