Thinking teams thinking clients: Issues of discourse and representation in the work of health care teams

The use of multi-disciplinary health care teams is an increasingly common aspect of service delivery in health care in Western countries. While the literature rehearses the putative benefits to practitioners and clients of such teams, there appears to be an absence of extensive evidence-based research on team practices to substantiate such claims. What evidence there is suggests that team work is in different ways problematic. This article is a progress report on a qualitative research project into the operation of health teams with responsibility for clients in hospitals and the community in New Zealand. The first part of the article presents some of the main themes in current research on health care teams. The second part argues that effective team work requires giving attention to a hitherto marginalised dimension of teamwork - the team's reflexive and representational practices. Attention to these practices appears to be particularly important in complex cases or when the team believes that its work with the client is not progressing as well as it might. The article concludes by highlighting the sociological significance of representational issues in team work and by drawing some inferences about factors affecting effective teamwork.