The Trials, Tribulations, and Triumphs of Teamwork

Article Outline

• Copyright

Reverend Peter Speck, Visiting Fellow, School of Psychology at Southampton University and Honorary Senior Research Fellow, King's College London (Department of Palliative Care, Policy and Rehabilitation), edited Teamwork in Palliative Care. Fulfilling or Frustrating? Of immediate interest is the provocative subtitle. Speck acknowledges that palliative care is based upon a team model but challenges his readers by noting the limited evidence that supports this widely accepted premise. Speck struggles with the need to increase the evidence base upon which we provide palliative care, while questioning (with coauthor Barbara Monroe) the future utility of specialized teams in an era of increasingly limited resources for health management (especially in rural and Third World areas). The text distinguishes between “teams” and “groups” and between multidisciplinary, interdisciplinary, and transdisciplinary teamwork models, while noting that these complexities in structure and membership further confound attempts to measure team effectiveness.

Contributors include authors from Israel, Australia, and throughout the United Kingdom. They write on a wide range of interrelated topics. Perhaps not surprisingly, there is a lack of consistency of tone throughout this generally well-written text. Although the authors' cite published research in support of their topic areas, many note the limitations of the evidence base in this largely unstudied field. There is stated awareness that complex concepts such as “team” are difficult to operationalize and that the varieties of setting, differing disciplines, and skills involved confound efforts to tease out the effectiveness of “team” interventions. The book's 14 sections address team dynamics, the importance of communication, team building, interdisciplinary team training, and the ethical and legal implications inherent in team practice. Case narratives are interspersed throughout to highlight principles of quality care and increase the reader's application of the material. Although British colloquialisms (“team hygiene”) and health care policies are used throughout the text, the conceptual underpinnings have wide audience applicability.

A particularly compelling chapter looks at a palliative care unit from the role of a “non-participant observer” who sits for an hour a week reflecting upon the comings and goings of staff, patients, and families as they cope with the strain of being in such intimate proximity to death:

…working with the dying will always stir up painful emotions and anxiety. Until professionals acknowledge the impact on themselves of working closely with dying patients, they are unlikely to recognize its impact on their clinical practice.

The authors explore the complex role of relationships that ultimately identify “successful” teams. Such messy concepts as distributive leadership, “followership,” the dynamics of power imbalances, victimization, and “bullying and harassment,” and the delicate art of managing stress and conflict between team members, are infused throughout the text. Membership and setting influences on teamwork are also analyzed, including a discussion on the challenges of inviting “user involvement” (patient/family) in the “multiprofessional” team. There is a useful reminder of adult learning principles and their application to team training strategies.

The UK National Institute for Health and Clinical Excellence 2004 guidelines support the benefits of specialist palliative care teams in homes, hospitals, and hospices as a means to improve outcomes. As health care increasingly recognizes the need to address the multidimensional concerns of patients and families, there is a growing tendency to adopt a team approach to care. This thoughtful text offers much to assist the reflective practitioner in improving his or her teamwork skill base, and I recommend it as a useful tool for those interested in better understanding the complexities of team dynamics.