Team reviews

What is a team review?

A team review is an advisory and voluntary service offered to healthcare organisations that is undertaken by two experienced advisers from Practitioner Performance Advice referred to as ‘reviewers’. At least one of the two reviewers will be from a clinical background. It is commissioned at the request of employing/contracting organisations to provide a better understanding of the barriers to resolving behavioural issues within the team and to suggest options for improving professional relationships.

The team review does not constitute any part of the commissioner’s formal procedures such as a disciplinary process. It is not a service review nor an investigation but seeks through questionnaires and semi structured interviews with team members to understand their views on how the team functions and what the issues in the team may be. A team review does not attempt to verify the veracity of what is heard, merely to understand what is causing the dysfunction.

Where concerns relate to the functioning of a clinical team, we can undertake a team review to identify any barriers to resolving the issues which have been highlighted and to suggest a plan for improving professional relationships within the team.

The circumstances in which we carry out a team review usually involve the following: issues of concern are usually longstanding, complex and deeply rooted; and the situation would benefit significantly from a fair and impartial view to clarify and communicate the net effects of the difficulties, as well as an exploration of the broader organisational context to the issues.

A decision on whether to offer a team review will be made, by our Intervention Consideration Group (ICG), based on the individual circumstances of the case. Please see: Team Reviews – factors to consider in decision making.

Where we have undertaken a team review, we will continue to support the healthcare organisation to implement the actions in order to ensure that necessary change is embedded in the team to achieve a resolution of the concerns.

We have a team of eight Associate Advisers, a small cohort of experts, who will along with Case Advisers help to deliver our growing team review service. They bring a broad array of knowledge and skills from across the NHS healthcare environment and will invaluable to the development of the service.

Case studies

We have created two team review case studies, which are designed to explore the process, explain why a team review may be necessary and the outcomes. While not describing real cases, they draw on real events and lessons learnt through cases referred to us:

Maternity team reviews

As numerous maternity services reviews have illustrated, the culture in a maternity service is directly related to the quality and outcomes of the service. Too many maternity service reviews have found evidence of team dysfunction, across different professional groups.

The importance of the role of the multidisciplinary team and working relationships between team members (not just obstetricians and midwives, but also, and not exclusively, obstetric anaesthetists, neonatologists and maternity support workers) cannot be understated. Issues can also arise within professional groups, for example, between midwives working in midwifery-led birth centres and those on consultant-led labour wards.

Teamwork, cooperation and positive working relationships have been identified as a key feature of safety in maternity units and, conversely, where this is not present, adverse consequence can arise from greater conflict and distrust between professional groups and a lack of investment in multidisciplinary working. For this reason, we have now built on our Team Reviews service to provide maternity team reviews.

The main differences between a maternity team review and our other team reviews are:

  • the team being reviewed may have members from the extended multidisciplinary team (as described above), rather than only doctors;
  • the reviewers have specific knowledge of maternity services; and
  • the reviewers may use focus groups as well as questionnaires and individual interviews to gather information.

How to request a team review?

Team reviews may be undertaken online virtually or on a face-to-face basis depending on what has been agreed with the commissioner of the service.  Requests for team reviews can be made by NHS employing and contracting organisations, from both primary and secondary care, as well as private healthcare organisations and health authorities in other jurisdictions.

The first step to requesting a team review is a discussion with your link adviser. Alternatively, contact nhsr.Advice@nhs.net who will put you in touch with the correct adviser.

Insights

Our Insights publications share analysis and research which draw on our in-depth experience providing expert, impartial advice and interventions to healthcare organisations to effectively manage and resolve concerns raised about the practice of individual healthcare practitioners.

Our team review Insight looks at key themes and data from the reviews completed between November 2016 and March 2021. It is intended to share information about team dysfunction and the adverse consequences that can arise from it, as well as our experience of what helps to enact positive change.

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