Developing the reflexive team

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Developing the reflexive team
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Reflexivity

• Teams are effective to the extent that they
  reflect upon their objectives, strategies and
  processes, as well as their environments, and
  adapt these aspects of their worlds accordingly.
• West et al, 1998

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Two dimension of reflexivity

• Task reflexivity demonstrated in the teams
  ability to achieve the teams objectives.
• Social reflexivity demonstrated in the teams
  ability to promote the well being of its members.

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Wests four team types
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• Research also shows that teams that are more
  reflexive are more effective and introduce more
  innovations.

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Reflection points

• I promote my own mental health by.
• The things about me and my behaviour that promote
  the mental health of people that I meet at work
  (users and colleagues) are..

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Stress, low job satisfaction and burnout

• mistakes
• higher prescription rates,
• less provision of information,
• lower patient satisfaction,
• higher non-attendance among users and
• lower compliance.

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Stress, low job satisfaction and burnout

• less time in direct contact with users.
• emotional disengagement from, or even blaming of
  service users
• ulcers, headaches, upset stomachs, and physical
  exhaustion due to lack of sleep, and anxiety.
• early retirement
• leaving

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Findings among mental health staff

• Emotional exhaustion very prevalent.
• But also high job satisfaction.
• Lower burnout among community staff.
• Even lower among ACT staff?

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Principle sources of pressure

• 39 Lack of resources
• 36 Work overload
• 31 Bureaucracy
• 28 Management-lacking understanding, not
  communicating, failing to lead/manage, not
  promoting participation
• 18 Managing competing tasks- e.g re emergencies
• 17 Organisational change

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Principle sources of pressure

• 13 Role problems- people misunderstanding roles
  of given disciplines, arguments over washing up
  cups
• 12 Interpersonal issues- e.g. clashes of
  ideology, inequalities, difficult to work with
  people
• 12 Impacts, (including emotional) of work with
  distressed or difficult to work with users
• 11 Working conditions- e.g. insecurity, poor pay
• 11 Team problems- e.g. poor communication, lack
  of leadership and unclear team goals.

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Principal Sources of Reward

• 52 Team/multi-disciplinary work
• 44 Being effective clinically- getting good
  outcomes for users
• 37 Contact with users and their supports
• 29 Aspects of the job itself- e.g. innovation,
  variety, challenge
• 25 Power- e.g. autonomy, influence in decision
  making, status
• 17 Being effective as a service
• 14 Being valued- e.g Thank yous

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The mental health of team members

• team members have better mental health compared
  to those working in looser groups or individually
• Mental health associated with better team
  functioning, in terms of clearer objectives,
  higher levels of participation, a stronger
  commitment to quality and better support for
  innovation

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Organisational interventions

• One of the most useful organisational
  interventions to improve mental health in the
  workplace appears to be by developing good teams
  one which have clear group and individual
  objectives, which meet regularly and which value
  the skills of individual members (Firth-Cozens,
  2000 p.88).

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• Generating ideas to boost morale exercise

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Factors associated with mental health among staff

• The degree of performance pressure.
• The freedom and autonomy to control work and
  exercise discretion.
• The extent to which work roles and objectives are
  clarified.
• Identification with the job.
• Opportunities to use a variety of ones skills.
• A sense that the job is valued.
• The quality of feedback received.

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Holloway et al (2000) advocated attention to

• Role characteristics Issues regarding the
  clarity of team members roles and their
  workload.
• Job characteristics e.g. re accountability and
  responsibility.
• Interpersonal relationships Improving
  communication systems
• Organisational structure and climate Encouraging
  decentralisation and participation in
  decision-making.

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Holloway et al (2000) advocated attention to

• Human resource management supervision,
  mentoring, appraisal, and Continuous Professional
  Development
• Improving physical aspects of the work
  environment.

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The personal focus

• Evidence for the effectiveness of work place
  counselling and stress management training
• Clarity needed about who does what in delivering
  staff support
• Important to recognise when more intensive
  psychological interventions are required.
• Need early interventions and removal of barriers
  to help seeking.
• Promote personal efficacy.

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A reflective space
Consultant
User
Worker
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Supportive relationships for staff need to
achieve

• The maintenance and development of therapeutic
  competence.
• Monitoring the effectiveness of helping
  relationships.
• Overseeing the quality and quantity of workload
  responsibilities (including the size and
  composition of caseloads).
• Assisting with the effective management of time.
• Enabling continuing professional development,
  including accessing appropriate education and
  training.

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Supportive relationships for staff need to
achieve

• Planning future career development.
• Ensuring awareness and effective use of
  resources.
• Acknowledging the effective and successful use of
  knowledge, skills and experience.
• Sharing and exploring the emotional demands of
  other peoples psychological difficulties.
• Helping to cope with stress, preventing burnout
  and addressing the negative aspects of work.
• Recognising and addressing personal needs and
  growth.

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Clinical review meetings should provide

• Affirmation the recognition of the work being
  undertaken.
• Information the sharing and clarification of
  details.
• Ideas generating new options, and
• Fun to ensure colleagues in the team are
  enjoying their work

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Reflexivity can be developed in the team by using
events that occur as learning opportunities, such
as

• Errors and failures When mistakes are made use
  this as an opportunity to reflect on why the
  mistake occurred and to put in place improved
  procedures and changes in working practices that
  prevent the errors and failures from reoccurring.
• Team conflicts If conflicts arise explore openly
  and supportively-explore the reasons for the
  conflict, particularly examining if and how lack
  of understanding about roles and responsibilities
  contribute to the conflict.

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Reflexivity can be developed in the team by using
events that occur as learning opportunities, such
as

• Team successes Celebrate team successes and
  explore the key factors that contributed to
  successes. Put in place mechanisms to support
  and encourage this good practice.
• Team member changes After new people have been in
  the team for three or four weeks, actively
  encourage them to constructively evaluate how the
  team works together, the way it delivers services
  and meets its objectives. Introduce changes and
  improvements based on these evaluations.

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Reflexivity can be developed in the team by using
events that occur as learning opportunities, such
as

• Organisational changes Use organisational
  changes, particularly those being introduced with
  the creation of new organisational
  configurations, as an opportunity to develop new
  ways of working.
• Changes in the services the team has to provide.
  These can also be used as an opportunity to
  develop new ways of working, to develop
  collaborative links with other teams and
  agencies, and to provide services in new, more
  effective ways.