Decision-Making in Teams

JOURNAL OF INTERPROFESSIONAL CARE, VOL. 15, NO.
2, 2001
Decision-making in teams: issues arising

from two UK evaluations
GLENDA COOK,1 KATE GERRISH2 & CHARLOTTE CLARKE1

University of Northumbria at Newcastle, Tyne and Wear & 2University of Shef eld, Yorkshire,
1
UK
J Interprof Care Downloaded from informahealthcare.com by Universitaet Zuerich on 05/06/15
Summary Interagency and interprofessional working has often been operationalised through the
development of integrated, multiprofessional teams in the UK. However, there is considerable
ambivalence reported about the success of such teams. This paper reports on two evaluations of
different types of inter-agency/intra-agency, interdisciplinary/unidisciplinary teams. One study used
a soft systems methodology to evaluate a health and social care team for people with enduring mental
health needs and the other used a pluralistic framework to examine integrated nursing teams in
primary care. In both studies, the team-working arrangements in uenced the decisions made by the
For personal use only.
team members such that client care became increasingly responsive and proactive. These changes were
made possible by two processes. First, information transaction was augmented and was instrumental
in supporting effective client-related decision-making. Second, there was enhanced support for
decision-making, especially in respect of problem solving. However, the increased autonomy of the
team members had the potential to marginalise those outside the team from decision-making. It is
suggested that working within a team can impact on the decisions made by team members, which
exceeds a collection of individual decisions. The strengths of complex multiprofessional teams for
service users may be realised if the processes of decision-making are respected.
Key words: decision-making; team-working; community nursing; social care; mental health;
primary care.
Introduction
The shift towards team working arrangements in primary health care
The importance of multiprofessional, interprofessional and inter-agency working has been
highlighted in UK health and social care policy throughout the last decade (e.g. DoH, 1989a,
1989b, 1990, 1994, 1996a, 1997, 2000). Alongside this there has been an increasing
emphasis on teamwork as a means of ensuring the most effective and ef cient provision of
health and social care (National Health Service Management Executive, 1993; DoH, 1996a,
1996b). Several factors have been imputed to the effectiveness of teamwork. Firstly, a team
approach results in better communication between professionals leading to an increasingly
co-ordinated service delivery with more prompt referrals between team members and less
likelihood of clients falling between services (Robison & Wiles, 1994, Bennett-Emslie &
Correspondence to: Glenda Cook, Room H009, Coach Lane Campus East, Faculty of Health Social Work
and Education, University of Northumbria at Newcastle, Newcastle, Tyne and Wear NE7 7XA, UK.
E-mail: glenda.cook@unn.ac.u k
ISSN 1356–1820 print/ISSN 1469-9567 online/01/020141–11 Ó Taylor & Francis Ltd

DOI: 10.1080/13561820120039874
142 GLENDA COOK ET AL.
McIntosh, 1995). Secondly, team working can lead to a more holistic approach to client
need, with the contribution of different practitioners being enhanced (Bennett-Emslie &
McIntosh, 1995). Thirdly, professionals identi ed teamwork as a more satisfying way of
working (as discussed in Robinson & Wiles, 1994).
Nevertheless, some potential disadvantages of team work in health care, particularly
primary health care have also been identi ed, such as dilution of individual professional
responsibility for clients and the possibility of personality clashes between colleagues
(Robinson & Wiles, 1994). Gerrish (1999) points to the complexity of developing team-
working arrangements.
Teams and team working practices vary considerably, hence it is dif cult to generalise from
the outcomes of particular teams. Øvretveit (1997), therefore, suggests that future work
should be focused on researching and evaluating which types of teams are most effective in
different settings for different clients. In addition, developing knowledge about the impact of
team working on processes such as decision-making is essential if the outcomes of team
working are to be truly understood.
Potential effects of team working on decision-making processes

Decision-making in the context of team working occurs at both the individual and collective
level. Decision-making in this context is a complex and problematic process as a consequence
of the diversity and uncertainty of information that must be processed and potentially
negotiated to identify possible courses of action, and decide on the action to be taken in a
given situation. Thus, the way individuals make decisions and the way a group affects the
decisions of its members, are relevant to understanding the potential impact of team working
arrangements on client and team focused decisions.
Investigation of the ways individuals make decisions has a long history, particularly in
cognitive psychology. The literature derived from this work can be broadly divided into the
following subdivisions: decision analysis and decision theory which involves statistical mod-
elling of the reasoning process (e.g. Kahneman et al., 1982); and information processing
which explores the cognitive processes that are functioning when making decisions (e.g.
Newell & Simon, 1972). In addition there is an increasing body of literature, largely in
nursing, pointing to the importance of intuition in the way individuals make decisions.
Benner & Tanner (1987) suggest that decisions based on intuitive processes are not grounded
in a systematic, logical analysis of the situation alone, they result from rapid information
processing, the use of contextual cues and pattern recognition. Although these explanations
of decision-making have been presented as diametrically opposed, recent debate has focused
on the argument that decision-making involves both analytic and intuitive processes (Hamm,
1988; Thompson, 1999).
One consequence of belonging to a group is the impact on the process and outcome of
decision-making. For example, decisions made in groups move towards polarisation, that is
the views of individuals become more extreme in the context of a group (Myers & Lamm,
1976). The in uence of information (new information and different arguments either
con rms or refutes the views of individual group members) and group norms (individuals
compare their own views with the norms of the group) have been attributed to this effect
(Atkinson et al., 1996). Also, processes of ‘groupthink’, whereby individuals suppress dissent-
ing opinions in the interest of the group, affect decisions made by a group (Janis, 1982).
The effects on decision-making demonstrated in groups cannot be directly extrapolated to
team working arrangements in healthcare, yet the potential for the in uence of others on
individual and collective decisions is possible. Øvretveit (1997) contends with this view and
suggests that team membership, team structures, management arrangements, degree of
DECISION MAKING IN TEAMS 143
integration of the team and client pathways through the team will in uence work-manage-
ment and clinical decisions within teams. Furthermore, the way individual team members are
involved in decision-making has been suggested as a potential indicator of team effectiveness
(Pearson & Spencer, 1995).
The espoused virtue of team working referred to earlier, points to the advantages of
different practitioners, with their unique professional knowledge, practice experience and
expertise working together. The brief overview of the literature relating to decision-making
indicates that this aspect of teamwork has received little attention in relation to contemporary
health and social care. Thus, the purpose of this paper is to draw on selected ndings from
two evaluations of team working arrangements to illustrate the impact of team development
on decision-making.
Methods
This paper draws on the ndings of two independent evaluation studies examining team
working arrangements. The rst study evaluated a community mental health team compris-
ing health and social care practitioners in one location in north-east England. The second
study focused on six integrated community nursing teams in a different location in the north
of England. A synopsis of the methods used in each study is presented together with details
of how the data concerning decision-making arising from the two studies were brought
together.
Study A: Community Mental Health Team (CMHT)

The evaluation focused on one team, with data collected longitudinally over 12 months, and
commencing three months after the team was created. The team included seven social
workers (SWs), three GP attached social workers, four community psychiatric nurses
(CPNs), six community support workers (CSWs) and four health and social service man-
agers. The aims of Study A were threefold:
(1) To inform the development of integrated health and social services in mental health.
(2) To analyse the local social and political context of integration over time.
(3) To describe the process of practitioner engagement with their changing role and the
impact on their professional knowledge, skills and practices.
The evaluation used soft systems methodology as a framework, providing an action research
approach that focuses on creating change rather than simply describing the issue (Checkland
& Scholes, 1990). The approach was participatory in enabling the various participants
involved in the evaluation to analyse the social and political climate in which they functioned
and share their various perspectives on the development. It was also educational in facilitating
participants’ learning about the process of integration.
Four data sources were used to establish a picture of the team’s development. Firstly, three
uni-professional focus groups were held (SWs, CPNs and CSWs), followed by a further two
focus groups with team members at the end of the evaluation period. Secondly, nine monthly
Collaborative Learning Group meetings were held with the team (with approximately 12
people attending each meeting). Their purpose was to contribute to the development of the
team, capture the problem solving nature of the team’s evolution and allow the team to be
responsive to the evaluation process. Topics discussed during these meetings included goals
and outcomes for the service and clients, sources of knowledge and the nature of integration.
Thirdly, 13 individual interviews were undertaken with service and professional managers,
project steering group members and practitioners who acted as key points of referral to and
from the integrated team (the team’s stakeholders). Finally, 10 individual interviews were
undertaken with the team members.
Data analysis drew upon the principles of constant comparison, seeking convergence and
divergence in the process of identifying the central issues for the development of the
integrated team. A detailed report of this evaluation (Clarke et al., 2000) and a parallel study,
which evaluated the impact of the team on the service users (Ramprogus et al., 2000), are
published elsewhere.
Study B: Integrated Community Nursing Teams (ICNT)

The overall aim of Study B was to evaluate the implementation of integrated community
nursing teams (ICNTs) within one community trust in England with reference to the success
of the initiative as perceived by different stakeholders. Core characteristics of the teams were:
· Teams were comprised primarily of district nurses, health visitors and practice nurses
attached to a particular general practice, although some included other community nurses,
for example school nurses who were not practice attached.
· Prospective teams opted in on a voluntary basis, becoming ‘self-managing’ by assuming
responsibility for managing their workload and a devolved budget.
· A team co-ordinator, appointed from within the team, was responsible for facilitating
communication between team members and the wider primary health care team.
A pluralistic evaluation approach (Smith & Cantley, 1985) was used. It starts from the
premise that it cannot be assumed that an innovation in service delivery has clearly articulated
and agreed aims and highlights the importance of considering these from the perspective of
different stakeholders and taking account of both anticipated and unanticipated outcomes.
A purposive sample of six out of the 28 teams established was included in the evaluation.
Teams were selected to re ect the heterogeneity of different teams (by size and professional
composition) and the characteristics of the practices serviced (by size of practice population,
number of GPs, inner city/suburban location). The teams varied in size from between four
and 13 members and had been established for between 9 and 30 months. Individual in-depth
interviews were undertaken with the six team co-ordinators, a GP and a practice manager
from each team, senior Trust managers, and the three team facilitators employed by the
Trust. Focus group interviews were undertaken with the members of each team. The topics
explored during the interviews included respondents’ views on the aims of the initiative, the
perceived degree of ‘success’ of the teams and the basis on which these judgements were
made, and factors perceived to have in uenced the development of the teams.
Data analysis drew on the principles of dimensional analysis (Schatzman, 1991). The
interview agenda had required respondents to identify the criteria by which they judged
the teams’ success. Initially, transcripts were scrutinised and coded in order to identify the
various criteria and their different dimensions. A more detailed analysis was undertaken
whereby data were coded in order to map the different dimensions of ‘success’ in relation to
each criterion. An account of the evaluation outlining the criteria for success is published
elsewhere (Gerrish, 1999).
Decision-making was a central issue in both studies A and B. Following completion of the
two studies, a cross-study analysis of the data was undertaken collectively by researchers from
both studies in order to conceptualise further decision-making within evolving teams.
Although the composition of the teams, their aims and purpose varied, a number of common
issues were identi ed relating to issues of process and autonomy in decision-making. This
process of cross-study analysis makes no claim to represent the whole ndings of either study
and is, of course, limited by the parameters of the individual studies. For example, neither
study collected data from service users and any perceptions of a change in service provision
is understood through the eyes of practitioners and managers only. The individual study
designs re ect rather than challenge the contemporary UK policy assumptions that team-
working is good and of bene t to service users. What the cross-study analysis does attempt
is to identify commonality and differences between the two studies and to externally map the
ndings of the whole into debates about decision-making and team-working.
Findings
Team decision-making processes
Decision-making within the teams can not be viewed in isolation from the purpose, aims and
context of team working. The intention in establishing the CMHT was to develop a model
of collaborative inter-agency working in order to enhance client care. A similar concern with
improving client care underpinned the creation of the ICNTs. Different professional groups
attached to the same GP practice, and who had previously worked in comparative isolation,
were brought together with the intention of providing a more integrated service to clients
registered with the general practices.
Two kinds of decision-making were apparent: those relating directly to client care, and
those which led to changes in the working practices of team members in order to provide a
more integrated service. This latter kind was more evident in Study B where managerial
devolution led to self-managed teams. The study participants associated the introduction of
interprofessional team working arrangements with changes in decision-making. These

changes were made possible by two processes. First, information transaction was augmented
and was instrumental in supporting effective client-related decision-making. Second, there
was enhanced support for decision-making, especially in respect of problem solving.
Information transaction within the team

The extent to which team members responded to changes in the circumstances of clients was
in uenced by an awareness of such changes and the way that information was processed in
the team. Whilst the teams in both studies facilitated the exchange of information, the
bene cial effects of knowledge transaction were more clearly illustrated in Study A. The role
of the CSW was instrumental in providing detailed information about clients. They devel-
oped close working relationships with clients enabling them to acquire a very intimate
knowledge of them, allowing the ne-tuning of care packages, the initiation of decisions
about changes to client care and ongoing review of client need.
We’re working with clients more closely than a SW or CPN, if there are problems
we can nip them in the bud by coming back and seeing the CPN or SW and letting
them know that the client is not taking his tablets, this or that is happen-
ing. … There is a problem and we may change the care plan immediately instead of
letting the problem fester for weeks and months. (CSW, Study A)
Information transaction was enhanced by the geographical proximity of the team members.
In Study A, team members were located in a shared open-plan of ce. In Study B members
of each team had been relocated into shared premises situated in the surgery of the GPs to
whom they were attached. This enabled informal, frequent encounters between team mem-
bers and provided opportunities for informal sharing.
When you were separate, a busy SW or CPN, a lot was done by leaving a message
and eventually you would catch up with each other. Now (with the CMHT) you can
respond to things more quickly. For example, if a CPN comes in (to the of ce base)
and says that they have been to see so and so, and indicates that they’ve got a
problem and the SW is sitting there, the SW may say that they will deal with that.
Previously it might have taken several days for that message to get through. (SW,
Study A)
Enhanced decision-making capacity

The creation of the teams evaluated in both studies resulted in the amalgamatio n of
professionals with diverse skills, knowledge and experience. This acted as a catalyst for the
pooling of expertise which then became a resource for all team members to draw upon.
It led to us seeking each other’s advice. If we had a problem with a patient, we knew
who to talk it through with, who could help us out. Before we became an integrated
team, we’d just ask our immediate colleagues but we weren’t really tapping the best
expertise. (Team member, Study B)
Moreover, team membership opened up access to wider professional and inter-agency

networks. This carried bene ts in maximising the resources available to individual team
members and enhanced creativity and diversity in problem solving. Hence, care could be
planned to respond to the needs of clients as illustrated in the following case of a client who
had a long history of alcohol-related problems associated with a psychotic illness:
It was hard to keep him stable and give him any social interventions … … I think
that since I have worked with the team (now there is access to the CSW’s)… we’re
trying to focus on social interventions for him now. Trying to engage him in day
care, trying to give him alternatives to his drinking and trying to set limits by giving
him social things to do with his time. Even though we’ve had an incident recently
he’s been off the drink for about seven weeks which was excellent. (CPN, Study A)
The pooling of knowledge across professional groups and agencies provided support to
individual practitioners. In so doing, it enabled practitioners to make a more effective
contribution, which resulted in a more responsive service to the client: ‘It’s a case of
supporting your colleagues to meet the needs of that service user’ (Stakeholder, Study A).
These changes in support resulted, for example, in more considered but potentially less
conservative decisions being made.
You don’t feel the need to make hasty decisions and you know you can discuss it
with somebody and you’ve got their opinions and support and again there’s this
feeling of back-up, you know, you say to somebody ‘right, we’re going to do this’,
you know that everybody is in agreement and that they support you in that. (CPN,
Study A)
A more proactive and responsive model of decision-making emerged as the teams became
established, with a shift from crisis-orientated, reactive decision-making to problem solving
and proactive service development. For example:
There was a problem in the past when the practice nurse was on leave. Her clinics
had to be cancelled, which was generally OK, but sometimes it caused problems if
patients needed close monitoring. The district nurses might then end up having to
do a home visit because the patient’s condition had deteriorated. Now, what we do
is look how we can work more exibly, when the practice nurse is away, she reduces
the number of patients on a clinic list but the district nurse steps in and runs a clinic
for her. It means that patients continue to get the care they need and it’s much more
ef cient than picking up extra home visits. (Team co-ordinator, Study B)
Similarly, in Study A, the formal inter-agency referral mechanisms (which may have taken
several weeks) were often replaced by less bureaucratic and more ef cient channels of
decision-making.
I think (there is) a much closer working relationship, a quicker response to crisis.
This helps to prevent hospital admissions. I think the knowledge I’m getting from
working so closely with the SWs because they are getting good feedback from the
CSWs, and the management of things actually gets things sorted out. It’s de nitely
helping to intervene quickly. We’re just gaining knowledge from each other all of the
time. (CPN, Study A)
The move to establish ICNTs was also perceived to have reduced bureaucratic channels of
decision-making. Individual team members were more accessible to each other and this
enhanced the opportunity for informal dialogue as well as formal consultation. The team had
the vested authority to make decisions regarding the working practices of team members, and
this resulted in increased risk taking, enhanced exibility, and stepping outside traditional
professional boundaries. Ultimately, this was seen to bene t client care.
Rather than work within our traditional boundaries we now look to ways in which
we can work more exibly. So, for example, we have developed a collaborative
approach to managing the heavy demand for ‘ u vaccinations in the autumn. In the
past, the practice nurse had to do them all, but now the community nurses help out,
and we have also started an evening vaccination clinic for those who nd it dif cult
to get to the surgery during the day. (Team member, Study B)
Team autonomy in decision-making

The enhanced decision-making capacity of the teams and the reduction in bureaucratic
channels of decision-making are indicative of the greater degree of autonomy that the teams
had. In particular, all the teams were able to consider how individual members might work
more exibly across professional boundaries and this led to role awareness and negotiation
among the team members.
We have a different focus with our work … One of the major things we found, we
were duplicating an awful amount of work. … It is about negotiation, it happens
naturally, quite diplomatically …what the role is that you’re actually carrying out,
what your function is and what you’re going to focus on. (Team member, Study A)
The team in Study A was building on previously good interprofessional relationships and
cross agency working practices, whereas, the teams in Study B had less history of collabora-
tive work and the success of role negotiation was dependent upon trust developing between
team members.
At rst we needed to get to know each other, nd out where each of us was coming
from and what expertise we had. We also needed to develop trust so that we could
begin to discuss things openly. If we didn’t trust each other, there was a risk of
decisions being undermined. (Team member, Study B)
However, there were clear limitations to the extent to which teams were able to exercise
autonomous decision-making. In the quote below, team members highlighted the pro-
fessional boundaries of their practice.
For example, there is a boundary between health and social care … … … there’s a
boundary between decisions (a CPN manager) can make and the decisions (a) SW
manager can make … .there are the boundaries the agencies put on you.
(Collaborative Learning Group discussion, Study A)
Although team-working was perceived to empower team members themselves, it also served
potentially to marginalise others who are more peripheral to the team such as GPs and
consultant psychiatrists. For example, in the team in Study A, multi-disciplinary discussions
had moved, in part, from the hospital (and consultant led ward reviews) to the community-
based team.
… sometimes you wonder whether some people might nd the fact that CPNs, SWs
and the CSWs between them have basically got the case sorted out. We’ve already
got care plans agreed. And they’re (Consultant Psychiatrist) still trying to write out
the referral note. (Team member, Study A)
Issues of team autonomy and empowerment in respect of decision-making were most marked
with the teams in Study B in relation to their self-managing status. The creation of ICNTs
was underpinned by the principle that decision-making concerning individual and collective
working practices would be devolved to the team itself, instead of being vested with a nurse
manager as had previously been the case. The introduction of self-management had affected
the power base of decision-making, the shift in the locus of control resulting in team members
feeling empowered in respect of the in uence they could exert over their own practice.
We’ve developed considerably since becoming a team. We’ve more control over
what we do and we’re in a better position to in uence decisions that affect our work.
(Team co-ordinator, Study B)
Moreover, they reported enhanced relationships with the GPs.
The GPs are more willing to listen to our views now. They see us putting forward
a collective voice on nursing issues and seek our opinion on developments that affect
the practice. We feel we’re contributing much more. (Team member, Study B)
However, although GPs generally welcomed the enhanced contribution from the ICNTs,
they sometimes had dif culty accepting a redistribution of power.
It’s good that the nurses are developing services but at the same time it can make
us (GPs) feel threatened. It’s sometimes dif cult for us to let go of our power base
and as they take on more responsibility for developing the service, we can feel that
our role is being eroded. Now, I’m not saying that change shouldn’t happen, but it
can be disconcerting. (GP, Study B)
As teams became more autonomous in their decision-making, tensions sometimes arose

between the team and the GPs and managers. GPs occasionally undermined the team’s
self-managing status by raising concerns with managers rather than the team itself. Likewise,
managers sometimes had dif culty devolving full responsibility for decision-making to teams
and on occasions undermined a team’s self-managing status.
There was situation where one of the GPs thought it would be good if the health
visitor took on responsibility for one of his baby clinics. Now he raised it with the
manager, but instead of her referring him to us to make the request, she came and
told us that the health visitor had to take this on. (Team member, Study B)
Discussion
Opportunity for different ways of making decisions is created by the development of complex
teams, whether this is within primary care nursing teams or across the health–social care
interface. Two issues acted as catalysts to decision-making in respect of cross-boundary
working. Firstly, the shared geographical location, allowing ease and timeliness of interprofes-
sional and inter-agency communication. Secondly, altered team structures, for example the
introduction of the Community Support Worker role or the restructuring of relationships
between existing professional roles such as Health Visiting and District Nursing. Thomas &
Corney (1993) and Bennett-Emslie & McIntosh (1995) highlight the lack of such catalysts as
a reason for team failure.
Cross-boundary working is manifest through the sharing of expertise and interprofessional
collaboration. The structural differences to the way that people work has three effects on the
nature of professional activity undertaken by the team members. Firstly, they minimise the
bureaucracy of the team, with both studies nding that decision-making (about the future of
the team or about client care) was a process and outcome shared among team members.
Indeed the teams were intolerant of autocratic modes of working. Fundamental to achieving
this was the holding of shared goals and beliefs about the practice of the team and its
members.
Crucial also was the autonomy of the teams such that they were able to orientate the
decisions to meeting the needs of the service users. In so doing, the teams challenged, and
even threatened, some of the previously existing orientations of service provision and lines of
accountability. As the teams grew in self-control, so others outside the team were potentially
marginalised as active participants in decision-making. This sometimes resulted in a disrup-
tion to the functioning of the teams from systems and people outside the teams. Paradoxi-
cally, relationships with people outside the teams were not diminished so much as altered
and, over time recast into a different form of working together (as the GP in Study B was
quoted as describing earlier). Given the current policy drive for interagency and interprofes-
sional working (e.g. DoH, 2000), it is important to recognise that the development of teams
provides stronger core team-working but it may be at some cost to the larger primary and
secondary care provision, at least in the short-term.
Secondly, the time taken to make decisions was reduced. Not only were the services able
to respond faster to service user need, but they were also able to take decisions, that would
have been regarded previously as carrying greater risks, secure in the knowledge that they
were able to respond swiftly and in a more supportive way. The speed and nature of decisions
were further enhanced because the team members had a better knowledge of each other’s
roles, skills and agencies, growing quickly to trust each other. Moreover, individual team
members brought their own ‘lens’ of understanding to a situation, allowing the team to
view the issue with a wider perspective. Myers & Lamm (1976) argue that team-working
polarises the decisions that are made by individuals and this process clearly impacts on the
nature of the decisions the teams were able to make. Similarly, Bennett-Emslie & McIntosh
(1995) found that team working enhanced holistic care and the contribution of different
practitioners. For example, in the context of a team, with peer support and the altered service
structures that allowed for Community Support Worker involvement 7 days a week (as in
Study A), decisions become less problematic than they would have been for an individual
practitioner. This was illustrated earlier by the CPN who described feeling less pressure to
make decisions on their own.
Thirdly, and consequent to the preceding points, was a move from service-led and even
crisis orientated care management to a more proactive and client-led style of care manage-
ment. To achieve proactive care management required the needs of service users to be
anticipated—that is, needs to be identi ed in their potential state rather than when they have
actually become a problem for people or the community. It is here that the altered team
structures play a part, allowing a ne detail assessment of service users (be they individual,
families or a community) such that alterations in their needs are detected, reported, assessed
and managed before they are of such magnitude that a crisis is precipitated. This is contextual
and client-centred knowledge that contributes to the basis for decision-making of practi-
tioners (as suggested by Benner & Tanner, 1987). For example, in the integrated community
nursing team study, service provision was reorganised to allow exible delivery of in uenza
vaccinations. In the community mental health team, such a shift to client-led and proactive
care resulted in a reduction of days spent in secondary care to just 31% of those spent prior
to referral to the team (Ramprogus et al., 1999).
Conclusion
Working within a complex team can impact on the decisions made by team members, which
exceeds a collection of individual decisions. The processes of team working, such as ease of
communication, collegial support and altered organisational structures allowed the teams in
both the studies reported in this paper to be more autonomous in making decisions about the
team itself or about the care of service users. As a result, the teams’ activities were able to
focus on identifying needs and providing services in a way that was client-focused. Changing
services can change care, and it is in respecting the nature of team decision-making that the
potential bene ts of team-working can be realised.
Acknowledgements
This paper would not have been possible without the contribution of the practitioners and
managers who developed the team working arrangements and took part in the evaluation
studies including Sunderland Social Services and Priority Healthcare Wearside NHS Trust.
The work of other members of the University of Northumbria at Newcastle research team is
also appreciated. In particular, Dr Catherine Gibb is thanked for her efforts in respect of data
collection, data management and contribution to ideas for this paper, and Pauline Gertig and
Maureen Morrow for their contribution in the evaluation of transdisciplinary working in the
new team.
References
ATKINSON, R.L., ATKINSON, R.C., SMITH, E.E., BEM, D.J. & HOEKSEMA, S.N. (1996). Hilgard’s introduction to
psychology. London: Harcourt Brace College Publishers.
BENNER, P. & TANNER, C.A. (1987). Clinical judgement: how expert nurses use intuition. American Journal of
Nursing, 11, 23–31.
BENNETT-EMSLIE, G. & MCINTOSH, J. (1995). Promoting collaboration in the primary health care team: the
role of the practice meeting. Journal of Interprofessional Care, 9, 251–256.
CHECKLAND, P. & SCHOLES, J. (1990). Soft systems methodology in action. Chichester: Wiley.
CLARKE, C., COOK , G., GERTIG, P., GIBB, C. & MORROW , M. (2000). Integration of a health and social work team
in mental health—an evaluation. University of Northumbria at Newcastle: Practice Development
Programme.
DEPARTMENT OF HEALTH (1989a). Caring for people: Community Care in the next decade and beyond. London:
HMSO.
DEPARTMENT OF HEALTH (1989b). Working for patients. London: HMSO.
DEPARTMENT OF HEALTH (1990). The care programme approach for people with a mental illness referred to the
specialist psychiatric services. HC(90)23/LASSL(90)11,DH. London: HMSO.
DEPARTMENT OF HEALTH (1994).Working in partnership: a collaborative approach to care. London: HMSO.
DEPARTMENT OF HEALTH (1996a). Primary Care: delivering the future. London: HMSO.
DEPARTMENT OF HEALTH (1996b) The health of the nation: building bridges. A guide to arrangements for
interagency working for the care and protection of severely mentally ill people. Wetherby: Department of Health.
DEPARTMENT OF HEALTH (1997). Developing partnerships in mental health. Wetherby: HMSO.
DEPARTMENT OF HEALTH (2000). The NHS plan: a plan for investment, a plan for reform (Cmd paper 4818–1).
London: HMSO.
GERRISH, K. (1999). Teamwork in primary health care: an evaluation of the contribution of integrated nursing
teams. Health and Social Care in the Community, 7, 367–375.
HAMM , R.M. (1988). Clinical intuition and clinical analysis: expertise and the cognitive continuum.
In: J. DOWEY & A. ELSTEIN (Eds), Professional judgement: a reader in clinical decision making. Cambridge:
Cambridge University Press.
JANIS, I.L. (1982) Groupthink: Psychological studies of policy decisions and ascos. Boston: Houghton Mif in.
KAHNEMAN, D., SLOVIC , P. & TVERSKY, A. (Eds), (1982). Judgement under uncertainty: heuristics and biases.
New York: Cambridge University Press.
MYERS, D.G. & LAMM, H. (1976). The group polarization phenomenon. Psychological Bulletin, 83, 602–627.
NEWELL, A. & SIMON, H.A. (1972). Human problem solving. Englewood Cliffs, NJ: Prentice-Hall.
NHS MANAGEMENT EXECUTIVE (1993). Nursing in Primary Health Care—New World, New Opportunities.
London: NHSME.
ØVRETVEIT, J. (1997). How to describe interprofessional working. In: J. ØVRETVEIT, P. MATHIAS & T.
THOMPSON (Eds), Interprofessional Working for Health and Social Care. London: Macmillan.
PEARSON, P. & SPENCER, J. (1995). Pointers to effective teamwork: exploring primary care. Journal of
Interprofessional Care, 9, 131–138.
RAMPROGUS, S., CARRE, M., MASTERS, A., COWAN, C., CLARKE, C., GIBB, C., COOK , G., MORROW, M. &
GERTIG, P. (2000). The pilot community support worker scheme in west sector, Sunderland—an evaluation.
Practice Development Programme: University of Northumbria at Newcastle.
ROBISON , J. & WILES, R. (1994). Teamwork in primary care: do patients bene t? Southampton, Institute for
Health Policy Studies.
SCHATZMAN, L. (1991). Dimensional analysis: notes on an alternative approach to the grounding of theory in
qualitative research. In: D.R. MAINES (Ed.), Social Organisation and Social Process, pp. 303–314. New
York: Aldine.
SMITH, G. & CANTLEY, C. (1985). Assessing health care: a study in organisational evaluation (1st edition). Milton
Keynes: Open University Press.
THOMAS, R.V.R. & CORNEY, R.H. (1993). Teamwork in primary care: the practice nurse perspective. Journal
of Interprofessional Care, 7, 47–55.
THOMPSON, C. (1999). A conceptual treadmill: the need for ‘middle ground’ in clinical decision making
theory in nursing. Journal of Advanced Nursing, 30, 1222–1229.

Decision-Making in Teams

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Decision-Making in Teams

Uploaded by

Copyright:

Available Formats

JOURNAL OF INTERPROFESSIONAL CARE, VOL. 15, NO.

Decision-making in teams: issues arising

GLENDA COOK,1 KATE GERRISH2 & CHARLOTTE CLARKE1

ISSN 1356–1820 print/ISSN 1469-9567 online/01/020141–11 Ó Taylor & Francis Ltd

Potential effects of team working on decision-making processes

Study A: Community Mental Health Team (CMHT)

Study B: Integrated Community Nursing Teams (ICNT)

interprofessional team working arrangements with changes in decision-making. These

Information transaction within the team

Enhanced decision-making capacity

Moreover, team membership opened up access to wider professional and inter-agency

time. (CPN, Study A)

Team autonomy in decision-making

Moreover, they reported enhanced relationships with the GPs.

As teams became more autonomous in their decision-making, tensions sometimes arose

You might also like