After writing about teams and models and the distinct possibility of talking past each other, I had a very quick search for a paper on teamwork and models this morning, and came across this one by a group of Canadian researchers. It is, like many of these pieces of research into the messy and complex area of decision-making and teams, a qualitative piece of work. It examines process and identifies underlying values within a team.
Values are interesting things – they’re the often unspoken ‘things we think are important’, and possibly represent the very things that we both share in common with each other – and at the same time, can be the very things that underlie our major differences of opinion with each other too.
In this study by Loisel, Falardeau, Baril, José-Durand, Langley, Sauvé, & Gervais, (hereafter ‘the authors’), they observed a single team discussing the cases of 22 workers off work due to musculoskeletal pain. They painstakingly transcribed then analysed the discussions (338 meetings, 75 hours of discussion transcribed!)…
The team consisted of : general practitioner, occupational therapist, kinesiologist, psychologist, ergonomist, and team coordinator. They held weekly team meetings to decide on progress, messages to give to employer and participant (an investment in meetings that I don’t see happening on a regular basis in many pain management settings today).
Data analysis is modelled after Glaser & Strauss, although thankfully they acknowledge they are not using grounded theory – instead, they coded, wrote memo’s, created flowcharts and looked for similarities and differences between each coded category until they came up with explanatory hypotheses that cohered to form a theoretical explanation for how the teams worked. For a full description of the types of grounded theory (so you can see how this study differed from a methodologically sound grounded theory) you can go to here and here.
The findings identified ‘ten common values and were shown as supporting the team’s decisionmaking process during case management. They repeatedly appeared during interdisciplinary team meetings and were reinforced by team leaders.’ The researchers thought they fell into four main groups: (1) team-related values, (2) stakeholder-related values, (3) worker-related values, and (4) general values influencing the intervention.
Team unity and credibility – this reflected the approach of the team to both arrive at consensus, and then act in consensus so that there were no ‘gaps’ or opportunities for the participant or employer to split the team.
Collaboration with stakeholders – this represented coordination of care, and the team worked hard to bring participants alongside with the team’s view, so that the person returning to work had consistency of management.
Worker’s internal motivation – the team worked hard to strengthen the worker’s internal motivation, so the worker was encouraged to be autonomous and assertive.
Worker’s adherence to the program – the team worked hard to ensure the person returning to work followed the team’s recommendations, seeing this as vital to the success of the programme. The authors found that it seemed important that the worker and the team were ‘thinking in the same way’, that they became ‘allies’.
Worker’s reactivation – being active = good, being inactive = bad. All workers were thought to be able to return to work irrespective of their diagnosis.
Delivering a single message – unity and consensus seemed critical to ensure everyone heard the same message and the aim of the programme was achieved.
Worker’s reassurance – that the person was doing no harm to themselves, that they would ‘make it’, and that the team was supporting them.
Stakeholders’ reassurance – to ensure the stakeholders felt comfortable with accepting someone back to work even if they weren’t at full physical capacity.
Interventions should be graded – because workers had been off work for some time, the team agreed that they should be gradually reintroduced to the workplace.
Pain is multidimensional and must be actively controlled – both physical and psychosocial factors were actively addressed throughout the programme, including ensuring the participant knew about the multidimensional nature of pain.
Work is therapeutic – the team supported the idea that being back at work is good in itself.
For me, this study illustrates that even if a team hasn’t clearly or explicitly discussed underlying values or models, they hold them. It’s probably (and I’m hypothesising here) a more effective team that is open amongst the members about the values or model they have, so that differences of opinion can be openly aired, and especially given that at least in this team, being united was thought to be so important.
I’ve recorded and tracked the discussion patterns across team members, and also looked at roles participants play within a team, but I’ve never examined the underlying values.
I think it’s an interesting approach to how living teams function, and it begs the question: how long does a team need to be together to cohere values? What is the effect of introducing a new person to a team? How does a team work to integrate or exclude values brought in by new team members that don’t align with the rest of the team?
It also brings into question the process of selecting a new team participant – maybe it’s much less about what the person knows, and much more about how comfortable that new team member is with the ‘way we do things around here’, or the values and culture of teamwork.
Loisel, P., Falardeau, M., Baril, R., José-Durand, M., Langley, A., Sauvé, S., & Gervais, J. (2005). The values underlying team decision-making in work rehabilitation for musculoskeletal disorders Disability & Rehabilitation, 27 (10), 561-569 DOI: 10.1080/09638280400018502