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Everybody pays lip-service to the idea that healthcare professionals should collaborate in delivering care to patients. In this article, Rosemary Rushmer explores how a new methodology, connate theory, could lead to improvements in our understanding of what makes healthcare teams tick
key words
* inter-professional working
* integrated working
* blurred-boundaries
* teamworking
* connate theory
Introduction
The need for effective teamworking in the NHS
As far as patients are concerned, health services are delivered by professionals working collaboratively. Patients move from one professional group to another in receipt of services designed to meet their clinical needs. The organisation, deployment and effectiveness of these collaborative networks are in-house issues, mainly invisible to the consuming public. This paper addresses those hidden aspects of health service provision, in looking at the arrangements made between health professions to work together in delivering those services.
As early as 1974, the term the 'primary care team' appeared (British Medical Association 1974). It reappeared as a term of wider inclusion across the NHS, the 'NHS family' (Scottish Executive Health Department (SEDH) 1998a) and wider again as 'health and social care' under the new care trusts in The NHS Plan (Department of Health (DH) 2000). These collaborative arrangements have the capacity to unite health provision across disciplines (integrated working), health sectors (intermediate care) and across agencies (multi-agency working between health, social work and the voluntary sectors), bringing simplified 'patient journeys' and move towards the 'seamless delivery of care'. The duplication of service delivery and thus costs can be reduced and potentially the productivity of the system, and how many clients it can process, increases (Rushmer et al 2003). Service provision can, it has been suggested, be joined-up (Cabinet Office 2000). As well as a strategy for effecting enhanced service provision, legislative changes (SEHD 1998a, 1998b) also identify flatter team-based structures in the NHS as a way of creating the involvement, empowerment and participation of all staff.
The difficulties in effective teamworking in the NHS
However, teamworking seems to have been easier to effect in name than in practice. Trie MHS Pian claims that the NHS is a "1940s system operating in a 21st-century world'. This failure in the system of healthcare provision is claimed to rest, partly, on the Old-fashioned demarcations...