October 17, 2012, by Emma Thorne
Mental health care — working together to reach full potential
Mental health professionals need to work together if they are to fulfill their potential and deliver the best possible patient care, a new report has revealed. Dr Hugh Middleton, of the School of Sociology and Social Policy, writes on how research is identifying success stories and offering new strategies for collaboration.
Hospital soap operas, everyday experience and what we hear about the “state of the NHS” all draw attention to strife between those who “do” health care and those who manage them, so it is good to see publication of some fresh research that tries to rise above this. October 10th saw publication of the final report from a group which has now completed a three year investigation of multi-disciplinary team working in mental health. Investigators included Dr. Hugh Middleton of the School of Sociology and Social Policy and participating organisations included Nottinghamshire Healthcare NHS Trust. The report’s findings and their practical implications are to be publicised at a one day conference which will be held at the Institute of Mental Health on October 30th.
Healthcare professionals must work together as effective teams if they are to provide the best possible patient care. This is important for mental health services where quality includes consistency and a reassuring sense of being known and understood. Providing these and at the same time working in shifts so that the service is available beyond conventional office hours is difficult without very good team processes.
Previous research shows that many such multi-professional teams fail to perform to their full potential, as they are not clear about their objectives, disagree about goals, their leadership and how to work together; or they find themselves trying unsuccessfully to meet the conflicting demands of senior managers from different disciplines and departments. The Healthcare Commission has discovered that as many as half of all NHS staff may work in dysfunctional teams, which can jeopardise patient care and undermine staff well-being.
The overall aim of this research was to explore such issues in more focused detail amongst teams providing NHS mental health services. A variety of settings were investigated. Service users, their families and friends, a full range of mental health practitioners and service managers were all consulted in the course of developing a novel measure of community mental health team effectiveness. Some 1500 practitioners from 120 teams took part in a survey which estimated how effective such teams were, and reported upon what it was like to work in them.
Sense of purpose
Unsurprisingly there were strong associations between team effectiveness, as measured on a scale which clearly reflects service users’ views of good and bad practice, and the quality of team working. This was assessed using the Aston Team Performance Inventory which is a now well-established measure of team working. It measures how well team members understand and agree upon their goals, how involved they feel, the quality of communication and support, opportunities for creativity and participation, and how well led the team is felt to be. Particular success in providing good quality mental health care was found amongst teams that had a clear sense of purpose, welcomed members’ participation in creative problem solving and were well led in a style that encouraged reflective practice.
Alongside this survey the investigators also observed a number of team meetings and interviewed 114 service staff, 31 service users and 13 users’ informal carers. This qualitative research has enabled enquiry into the interactions and relationships that lie behind numbers derived from the survey. In terms of what matters to service users it revealed disparities between what they find important and helpful, such as relationship, flexibility, availability, consistency and understanding, and requirements of the organisational settings from which care is provided.
Of service users, in the words of one community mental health team manager:
“… they don’t really want to see the paperwork and they don’t really want to see the risk assessment, don’t really want to see the care plan, sometimes they’ll talk to us about the care plan but they don’t want copies of it … a care plan doesn’t mean anything to them in that sort of sense but I think we do keep trying to engage with them … “
In relation to creativity, in the words of a support worker:
“So there may be some patients who would really, really benefit from you say taking them for a day at the seaside, because that was what they remembered their parents doing for them when they were little and that would mean so much for them to do that. We obviously can’t do that, and we are, time is probably our most valuable resource really”
These are readily dismissed as intuitive and predictable findings. Perhaps unsurprisingly they relate good clinical mental health outcomes to team creativity, task focus, participation, supportive leadership and interest in true relationship. On the other hand they are also timely and novel. They identify clear relationships between organisational determinants of the practitioner’s context and well being, and the outcome of their clinical activities. It will require further studies to establish whether such interactions are also in health care settings that are possibly less dependent upon practitioners carrying out “emotional work”, but an element of that is present in all health care settings. What this research demonstrates is that the success with which “emotional work” is conducted, in part reflects the emotional well being of the practitioner, and that is in the hands of those who manage and commission health care. There are connections between the management of health services and the service user’s experience which are not simply reflections of business efficiency, but provide the creative commissioner or manager with more sophisticated opportunities to influence real outcomes.
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