Teamwork and interprofessional networks in stroke care : towards an understanding of joint working practice

This study is set in the context of government-led changes to working practice for health professionals in the UK. Policy documents relating to the National Health Service advocate that care should be increasingly delivered by joint working, however an examination of the literature suggests that this concept is currently unclear. This investigation considers one particular area of healthcare, the delivery of stroke services, where provision has been reorganised into specialist stroke units, and where teamworking is being associated with improved patient outcomes. The study aimed to analyse the meaning of joint working by exploring the elements of commonly-used terms such as teamworking and interprofessional working, seeking a greater understanding of the process of joint working by exploring staff and service user perspectives. A qualitative methodology was employed, using a multiple case study approach and data generation methods of fieldwork observation, interviews and visual imagery. Three case studies were carried out, examining services at different points along a stroke care pathway. The findings describe a framework of joint working practice in healthcare consisting of twenty-six elements within domains relating to: the organisation; team process; the individual; professionalism; communication, and the service user. It is proposed that by examining these elements, different types of practice can be distinguished, which can be termed teamworking and interprofessional network working. The investigation suggests that these different types of joint working need to be fully considered in evaluations of practice, if there is to be a greater understanding of links between changing staff working practices and patient care. It also highlights the importance of the interrelationship between elements identified, suggesting that attention to single aspects of practice without considering the individuals and context is unlikely to achieve the changes sought. The central purpose of the investigation was to understand joint working practice, however the findings also have application to the education of healthcare students. The study describes a proposed transition from network working to teamworking associated with experience, discusses the importance of professionalism, and considers changing professional role. Whilst focussing on professional perspectives, the work offers suggestions for further work on service user involvement, and also considers how the findings may offer additional insights into perceived benefits and losses associated with joint working