Emergent modes of work and communities of practice

Abstract

This paper argues that the recent emphasis on teams in the health services research literature tends to be attributed to our rising recognition that flexible and self-organizing teams are in the best position to handle the increasing complexity and fragmentation of health services. With a brief review of two papers on health-care teams as its point of departure, this paper argues that the concern with teams harbours a realization that the organizational-managerial point of gravity of most clinical work lies with those who do the work. In the context of health reforms sweeping across most countries in the industrialized world, this means that teams are to embody dynamic self-organization as do 'communities of practice (CoPs)', and be the origin of the managerial and documentary realities that describe, define and validate them. Following through on this last point, the paper reflects on some of the constitutive facets of teams as CoPs, and proposes that in the context of health reform such emergent teamness encompass participating, knowledging and boundary spanning. Fusing contextual, attributional and processual dimensions of team conduct, these notions are elaborated to show how descriptions of teamness can be rendered sensitive to the prerogatives of health reform. The paper concludes with outlining some of the implications of this proposal for how we reconceptualize health services management.

A systematic exploration of differences in contextual factors related to implementing the MOVE! weight management program in VA: A mixed methods study

“…staff at high implementation facilities described a more cohesive team of committed staff, despite the fact that each team member reported to a separate supervisor in separate units. There is support for coalescing multi-disciplinary teams [33] contributing to successful implementation [34]. These teams displayed an assertive, problem-solving approach to overcoming issues.…”

Effective healthcare teams require effective team members: defining teamwork competencies

“…While there has been substantial study attempting to identify and define the requirements for effective healthcare teams, the predominant focus has been on improving existing teams [8-10]. There has been little research into the educational and training needs of healthcare professionals to enhance their participation in workplace teams; healthcare team members do not understand the personal competencies required for team success [11].…”

Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education

“…Our case is supported by the findings of the American Academy of Family Physicians' National Demonstration Project (NDP), 26 which suggest that practitioners who network, build trusted relationships, and interact regularly-characteristics referred to as the Adaptive Reserve of the practice-respond more positively to practice improvement initiatives than practices that lack these characteristics. 26 A COP also demands high-quality interpersonal relationships among members and reciprocal ties of accountability, dependency, and trust, 27 behaviors that are similar to those included in the adaptive reserve of NDP's model practice. 26 These behaviors have been observed in practitioners in clinical settings that respond favorably to improvement initiatives.…”