Organizational Structures of Health Care Teams: Impact on Team Development and Implications for Consultation
This paper was originally published in the Proceedings of the Eigth Annual Interdisciplinary Health Team Care Conference, which took place September 18-20, 1986 at the Ohio State University in Columbus, Ohio. It is reproduced here with the permission of the authors.
Theories of group development (Tuckman, 1965) imply that a health care that is unencumbered by organizational constraints will pass through the stages of development more easily than one that is constrained. For the team in the traditional hospital setting, demands from various departments of the hospital, constraints of professional reference groups, and traditional professional roles would all seem to conspire to inhibit development. If this were so, then a team that functions on the periphery of the hospital might be expected to work its way through the difficulties of the early stages of development and reach the stages of smooth functioning more readily than one that is constrained by its bureaucratic environment. If the members have only each other to take into account, they should more readily develop strong cohesion and effective means to fulfill their tasks. It would also follow that consultation designed to facilitate team development should be easier with the more autonomous team. Being more autonomous, they should be more able to implement what they learn.
Our findings from educational consultations with two teams over a two year period have led us to question this line of reasoning. Contrary to our initial expectations, we found it more difficult to move the more autonomous team to the later states of development than it was to move the less autonomous team.
In this paper, we first discuss our thinking about the stages of team development and about the structural and cultural factors that affect such development. Next we present the quantitative evidence that enabled us to compare the two before, immediately after, and six months after consultation. Finally, we discuss our experiences while consulting with the two teams.