Effective rehabilitation requires multidisciplinary teamwork. This is the second major defining characteristic of rehabilitation. The importance of multidisciplinary team work is increasingly recognised in al healthcare, and is a rational response to the complexity of many healthcare problems. Unfortunately, some people equate teamwork to a group of patient being involved with a particular patient, which constitutes a ‘pseudo-team’. They fail to appreciate the important characteristics that define a team. Detailed information about teamwork in rehabilitation is available here. An overview will be given in this part of the website, and is shown in this graphic.
A team is a group of people who work together towards common goals, each member contributing according to their expertise and ability. A team is itself a complex system, and a team is resilient and resists degradation. Absence of a team member can be compensated for without much loss of team effectiveness in the short-term (days).
The following features are important determinants of team effectiveness:
- identifying the patient’s need, usually on the basis of the biopsychosocial model of illness
- having shared goals and a common, shared understanding of actions needed
- establishing a particular group (team) for each patient, able to meet his/her specific needs
- having good communication and coordination between all team members, and the patient and family
- having, within the team, the range of knowledge and skills needed for the range of patients seen by the team
- presence of trust and mutual respect between members, being able and willing to share knowledge (this is the only feature that concerns culture)
- evaluating progress, and altering goals or actions as required
- organising for teamwork, making opportunities (e.g. team meetings about the purpose of the team and how they work) to develop team identity and culture
There are also debates about the types of teams that may exist such as:
- multidisciplinary; work undertaken with other disciplines in parallel or sequentially
- interdisciplinary; work undertaken jointly with other disciplines
- transdisciplinary; work integrated across many disciplines, and undertaken collaboratively.
These distinctions are probably artificial, and not useful.
It is more important to realise that teams cannot work in isolation. The healthcare system is a system; it has a hierarchy of systems that interact at the level of a patient, or a ward or department, or a hospital, and at many levels in between. Any team is part of a network of teams, as this figure illustrates. Any single patient will be involved with several, if not many teams. To put it another way, “No team is an island entire of itself; every team is a piece of the healthcare system.”