At Motherwell CFC the core of our functioning is [ie in 1990] as a multidisciplinary team - a very small one for many years! Before we became larger and more established, we summarised what we found it had taken. Anne Hood is now CFC's consultant child and adolescent psychotherapist. The paper would need a lot more updating and referencing to bring it up-to-date, but I leave it as it was then.
The principles of making a team work well have been described often. But the wheel may need to be discovered afresh, and research usefully confirmed by repetition. With some variations and students, the two of us - social worker and psychiatrist - were the Motherwell/Clydesdale District team of Child and Family Clinics, Lanarkshire for over five years, 1985-90. This is what we wrote at the end of that time, beginning with a description of the service then.
We work in the peripheries of excellence. Lanarkshire is South and East of Glasgow. Child and Family Clinics is a small, egalitarian, multi-disciplinary, health-service-based, dedicatedly community-oriented service, based in two clinics in Coatbridge and Motherwell. We're still short of even our minimal basic target of nine professional staff, that is, three district teams of psychiatrist, clinical psychologist, and social worker [employed and line managed by the Regional Social Work Department] - with [of course] a secretary per team. There are no day or in-patient units or any specialist adolescent service - we take 0-16yr olds and over. Each district has a population of 200,000. Like the other two teams, the two of us operate a demystified family-systems approach. We're particularly keen on routine live team consultation as the way to all kinds of quality work with family or individual. We're also committed to liaison and providing useful case consultation to other agencies.
We reviewed our 5 years experience and identified the following principles for making a team. None of the following are claimed to be original.
1. Clarify who is in the team and who is not. To work through what is described here may take a while - years, in our case. So the question of how long the members will be around matters.
2. For live consultation methods - if not other kinds of team - two can be as good and economic as more, and a team meeting for two people is as easy to arrange as passing in the corridor! But three is better than two, giving greater strengths together. Since three people allows three differen pairs with the third free to stand back from or drop out of any particular activity, there is also greater freedom, flexibility and continuity through individuals' unavoidable absences of various kinds. We have found it interesting to tackle gender issues by being a mixed gender team. For constant live team work, four allows different pairings to enjoy and double productivity with double bookings.
3. Are the ideas of "team" that the team members are committed to compatible enough?
4. Are the team's weekly timetables compatible enough? What line management backing do the members get - and what other commitments [voluntary or imposed] may take them away from agreed team working time? Are members full time or part time team members, or a mixture of both?
5. A focus on task and work - especially screening - necessitates and focusses team functioning.
6. But ideas and ideals need to be properly and fully discussed by the team - for example, stimulated by preparation for presentation to outsiders.
7. Time can be wasted, but when a team is working well, time is ultimately saved by spending enough time sorting things out as a team, and especially basics and details of setting appointments up properly in advance.
8. In the early phase of a team's life, it may be necessary for unpleasant polarisation and disagreement to be expressed and worked at on the way to resolution and respect for differences in establishing the team.
9. Personal work needs to happen somewhere along the line, eventually including ourselves and our own families, past and present.
10. Key pieces of work form and mark the development of the team and its methods.
11. A challenge may be needed to make people pull together as a team. This may be an inner challenge [personal drive or ideal], an outside one [ignorant managers or other agencies], or both.
12. The team needs to be able to rely on ordinary nurturance and support from around it [e.g reliable service and some personal concern from other non-team colleagues and secretaries].
13. New team members [of course] must be properly teamed up though this requires consideration of how far the system is to remain rigid versus how far the team is prepared to accommodate very different sorts of team member. In the choice of new staff, there must be a real sense of participation from those who will be working with them, including those not in the team but working alongside and in line management. The arrival of a new permanent team member is a good point to review functioning - the new team member should get a full and personal introduction and description from their team colleagues and give a fresh incomer's view on what is good and what may need changed.
14. The hallmarks of good team functioning are a sense of supported permissiveness from colleagues and discovering that if you keep working at it you can get to your ideal or something good enough or better!
15. Sufficient time is required for all this [several years in our case] with a benign enough management to support the team as it gets its act together.
16. Teams must be prepared to change when necessary but also to stay firm and not change when necessary.
17. For this kind of work, the team is first of all a group of "persons" not professionals, the professional role being one of the aspects that the persons involved in a team have to pull together, especially in a multi disciplinary team.
18. Especially when a team is not properly constituted as such with management backing, and in this kind of work, the team needs to be made afresh each day in some respects. For CFC this happens at our initial informal morning "tea[m]-making" and information exchange meeting!
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