Team Approaches: Working Together to Improve Quality
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Team Approaches: Working Together to Improve Quality
By Camille Catlett and Anita Halper
The following article was originally published by ASHA in the Summer 1992 Quality
Improvement Digest.
The team approach is not unique or new to involved in the delivery of services. The
the discipline of human communication approach, however, is discipline-oriented
sciences and disorders. Models for teaming with each team member responsible only for
and the dimensions for team effectiveness the activities related to his or her own
have been in place for many years; they discipline (Melvin, 1989; Rothberg, 1981).
derive from the human relations model of One team member is affected very little by
management. This article presents two the efforts of the other team members. In
perspectives on team approaches; one from reality, this may be the easiest way to
health care, the other from education. Team deliver services. But it is not always in the
approaches are defined, benefits and best interest of the patient.
challenges of team-based approaches are
identified, and tools and strategies for An interdisciplinary approach to service
facilitating more effective teaming are delivery presupposes interaction among the
introduced. disciplines. Not only are individuals from
several disciplines working toward a
Team Approaches in Healthcare Settings common goal, but the team members have
Anita Halper the additional responsibility of the group
effort (Rothberg, 1981). This approach
There are a number of different ways to necessitates effective communication among
define rehabilitation, but a common one is the various individuals involved in the
Melvin’s (1989). He describes it as “that patient’s rehabilitation (Melvin, 1989). The
process which maximizes the physical and team includes not only the professionals but
psychological health, and the social, the patient and his or her family and
economic and vocational or educational significant others as well.
status of an individual” (p. 273). Although
this description delineates the wide scope A transdisciplinary approach is based on the
and complexity of rehabilitation, it does not premise that one person can perform
provide a framework for delivering professionals’ roles by providing services to
rehabilitative services. Given the scope and the patient under the supervision of the
complexity of rehabilitation, team individuals from the other disciplines
approaches provide the most logical solution involved. Representatives of various
to service delivery. Teams, however, are disciplines work together in the initial
seldom defined or understood clearly. evaluation and care plan, but only one or
two members actually provide the services.
The terms multidisciplinary, This model is often used in high-risk
interdisciplinary, and transdisciplinary often neonatal and early-intervention programs. It
are used interchangeably. But they do have should be noted that regardless of who is
distinct meanings. A multidisciplinary providing the service, professionals are still
approach to service delivery means that accountable for areas related to their specific
persons from several disciplines are discipline and for training the team member2
who is delivering the service (Connor, 1981; must be considered. A substantial amount of
Bailey & Wolery, 1989). time can be spent by team members from
various disciplines in communicating.
It is my contention that the interdisciplinary Think, for example, of the salary costs of a
approach to rehabilitation is the most team conference or rounds. In addition, most
effective for the patient. The end product of professionals have a productivity standard
a true interdisciplinary approach is an that must be met. This can impose a
integrated plan of care that involves limitation on the time such individuals have
effective collaboration between the team for participating in these and other
members (Bailey & Wolery, 1989). This can interdisciplinary activities. As a further
be a difficult thing to achieve, and there are complication, there are personnel shortages
some issues that have to be considered in the in many of the rehabilitation professions.
deliver of services under this model. Each Costs combined with staff shortages can
facility has to determine whether these certainly affect the ability to deliver
factors will impede its ability to implement rehabilitation services under an
and sustain interdisciplinary rehabilitation. interdisciplinary model (Melvin, 1989).
The benefits and challenges of this approach
must be weighed carefully. Some team members and professional
groups are threatened by the notion of
Benefits and Challenges giving up some of their autonomy to the
group effort. There is a lack of confidence
The benefits of teamwork are obvious. Team and trust in the opinions and decisions of
practice has led professionals to see clients individuals from other disciplines. In
and their families as whole persons, not as addition, team members’ perceptions of their
parts of a whole (e.g., mouths, brain, arms, respective roles and contributions to the
legs). An appreciation of other disciplines team may clash. This may lead to
allows professionals to accommodate larger individuals feeling that others are usurping
functional goals and integrated their domain. This issue of territorialism can
interventions, instead of working on isolated destroy a functioning team (Rothberg,
tasks. From the patients’ and families’ point 1981).
of view, it is easier to communicate with a
cohesive team, rather than numerous In spite of these economic and professional
practitioners who work in isolation. It is also factors, the interdisciplinary approach can
less overwhelming if information related to improve the delivery of services to patients.
intervention is synthesized across All team members are working toward
disciplines, rather than presented separately common goals and not in isolation.
from each practitioner. Teamwork brings
together diverse knowledge and skills and Team Approaches in Education Settings
can result in quicker decision making. As a Camille Catlett
result of professional collaboration,
redundancy or fragmentation of service can Prior to the passage of Public Law 94-142
be reduced or eliminated, thereby increasing (the Education for All Handicapped
the cost efficiency of service. Children Act of 1975, subsequently
reauthorized as IDEA, the Individuals with
But there are drawbacks to teaming as well. Disabilities Education Act), children with
Certain economic and professional factors disabilities were typically served by a single3
representative of a single discipline, most characterized as collaborative services
frequently a classroom teacher. Other (ASHA, 1991).
“specialty services professionals” were
recommended on the basis of the child’s In the transdisciplinary/collaborative model,
“primary presenting problem” or “primary it is assumed that “no one person or
handicapping condition.” Speech-language profession has an adequate knowledge base
pathologists and audiologists treated most or sufficient expertise to execute all
children in settings isolated from functions (assessment, planning, and
educational programs. intervention) associated with providing
educational services for students (ASHA,
The multidisciplinary team evaluation and 1991). Thus all team members contribute to
the related services mandated in P.L. 94-142 the coordinated approach (educational
were products of a growing understanding program, IEP, IFSP) designed for each child
by parents and professionals of the (and family), although each team member’s
compound effects of developmental delays responsibility for implementation may vary.
and disabilities. In accordance with the law,
speech-language pathologists and As members of effective transdisciplinary
audiologists working in educational settings teams, speech-language pathologists and
began to “join” educational teams. audiologists can be involved in the total
education program. For example, if a child
But the nature and function of educational with a communication disorder needs to be
teams differ widely across educational provided with simple directions in the
settings. In some service delivery models, classroom, the speech-language pathologist
the speech-language pathologist serves as a can assist the classroom teacher in
member of a multidisciplinary team implementing specific techniques and
composed of educators and parents, working strategies. Similarly, an audiologist might
independently with little or no collaboration work with a classroom teacher to coordinate
(Peterson, 1987). In other models, the seating and environmental modifications for
speech-language pathologist serves as a a child with a hearing loss. Or a speech-
member of an interdisciplinary team whose language pathologist, social worker,
members meet and discuss findings classroom teacher, and parent might work
regarding each student, often with little together to improve the self-image of a child
collaboration beyond discussion. A variation with multiple disabilities.
of the interdisciplinary model that operates
in secondary education environments may Benefits and Challenges
feature teams that include community
members, such as employers. Another There is an abundance of literature and
approach that has evolved as teachers, anecdotal information extolling the virtues
therapists, medical professionals, human of different styles and approaches of
services professionals, and family members teaming (ASHA, 1991; Garland & Linder,
have worked together, discussing child 1988; Hoffman, 1990). In fact, most
needs and planning programs that integrate effective teams probably operate through the
efforts across developmental domains and judicious use of several approaches.
disciplinary boundaries, is called However, the legislative and practical
transdisciplinary. Services provided by considerations remain that children with
transdisciplinary teams are often disabilities and their families are best served4
through well-coordinated team approaches. among speech-language pathologists and
And effective team members must, first and audiologists, how can we take leadership
foremost, be committed to the concept that roles in facilitating team development?
the most effective way of providing Many answers may be found within the
effective intervention is through a service business, psychology, and organizational
delivery model conducted by a team (Durbin development communities, where
& Dodson, 1990). approaches that can foster team building and
team leadership skills have been developed.
Although there are many benefits to Knowledge of existing tools and approaches
teamwork (for professionals, family can facilitate productive team building in
members, and children), it should be both old and new teams.
recognized that well-functioning teams
require attention, time, and support. Time is One approach, developed by David W.
needed for team members to get to know Miller (1992) of Phoenix International, is
each other and learn about each other’s the use of clarifying questions. These
professional philosophies, work styles, questions can be used singly or collectively
attitudes about change and innovation, and for independent reflection, followed by
approaches to conflict and conflict group (team) brainstorming). Some
resolution. Team members must assess clarifying questions Miller suggests include:
themselves and explore strategies for 1. What are the characteristics of an
improving teamwork. This, too, takes time. effective team? How do you know (a
More time is needed to allow for team named characteristic) when you see
meetings to discuss student, family, and it, i.e., What happens? What do
programmatic issues, as teams are more others on the team say and/or do?
likely to be successful and work together
effectively if they are allowed to develop 2. How do you negotiate the creation of
their relationships, expertise, and program a team when team members vary in
(Hoffman, 1990). Professional “turfism,” the value they perceive in teamwork?
differences in treatment approaches, lack of
time, staff turnover, lack of administrative 3. What problems do you encounter in
support, and distance are a few of the team meetings that you would like to
practical variables that confound educational resolve? (As you think about this
teaming. Yet a larger issue is that few question, consider team meetings to
speech-language pathologists and plan meetings with family members,
audiologists have been trained in team meetings with family members,
negotiation, conflict resolution, team meetings to review/revise the
collaborative goal setting, or other areas that implementation of a sequence of
are essential for serving as effective team intervention, and any other team
members or team leaders. situations you can think of.)
Tools and Strategies for Effective 4. What individual team member
Teaming behaviors do you find it most
difficult to deal with? What have you
If effective teams require attention, time, tried? What has worked?
and support, and the skills for accomplishing
team development are now widely held5
5. What team meeting behaviors have Summary
you tried or observed that help a
team to be effective? What behaviors Effectively functioning teams are essential
do you exhibit that don’t help (or for delivering effective services to children
even hinder the group)? How does and adults with disabilities, as well as their
the way you typically deal with families. As important as it is for
conflict affect teamwork? professionals from different disciplines to
work closely and cooperatively together,
6. What does it mean to lead a team? efficient team functioning is often difficult
What is ineffective leadership? What to achieve. Administrators must allow time
can you do about it, either as a team for the team to plan, practice, and critique
leader or as a team member? their work together, while simultaneously
encouraging a sharing of information and
7. What types of team meetings do you skills. When team leaders and team
have? What’s the shape of a well- members commit their time and professional
managed meeting of each type? expertise, the results have been shown to be
What happens during the meeting effective. Henry Ford summarizes the
and in what order? How do you get challenges and benefits of teamwork
an off-track meeting back on track? succinctly: “Coming together is the
beginning, keeping together is progress,
An annotated list of additional tools for team working together is success.”
building is provided in the Tools for Team
Building section that follows. Approaches to Tools for Team Building
the use of these tools for team building have
been as unique as the teams. Some teams Analyzing Teamwork. David W. Miller.
have elected to prioritize a set amount of (1991). A tool for examining the goals,
team development time into regularly roles, procedures, interpersonal
scheduled meetings. Other teams have found relationships, and systems of a team.
it helpful to bring in a nonteam member to Available from Phoenix International, 17
facilitate discussion. And yet others have Pipestem Court, Potomac, MD 20854.
wanted to limit participation to the members
of the team. BRASS TACKS: Part I – Program Policies
and Practices. P. J. McWilliam & Pam
Whatever strategy or approaches are Winton. (1990). An instrument to assist
selected should be well thought out and, like early intervention programs and teams in
good team work, coordinated. While it may determining the extent to which practices
seem impossible to fit more time for reflect a family-centered approach and to
teaming into the competing priorities of identify specific areas for change. Available
healthcare and educational professionals, the from Carolina Institute on Infant Personnel
time spent working on more effective Preparation, Frank Porter Graham Child
approaches may actually save time in the Development Center, University of North
long run. Carolina at Chapel Hill, CB No. 8180,
Highway 54 Bypass West, Chapel Hill, NC
27599-8180.6
Dyer’s Team Building Checklist. W. Dyer. Team Effectiveness Rating Scale. R.
(1987). A single-page tool for assessing Neugebauer. (1983). A tool for examining
group preparedness for a team-building team functioning in 10 different areas,
program. Available from Team building: including clarity of goals, openness of
Issues and alternatives (2nd ed.). Reading, communications, and handling of conflict.
MA: Addison-Wesley. Available from Child Care Information
Exchange, November 1983.
Managing Quality Through Teams: A
Workbook. L. Miller and J. Howard. (1991). References
A skills training workbook for team leaders
and members who are working toward American Speech-Language-Hearing
continuous improvement. Included are such Association. (1991, March). A model
topics as customer focus, process for collaborative service delivery for
management, decision making, action students with language-learning
planning, planning and managing team disorders in the public schools. Asha,
meetings, facilitating participation, and 33 (Suppl. 5), 44–50.
problem solving. Available from
GOAL/QPC, 13 Branch St., Methuen, MA Bailey, D. B., & Wolery, M. (1989).
01844-1953 (Telephone: 508-685-6360). Assessing Infants and Preschoolers
With Handicaps. Columbus, OH:
The Family Report: Consumer Opinion in Merrill Publishing Co.
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to the services they receive and their desires Infants and Toddlers With
for program changes related to family- Neuromotor and Other
centered practices. Available from Carolina Developmental Disabilities. New
Institute on Infant Personnel Preparation, York: Teachers College Press.
Frank Porter Graham Child Development
Center, University of North Carolina at Durbin, C., & Dodson, S. K. (1990). The
Chapel Hill, CB No. 8180, Highway 54 speech/language pathologist: A team
Bypass West, Chapel Hill, NC 27599-8180. player in ECI. Texas Journal of
Audiology and Speech Pathology,
The Team Handbook. P. R. Scholtes. XVI(2), 19–20.
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succeed in improving quality and Garland, C., & Linder, T. (1988).
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work processes. The approach focuses intervention. In J. Jordan, J.
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data. These databased methods draw from education: Birth to three: Reston,
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speech-language pathologists. Texas introduction to early childhood
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