Achieving teamwork in stroke units: The contribution of opportunistic dialogue

Abstract

Collaborative interdisciplinary working is central to contemporary health policy. The specialized and co-ordinated multidisciplinary care provided in stroke units is considered to contribute to improved patient outcomes in such units. However, how stroke unit teams co-ordinate their work is not clearly understood. This paper reports on a grounded theory study which explains how health professionals in two stroke units in northern England achieved teamwork. Data were generated through 220 hours of participant observation and 34 semi-structured interviews. Interviews were undertaken during and following participant observations. A basic social process common to teamworking in both units was identified; this was termed “opportunistic dialogue”. The division of labour in respect of rehabilitation activities was negotiated through this interactional process. Co-location of most team members led to repeated engagement in sharing patient information and in exploring different perspectives. Opportunistic dialoguing contributed to mutual learning and explained the shift in thinking and team culture as team members moved from concern with discrete disciplinary actions to dialogue and negotiations focused on meeting patients' needs. The findings indicate that routinely incorporating periods of joint working in which team members articulate the reasoning for their decisions and interventions, contributes to achieving interdisciplinary teamworking in rehabilitation settings.

Keywords:

• Teamworking
• interprofessional teams
• stroke rehabilitation
• grounded theory
• negotiations
• dialogue

Acknowledgements

This research arose as part of a PhD programme. Thanks are extended to Professor Anne Forster and Dr Geof Mercer for their help and guidance during the study. Thanks also to Professor Andrew Long and Dr Joanne Greenhalgh and the anonymous reviewers for their comments on earlier drafts of this paper.

Research ethics approval

Ethics approval was obtained from Leeds West Local Research Ethics Committee and Calderdale and Huddersfield Research Ethics Committee.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper. The study did not receive funding from any source. The author had no prior involvement with either of the units where the study was conducted.