Achieving teamwork : a grounded theory investigation in selected stroke units in the north of England
The development of collaborative interdisciplinary working is a key element of contemporary health policy. Future healthcare workers will need to work. individually, collaboratively and in teams if they are to meet the complex and changing needs of the patients they serve. The literature related to health professional team working identifies many barriers and sources of potential conflict, but there is also evidence that effective interdisciplinary teamwork can be achieved and is associated with improved health outcomes. The specialised and co-ordinated multidisciplinary team care provided in stroke units was considered to contribute directly to the improved patient outcomes seen in these units. However, the ways in which stroke unit team members co-ordinate their work was not clearly understood. This study utilised a grounded theory approach to develop an explanation of the ways in which health professionals in two stroke rehabilitation units in the North of England achieved teamwork. Data were generated through over 200 hours of participant observation and thirty four semistructured interviews with a range of team members. The findings of the study identified a basic social process which was common to team working in both stroke units; this process was termed 'opportunistic dialogue'. This represented an interactional process through which the division of labour in respect of specific rehabilitation activities was worked out and agreed by team members on a day-to-day basis. Co-location of most team members in both units led to repeated engagement in sharing and validating patient information and in exploring different perspectives. Opportunistic dialoguing contributed to mutual learning in the stroke unit teams and explained the shift in thinking and team culture which occurred as team members moved from concern with discrete disciplinary actions to dialogue and negotiations focused on collaboration to meet the needs of stroke patients. Negotiations played a major role in opportunistic dialogue and coming to agreement on the teams' rehabilitation work. The study findings emphasised the interrelatedness and interdependence of these concepts as core interactional processes contributing to the achievement of teamwork in stroke units. The study confirmed the utility of the negotiated order perspective in understanding and explaining workplace interactions, but identified that whilst negotiations were a key feature of opportunistic dialogue, other processes also contributed to achieving and maintaining teamwork. Focussing on dialogue demonstrated that patterned talk-in-interaction processes maximised the contribution of opportunistic dialogue to coordinating the skills and knowledge of the different disciplines participating in stroke rehabilitation. The achievement of teamwork in these units occurred through access to and participation in opportunistic dialogue.