Impact of Team Work on the Quality of Care in Health and Social Care: A Study of a Team of Healthcare Assistance `In London Residential Homes

Introduction

Teamwork is an essential component of any workforce in an organization. Focusing on the case of health and social care organizations, teamwork amongst the employees is vital in ensuring that accuracy and reliability within the workplace in terms of providing health care services to the employees. A number of researchers have indicated that the collaborative nature of the teams within any health and social care facility influences the nature of the services that they can offer (Valentine, Nembhard & Edmondson, 2015). Moreover, their effectiveness in communication with each other within the teams also influences their ability to offer quality services to the patients (Weaver, Dy & Rosen, 2014). There are a number of studies that have focused on the influence of teamwork on the quality of care within the health and social care sector. Carayon et al., 2014) focused on the influence of teamwork amongst the nurses within the intensive care unit in the provision of quality care within the pediatric department. Most of the studies have also focused on the importance of teamwork amongst the care nurses in the general wards in different hospitals within the UK and in other regions across the world.

Teamwork is associated with quality in health and social care; however, this has only been limited to the teams of nurses within the social and healthcare facilities. Minimal research has been conducted on the influence of the healthcare assistance teams on the quality of services they avail to the patients and other individuals under their care. According to Price et al. (2014) as much as these individuals work under the nurses their contribution towards the provision of care cannot be underestimated. Since teamwork has been associated with success in the provision of care services amongst the other care services, mostly nurses, it is necessary to determine the influence of the healthcare assistance teams on the quality of care within the social and health care facilities (Hicks, Rosen, Hobson, Ko & Wick, 2014). The proposed study will therefore determine the influence of the healthcare assistance teams on the quality of care provided to the individuals living in the selected residential homes in London. The proposed study will look at the nature of teams observed within the different residential homes as well as the quality of care services offered in the different homes.

Study Problem / Purpose

Teamwork in any health and social care facility has been associated with the provision of quality services that translates to quality care being received by the patients. However, it is not a guarantee that every team within the facilities is likely to offer quality services to the individuals in need (Kalisch, Aebersold, McLaughlin, Tschannen & Lane, 2014). According to Valentine, Nembhard & Edmondson (2015) the nature of the teams also influences the kind of services that they can avail. Only teams with appropriate communication strategies, high level of collaboration and good interpersonal relationships are likely to offer quality care services to the patients. It is therefore important that the nature of the teams observed within the workplace be determined to ascertain whether they are capable of providing quality care services and to offer suitable recommendations for further improvements. It is also evident that most of the studies that have determined the relationship between teamwork and quality care have focused on the team of nurses working within the hospitals and various health care facilities (Price et al. (2014). Minimal evidence is available on the influence on the healthcare assistance teams on the quality of the services and care that they avail to the persons under their care. It is important to analyze the influence of the health assistance teams on the quality of care since they also play a significant role in the provision of health care especially in the care homes (Weaver, Dy & Rosen, 2014). The proposed study will therefore determine the impacts of the health care assistance teams on the quality of health and social care within the selected residential/care homes in London. Emphasis will be on the nature of the teams observed in these places and the level of care that have been received to establish the effects of the different kinds of teams on the quality care received by the individuals living in these residential homes.

Study Relevance

It is evident that there is limited information on the influence of the health assistance teams on the quality of care. Since these individuals plays a significant role in the provision of care within the workplace, the nature of the services that they avail to the patients under their care will equally have significant effects on the perceived quality of care offered by the health and social care facility under which they work. Teamwork has been associated with quality care in other contexts, it is therefore important that a study be carried out that will determine the influence of teamwork on the quality of care focusing on the context of healthcare assistance. This information will be relevant to the health and social care organizations who work with the healthcare assistance in identifying the nature of teams that are capable of offering maximum quality care to the individuals living within the care homes.

Research Objectives

Research Objectives

Main Objective

The main objective of the proposed study will be to determine the influence of teamwork on the quality of health care focusing on the case of health assistance teams working in the selected residential homes in London. To achieve this broad aim, the following specific objectives will be explored

Specific objectives

  • To identify the nature of teamwork observed within the selected residential homes
  • To establish the influence of the teamwork on the safety of the patients
  • To establish the influence of the teamwork on the reliability of the health care assistance in the provision of care
  • To establish the influence of the teamwork on the satisfaction of the patients with the health care offered to them

Research Question

  • What is the nature of the teamwork observed in the selected residential homes?
  • What is the impact of the teamwork on the safety of the patients within the residential homes?
  • What is the influence of the teamwork on the reliability of the health care assistance in the provision of care?
  • What is the impact of team work on the satisfaction of the patients with the health care that they receive?

Brief Review of Literature

Teamwork

There is a consensus in literature that a team consists of two or more individuals who share a common goal, have specific tasks to perform and are adaptable in nature. According to Humphries et al (2014) in order for a team to work effectively, the team members must have certain skills, attitude and knowledge needed in executing the roles or tasks assigned to them. Based on the aforementioned definition of a team, it is obvious that a team is critical for the delivery of health and social care service. Weaver, Dy & Rosen (2014) has pointed out that physicians, nurses, technicians and other health care professionals need to coordinate their activities to offer safe and efficient care to the patients.

Despite the important role of teamwork in health care, the nature of the teams within the health care unit is also important in evaluation of the quality of care that they can deliver.According to Figueroa, Sepanski, Goldberg & Shah (2013) there are critical components of teamwork that indicates a possibility of obtaining quality care. Extensive research on teamwork has highlighted the interdisciplinary role of health care professionals and their distinct duty to the patients. However, it is reported that despite the difference in the qualifications and the role of the different health care practitioners, their working as a team is essential in improving the safety of the patient. Weaver et al (2015) has indicated that when a surgeon, a nurse and physicians all work as a team in the provision of care to the patient, then the possibility of reporting a high level of patient safety and satisfaction is higher. Teamwork is therefore critical in promoting patient safety and satisfaction with the care provided.

Teamwork is also likely to be beneficial in cases where the health care professionals have a common duty to the patient. For instance, teamwork amongst the nurses is essential in ensuring that the patients receive quality nursing care. As much as the role is similar and can be executed by a single person, working as a team reduces the workload on an individual and provides an opportunity for consultation amongst the workers. As such, teamwork is equally visible amongst the health care practitioners with a common role in the provision of health care services to the patients.

From a different perspective, Blumenthal, Song, Jena & Ferris (2013) have looked at the characteristics of an effective team in the health and social care sector. According to him, teamwork cannot lead to the provision of quality health care when the teams involved are not effective. In his analysis he pointed out that there must be a high level of collaboration amongst the members of the team for their teamwork to be effective. Moreover, teams whose members share a common commitment levels towards the attainment of the organizational goals are likely to perform better. Al Sayah, Szafran, Robertson, Bell & Williams (2014) have also pointed out that the effective of the communication process amongst the team is also likely to influence its effectiveness. The communication process within the teams must be effective and the team members must be able to understand each form of communication adopted by the team members. An effective communication process will enhance the effectiveness of the teamwork that can be offered by the different team members.

Regardless of whether the team has consistent membership or not, when the team members have a good interpersonal relationship at any particular time, they are likely to offer quality services. This kind of good relationship allows the team members to perform all the tasks without any form of complaint or difficulty. In addition, the team members are able to interact freely with each other enhancing their ability to offer quality services through the sharing of knowledge and ideas.

West (2013) has also pointed out that the competencies of the team also influence their ability to offer quality care. It does not matter whether there is a different level of competency of the members of the team, but as long as the team members work together, they are capable of attaining a high level of competency in the services that they offer. As such, the team must be competent enough for it to offer quality services to the patients. As such, teamwork is not capable of offering quality care unless the teams are highly competent, there is a high level of collaboration amongst the team members, good interpersonal relationship and they equally have an effective communication process.

Quality Health Care

Quality of care can be measured based on different kinds of parameters. Mitchell et al (2012) has indicated that quality can be measured based on the effectiveness of the intervention strategies adopted in treating the patients. This is the nature of the process as well as the quality of the drugs and therapies used for treatment. Hartgerink et al (2014) have pointed out that apart from the quality of the intervention processes adopted in health care, the quality of the health care services offered by any health and social care facility can also be determined by the nature of the outcome reported. According to Sacks et al (2015) the level of patient safety and the number of patients recovering from different forms of illness can be used in judging the quality of care offered by the health care practitioners working within a particular facility. Moreover, the satisfaction levels of the patients with the services they receive within the health care facility can also be used in determining the quality level of care that are offered by the health care practitioners.

As much as some people may rely on the quality of the process and intervention in evaluating the quality of health care provided, Hojat, Louis, Maio & Gonnella (2013) have indicated, that the nature of the outcomes is the most reliable parameter in evaluating the quality of care to the patient. It is expected that some intervention may be considered poor in the perspective of different individuals; however, as much as the process is capable of offering positive outcome, the health care services providers are believed to have provided quality care to the patient. On the other hand, as much as the process/intervention may be of higher quality, if the outcome is unpleasant than the care provided cannot be regarded as quality. It is therefore more reliable to determine the quality of care provided by the health care practitioners based on the outcome of the care services provided.

Teamwork and quality health care

A number of researchers have associated teamwork with quality care. According to True, Stewart, Lampman, Pelak & Solimeo (2014) teamwork within health care promotes the sharing of roles that allows for quality services to be offered to the patients. Cunningham (2012) have also pointed out that working as a team allows the health care practitioners to share knowledge and information on the tasks to be handled thereby ensuring that the patient receives quality services. As much as teamwork is associated with quality within the workplace, True et al (2014) have ascertained that unless the teams involved are effective in nature, the attainment of a higher level of quality is impossible. As such, the teams must be effective for them to offer quality services to the patients (Figueroa, Sepanski, Goldberg & Shah, 2013). As indicated above, effective teams consists of those teams where the team members have a higher level of collaboration, have an effective communication process, have a higher level of competency and have developed a good interpersonal relationship amongst them. Unless the teams in place are effective, their ability to offer quality health and social care are limited. Based on the above review of literature, it is hypothesized that there is a positive relationship between effective teamwork and quality health and social care.

H1 Effective teamwork has significant positive influence on the quality of health and social care

Research Methodology

Study Design

Qualitative versus quantitative design

Quantitative and qualitative are the two kinds of research designs that can be adopted in a study. According to Zikmund, Babin, Carr & Griffin (2012) the qualitative design focus on the use of the subjective views of the study participants engaged in a study to respond to the research questions. This design is applicable in studies where the data being gathered cannot be quantified as such must be presented in form of words. On the other hand, the quantitative study design entails the use of numerical data to respond to the research questions developed. According to Jackson (2015) this approach is mainly adopted in cases where the responses can be quantified and presented objectively. It is observed that the qualitative study design releases subjective data that are mostly prone to bias; however, the objective data are likely to be more accurate making them reliable in cases where a high level of accuracy is needed. The proposed study will adopt the quantitative study design where the research questions will be answered objectively. This will enhance the accuracy of the information being gathered on the influence of teamwork on health and social care quality.

Descriptive study design

According to Bryman & Bell (2015) a descriptive study is a kind of research where the information needed by the researcher is collected without changing the environment. This type of study is not a real experimental study but mainly encompasses an observation of certain occurrences within the environment. The proposed study will be based on the descriptive research where the information on the influence of the teamwork on the quality of care will be determined by making observations within the selected residential homes in London. This observation will be determined without interfering with the environment.

It is reported that a descriptive study can either be based on a one-time interaction with the study participants (cross-sectional study) or might involve following the participants over a certain period of time (longitudinal study) (Fowler, 2013). The proposed study will adopt the cross-sectional design where the researcher will have a one-time interaction with the study participants.

Descriptive studies where the researcher interacts with the study participants may entail the use of interviews of survey to collect the necessary data needed. On the other hand, in descriptive studies where there is no interaction between the researcher and the study participants would entail the adoption of the existing information in form of records to obtain the necessary data needed (Bryman & Bell, 2015). The proposed study will require an interaction with the study participants, as such; the researcher will adopt surveys as the method of data collection. The proposed study will therefore adopt the descriptive cross-section survey design.

Study Participants

The study participants for the proposed study will include the health care assistance and the management to the residential homes. The study participants will include about 40 health assistance and 40 patients living within the residential homes. On the other hand, about 10 managers from different residential homes will also be engaged in the study. The number of residential homes to include in the study will be determined by their willingness to be involved in the study.

Inclusion / exclusion criteria

Only the health care assistance, the patients or adults living in the residential homes and the managers will be included in the study. The inclusion criteria will be based on their availability on the date when the questionnaires will be distributed as well as their willingness to take part in the study. Other health care practitioners with other roles within the residential homes will not be involved in the study.

Sampling

Random sampling technique will be adopted to select the individuals to include in the study. Based on this sample, the population under investigation has an equal chance of participating in the study (Fowler, 2013). In this case, the health assistance, the children or the elderly living in the residential homes as well as the managers to the respective homes have equal chances of participating in the study. Random sampling will be adopted since it is a suitable way of ensuring that the study participants clearly represent the entire population. In addition, this kind of sampling is likely to eliminate sampling bias making it the most suitable sampling procedure.

Recruitment

The researcher will send letters to the management of the selected residential homes to obtain permission for carrying out the study. The letter will be addressed to the patients and/or the elderly and children living in the residential homes and to the manager. The letters will contain information describing the study and its importance. The date for the commencement of the study will also be indicated to ensure that the targeted participants are informed on when the study will begin.

Study variables

The dependent variable of the proposed will be quality care while the teamwork variables will be the independent variables. Teamwork variables will entail collaboration within the team, team communication and personal relationships within the teams. On the other hand, the dependent variable quality of care will be determined based on the safety of the patients, the satisfaction of the patients with the care provided and the reliability of the health assistance in the provision of care.

Data Collection methods

Surveys will be the method of data collection for the proposed study. The research will adopt questionnaires as the data collection tool for the study. The questionnaires will be distributed to the health assistance, the managers and the patients to obtain their view on the different questions that will be presented in the questionnaires. The questionnaires will contain different kinds of questions suitable for the group of participants being engaged. For instance, the health care assistance will have a different questionnaire from that of the patients and the managers. This will ensure that every question that is relevant to the different groups of study participants is properly answered.

Data Analysis

The quality and present ability of the raw data collected in any study can only be attained when the data collected is analyzed (Zikmund, Babin, Carr & Griffin, 2012). The data collected from the questionnaires will be analyzed using the statistical methods of data analysis. SPSS software will be adopted to establish the relationship between teamwork and quality care. Descriptive statistics will be adopted to obtain the mean values of each of the variables included in the study. The researcher will then adopt multiple regression analysis to establish the relationship between the independent and the dependent variables identified in the proposed study. The sign of relationship observed between the study variables will be determined by correlation analysis.

Validity and Reliability

Validity refers to the effectiveness of the data collection tool in collecting the desired information. Construct validity will be adopted in the formulation of the questions included in the questionnaire to ensure that only the questions that are capable of sufficiently responding to the research questions are included in the questionnaire. On the other hand, reliability refers to the extent through which the assessment tool produces consistent information. Test-retest reliability method will be adopted to ensure that the information being collected from the study participants are consistent. Administration of the same questionnaires at different period to the study participants will be used to ascertain that they are providing consistent information. Only the consistent data will be included as the findings for the proposed study. The aforementioned approaches will ensure that the data being collected from the study participants are valid and reliable.

Ethical Considerations

The study participants will be informed on the content, purpose and sponsorship of the survey prior to being engaged in the study. This will ensure that they make informed judgment on whether to participate in the study or not. Confidentiality of the information presented by the study participants will also be assured, by marking the questionnaires using codes and also by not disclosing the information presented by any participants to the other respondents (Ferrell & Fraedrich, 2016).

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