Fundamentals of Midwifery: A Textbook for Students (14 page)

Chapter 2‌
Team workingMary Beadle
University of Hull, Hull, UK
Sue Townend
Calderdale and Huddersfield NHS Foundation Trust, West Yorkshire, UK
Learning outcomesBy the end of this chapter the reader will be able to:

recognise, respect and value the role that women and their partners have within the team

define the terms ‘team’, ‘management’ and ‘leadership’

discuss the possible differences between a manager and a leader

describe what makes an effective team

identify the characteristics of a team player

reflect on own team working skills

discuss the challenges of collaboration

examine the importance of handovers.
Introduction
Before embarking on this chapter, it is important to make the distinction that when discussingteamwork in maternity care, the woman must be acknowledged as a key team member.The National Health Service (NHS) Constitution (Department of Health (DH) 2013a) states quite clearly that the patient must be at the heart of everything that the NHS does. This is further supported by the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013, p. 4) which states that the NHS must ‘
foster a common culture shared by all in the service of putting the patient first
’. Therefore everyone who works within the NHS and social care must find a way to do this, in a way that is acceptable to the patient. Within midwifery the voice of the woman’s partner and where they sit within the team is also an important consideration. The Nursing and Midwifery Council (NMC) (2009) are explicit in their identification that all midwives must be able to work in partnership with women to facilitate and encourage team working, whether this be intraprofessional, interprofessional or interagency. Effective communication and team working is the cornerstone to best practice. This chapter will examine the dynamics
Fundamentals of Midwifery: A Textbook for Students
, First Edition. Edited by Louise Lewis.© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion website: www.wileyfundamentalseries.com/midwiferyof teams, the role of leadership and characteristics of team leaders and members. The purpose and features of effective communication with be explored including the value of accurate‌
record keeping in accordance with professional standards. 23
Woman-centred care
The woman should be seen as the key to all care decisions, and is essential for good qualitycare. One way to illustrate this is to see the woman as the owner of a boat, ‘Emancipation’; they decide who is allowed onto the boat and who is responsible for steering the boat. Who is needed on the boat depends on the condition of the sea and the weather forecast, and the potential challenges of the journey. If the sea is calm and the forecast is good, then the woman will only need the midwife and her partner on board. If the seas become rough then she may need other members to join the crew, including doctors and anaesthetists. If the forecast dem- onstrates risk then doctors may be already on board. The type of boat, the crew and journey will depend on what the woman wants based on her previous experiences. An inexperienced woman may want more crew on board, and further support, whereas an experienced woman may feel more comfortable with less crew. The crucial element is that the woman is in charge, based on her knowledge and experience and that it is her decision on the type of journey she wants. What everyone plans is a safe journey which is plain sailing and to reach their destination in good health, having had a successful trip. Figure 2.1 illustrates a woman on her journey with different crew members on board.
Effective team working
There is a general consensus that the ability to work effectively as part of a team is a key trans-ferable skill and is something that is seen as an essential attribute for all employers. There has
Figure 2.1
The woman as the owner of a boat with different crew members to support her journey. Source: Reproduced with permission from J. Green.been a strong drive towards this within the NHS in the United Kingdom and worldwide, particu- larly around interprofessional working (NMC 2009). This is often articulated in terms of what
24 happens if teams do not work well together, therefore setting a negative tone to team working. The consequences of poor team working are well documented within many reports (Francis2013; Healthcare Commission 2006; Mencap 2009). Lessons can be learned from these reports, but it is also important to reinforce what key characteristics are needed for good team working, as well as the benefits to the worker of being a good team player. It is important not to get bogged down in terminology; however, it is important to be clear what is being discussed, to facilitate the practice of working as part of a team.
What is a team?
Newson (2006, p. 541) defines a team as:
. . . A small number of people with complementary knowledge and skills who are committed to a common purpose...
This is the definition that will be used throughout this chapter, although, there are multiple other definitions and an identification of the difficulties in defining the term (Bleakley 2013).
Activity 2.1 Take a few minutes to think about what a team is, and the types of teams that you havebelonged to.There are team-working theories, which attempt to identify roles and responsibilities within teams (Belbin 2000; 2010; Bayliss 2009; Day 2013). These can be helpful when exploring how teams work and what roles individuals within a team take on. They can however be limiting, in that it is not always possible to ascribe a relevant descriptor to a person within the team. This is particularly the case when identifying the role of the woman and their partner who should be part of any healthcare team. This could be seen as a fundamental flaw in using frameworks, which are not specifically designed for use within the healthcare setting. There is a great deal of literature around the role of the woman and her partner within the decision-making process (DH 2007) and therefore it is essential that they are seen as part of the team. Care cannot be women-centred if she is not recognised as part of the team. However, there are many examples of where the patient is not so identified (Tingle 2012). Women themselves may not see their role within the team, relying on the health professionals to either make decisions for them or to recommend a course of action. There are women who have little or no experience of making their own decisions and therefore may find the need to make a choice unsettling and over- whelming. This will be discussed later in this chapter.Every team needs to have an attainable goal to work towards, with clear identification and understanding of each member’s role and responsibilities in meeting the desired goal. There also needs to be a mechanism for evaluating the team’s success in achieving the goal.Within maternity services the goal is for a healthy and successful birth outcome for both mother and baby. Difficulties can arise in the team when there is a lack of consensus on how to reach this goal. Issues can arise around team members’ role boundaries, blurring of those boundaries and a lack of understanding in the team of each other’s roles. This can be as a result of conflict in the risk assessment versus normality debate, changes of leadership of the team
and poor communication between team members including the woman. Such tensions are evident in many healthcare settings around the world, with issues of unequal partnerships (McIntyre et al. 2012), and conflict between professional groups around whether to submit or
₂₅
‌collaborate with each other (Fujita et al. 2012).
Activity 2.2 Think about how you would find out about the different roles and responsibilities of a team youare member of. You might find the article identified below gives you some ideas.Wright, A., Hawkes, G., Baker, B., Lindqvist, S. (2012) Reflections and unprompted observations by healthcare students of an interprofessional shadowing visit.
Journal of Interprofessional Care
26, pp. 305–311.
Leadership