Per Sederblad & Helena Stavreski Center for Work Life Studies/Urban studies, Malmö University

1. Inter-professional teamwork in a multi-professional healthcare organization - challenges and possibilities for team development Per Sederblad & Helena Stavreski Center for Work Life Studies/Urban studies, Malmö University Presentation of paper to IWOT 19 Leuven 7 September, 2015

2. The Backgroundof the paper • Action research projects and evaluations in healthcare in the Skåne (Scania) region. • Meetings with professionals (in medicine and HR) to build up a “learning network with research support” in Skåne. • Planning of an organizational development project at the Clinic for medicine care of children at SkåneUniversity Hospital (Malmö/Lund).

3. The Aim of the paper - To discuss how to organize research/development projects, e g as action research, in healthcare. - To discuss how to build up and develop a network with participants from healthcare, HR-experts and researchers. - To identify the challenges for the health care system and to reflect about how to meet the challenges, e g by using models for teams and team development.

4. how to organize research/development projects in healthcare? Health care processes and personnel improvement work - an action research project - Pilot-study conducted November 2011-June 2013 financed by VINNOVA, a Swedish state agency for support of innovation systems. - The aim was to identify the needs and challenges within health services and to develop ideas and concepts for how these challenges can be met. - Clinics involved: infection, orthopedics/emergency care and psychiatry in the Malmö/Lund region. - The partners were various staff at the clinics: managers, HR-staff and trade union representatives. - Interviews with 16 employees in five groups of mixed composition. Eight individual interviews with staff and managers. Workshop with ten participants. - Two areas were followed up and analyzed: the importance of improved communication and coordination between departments and professions, and organizing in inter-professional teams.

5. how to build up and develop a health care network? The learning network with researcher support - collaboration for improved quality of health care and innovation - Aim to enhance the ability of managers to lead organizational development and tocreate conditions for increased innovation capability of staff. - Focus on children& youth health care in the Skåne region. Development project at clinic for medicine care of children. - Process in which a network of participating health care organizations, with the support of researchers, will be working on problems that they themselves have defined in their organizations. - Participants from the organizations are representing different professions and are having positions at various levels in the organization, as managers or administrators. - Theoretical framework based on the concept of innovation and its relationship to the need for exploration and autonomy for the innovation work. - Researchers will be collaborating in the network, as well as contributing with support in form of methods and techniques in the innovation processes.

6. The Clinic for medicine care of children at Skåne University Hospital - Multiple professions are involved: doctors and nurses with specialist competencies, psychologists, almoners, nutritionists and several other professions. - The organization consist of five inter-professional teams with different professionals involved in each team respectively and some of them with personnel both from Lund and Malmö. - The basic principles for the teams at work to follow are the diagnosis and the patience’ needs.

7. challenges for the health care system • Increased need for health care in society due to an aging population and unhealthy psycho-social work environment. • The financial resources for health care is insufficient, which means lack of personnel and stress at work. • The professionals have less time for doing their professional jobs respectively, they have to do other work tasks. • High degree of turn over and temporary employment, which result in increased need to introduce new personnel and further increased stress.

8. possibilities to use team development to meet the challenges - Our project “Health care processes and personnel improvement work” indicated the importance of improved communication and coordination between departments and professions, and organizing in inter-professional teams. - The discussions with the personnel to create a “learning network” have made it obvious that recent challenges with increased problems in health care have resulted in that first the basic conditions for the teams have to be focused. - Recruitment and introduction of new personnel and a lower share of temporary employed employees will be preconditions for this development. - Then in a second stage, models for team organization and team development can be introduced as tools.

9. Models for teams and team developmnent Philip G. Herbst(1976) presented the “compound autonomous groups model”, presented by (1976), and characterized by employees with broad competencies and job rotation in and between teams, can be a suitable model to start with. However, the work in a hospital is for e g doctors and nurses are often very specialized and the job rotation has to be adjusted to this situation. Pierre and Geoff van Amelsvoort (2000) have presented similar ideas as Herbst. Their model is also building on employees with broad competencies, even if the number of work tasks competencies varies between the individuals. They suggest a four stage model for development: bunch of individuals, group, team and finally open team – that means open to contacts both internally and externally in the organization. Deborah Ancona and Henrik Bresman(2007), call the new teams emerging in working life “X-teams”, where X stands for that the members of the team are externally oriented.The first principle for the X-teams is that members of the team work also outside the team with establishing relations with other persons inside and outside the organisation. “Distributed leadership” is practiced, both in the organisation and in the teams.

10. Concludingremarks The project was a pilot-study and we have not yet had the possibility to test the value of the identified two ideas for team development; increased communication and coordination between departments respectively developed use inter-professional team work. However, we have got some support for the focus on this themes in our later discussions with health care personnel. We used our former contacts to build up a “learning network with researcher support” in health care, and we also took some new contacts. We were met in a very positive way, especially in clinics working with children and youth diseases. The network has now been built up and we hope to be able to have financing for the planned activities to create a platform for research and development projects. The tools that then can be used can e g be models for organizational design in form of teams and team development. In an “interactive session” in the Global STSD Network meeting on Friday, I will more in detail present some more recent models and I look forward to an open discussion about their usefulness and applicability e g on health care.

11. References Amelsvoort, P van & Amelsvoort, G van(2000): Designing and Developing Self-directed Work Teams. Vlijmen: ST-GROUP Ancona, D & Bresman, H (2007) X-teams: How to Build Teams that Lead, Innovate and Succeed. Boston: Harward Business School Herbst, P G (1976): Alternativtil hierarkiskorganisasjon. Oslo: Tanum – Norli Sederblad, P (2013): ”How to coordinate autonomous teams?” Paper presented at IWOT 17, TNO, Leiden Stavreski, H (2013). Implementeringsprojekt Regionalt Vårdprogram för barn och ungdomar med AD/HD vid BUP – Malmö/Trelleborg. Utvärderingsrapport jan 2013. Centrum för tillämpad arbetslivsforskning, Malmö Högskola