Introduction
Imagine a world where we could all just sit together at a table and instantly produce the perfect solution for every service user that we are presented with. Well that is probably not going to happen. But the alternative is that we sit around a table and never agree to anything. Over the last 100 years, there has been a proliferation of healthcare professionals, so that now we have occupational therapists, physiotherapists, nurses, clinical psychologists, psychiatrists, doctors of numerous forms, medical assistants, nursing assistantsâŠ. The list is endless. They each have different levels of training and speciality, but one professional requirement they all share is that they need to be able to work together. As this increased diversification has occurred, it is arguable that the importance of joined up, collaborative care has also increased. The service user, amid all of these would-be helpful people, has to be able to feel that these professionals are working in some form of coherent manner. This need for effective collaborative care in itself creates a dilemma for these different professionalsâhow to work together as a team whilst simultaneously maintaining their professional identity and autonomy.
This book specifically examines team working in various mental health contexts. Within mental healthcare settings, collaboration is essential to ensure that people feel confident in the care that they receive, and that anxiety levels or feelings of disengagement are not further exacerbated. Collaboration in mental health can require specific forms of communication that might not be as relevant in other areas of health care; for example, there are particular sensitivities concerning the ways to approach service users, or the how to support staff (Chong, Aslani, & Chen, 2013).
This book reports a research programme that examined in detail how interprofessional working is implemented in a range of mental health settings. We are particularly privileged to have been able to study interprofessional care at a unique point in time when service user involvement is increasingly valued, and so hope that this book will instigate a new generation of researchers to understand better all of its components. We would like people to understand the face-to-face aspects of interprofessional care, in particular how multidisciplinary team meetings are managed and organised by the people who actually take part in them. Our research programme conjoins advances in mental health care prioritising patient experience, a culture of service user and carer involvement and consultation in practice and research, with advances in the study of how language works as a practical accomplishment in everyday settings.
In this chapter, we hope to orientate the reader to how the focal research programme, which we termed MDTsInAction , developed. We then explore briefly the global concern to enhance interprofessional working and the UK manifestation of this as multidisciplinary teams (MDTs ). A literature review of the effects of communication failures in health care is then presented, identifying some of the foundational concerns for this research programme. Finally, the broad aims and methods of the research programme are included before introducing the remainder of the book.
The Development of the MDTsInAction Research Programme
The MDTsInAction research programme was developed within Plymouth University Clinical Psychology Training Programme. The lead researcher, CS, as a research tutor participated in a number of discussions in teaching groups, reading groups, service user groups and with clinicians around mental health care of different forms. The conversations included hearing the frustrations of service users that decisions seemed to be made that were âbeyond their controlâ (see Chapter 13). Service users told us that one member of staff did not seem to know what another was doing or had told them. They cited examples of how it had been very difficult for them to get input or support from different practitioners, the very reason that interprofessional care exists.
Discussions with staff and clinical psychology trainees revealed frustrations in knowing how to be heard in team meetings , perceived difficulties with power hierarchies, and difficulties in expressing and actioning service user perspectives. The staff and trainees seemed frustrated that they were being, or had been, trained to work in teams together, but that these approaches were idealised and did not match the complexities of actual team working (see Chapter 2). Within the local clinical psychology training programme, trainees noticed that they were trained mainly in therapeutic interventions such as family therapy, which promotes good local relationships within families, and yet, some of these ideas did not seem to be more widely understood within team meetings .
At this same time, there were other new changes occurring both locally and nationally in the UK, where services were increasingly adapting to use what the NHS termed multidisciplinary teams to form diagnoses together (NHS England, 2014), for example in memory clinic and neurodevelopmental services. These new clinic-type approaches necessitated even more a form of joint working between clinicians, taking the entirety of the responsibility away from the medically trained professional (see discussion of creeping genericism in Chapters 2 and 10). Alongside this were moves within the professions of clinical psychology and mental health to develop the notion of team formulation (Johnstone & Boyle, 2018). Formulation has been evolving in clinical psychology for at least 20 years as a way of understanding mental well-being for service users that considers the multiple different factors that are involved in maintaining behaviours that are distressing (Johnstone & Dallos, 2014). Team formulation is now evolving, emphasising how these âassessmentsâ of need could be enhanced through multiple professionals engaging in formulation together (See Chapter 7). A research question which follows on from these developments is to understand exactly how teams of professionals jointly accomplish their formulation of peopleâs problems.
Although there have been attempts to answer this research question, these attempts have frequently relied on qualitative methodologies in which interviewees provide a retrospective account of their experiences or on ethnographic approaches which rely on participant observation of teams in action. These approaches do not accurately capture the moment-to-moment engagement of team members with one another and are subject to a range of epistemological limitations. Our own solution to understanding how teams work is to examine team interactions at a micro-level of detail (see Chapter 2). Over the last 50 years, there has been significant development in discursive methods so that we are now better able to examine in detail how social interaction is organised and to explore how meanings are generated and changed. Studies in this vein were initiated by the work of Harvey Sacks in the 1970s and have gradually moved from analyses of phone calls to include face-to-face interac...