Interaction in Multidisciplinary Teams

William Housley

• Publisher: Taylor & Francis
• Year: 2017
• Print ISBN: 9781138725928
• eBook ISBN: 9781351752756
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This title was first published in 2003. In this key volume, William Housley examines the concepts of multidisciplinarity and team practice in social care settings and considers how and why the two concepts have been brought together in recent years. Furthermore, he discusses the various theoretical assumptions that underpin models of multidisciplinary teamwork. This is contrasted with interactional and ethnomethodological approaches that have examined the lived reality of work practices and social organization. The author applies these approaches to understanding multidisciplinary team interaction and communication within social care settings through the use of conversation and membership categorization analysis. Topics covered include the negotiation and accomplishment of professional and lay role-identities, claims making and the display of knowledge in team settings, the use of narrative and stories in decision making and the local organization and accomplishment of team leadership. Furthermore, it is argued that recent developments and ideas concerning the re-engineering of team structures within health and social care settings would benefit from some consideration of observations generated from this approach to exploring multidisciplinary team practice.

1 Bringing the Multidisciplinary into Team

Introduction

During the course of this book I will attempt to make some observations about professional practice within social work/care work teams. These observations are drawn from ethnographic, ethnomethodological and discourse analytic research into multidisciplinary social/care work team practice. The research investigated the interactional dynamics of a number of theoretically sampled multidisciplinary social/care work teams. The book attempts to report and bring together a number of observations generated during the course of this project. In order to do this I will first explore some of the ideas concerning multidisciplinarity and team work. This is followed by a discussion of my observations on multidisciplinary team practice. These observations will be relayed through the use of some illustrative examples of talk and interaction gathered from a case study of one of the multidisciplinary teams that the research examined. During the concluding chapter of this book I will reflect on some issues facing the development and promotion of multidisciplinarity within team based settings.

Multidisciplinarity

At the core of the conceptual apparatus of multidisciplinarity is the concept of knowledge and it's social organisation. The concept of multidisciplinarity is one that is grounded within a functionalist and systems based account of the social organisation of knowledge. The systems oriented organisation of knowledge in this way is seen as crucial to the efficiency and utility of knowledge systems in solving human problems. Furthermore, knowledge within Western societies has been subject to fragmentation (Kline 1995), multidisciplinarity, as a systems based concept, is an attempt to overcome fragmented thinking and develop holistic modes of enquiry, decision making and practice (Kline 1995). The systems approach towards knowledge has, through various histories of science, the philosophy of Kuhn (1962) and Popper (1902-1989), promoted a view of knowledge systems as functional entities subject to organisational and homeostatic tendencies. Furthermore, the heterogeneity of human knowledge, due to historical and social factors, had been seen to produce a fractured picture of the world within which holistic solutions to human problems had not been forthcoming. The notion of holistic truth is one that can be understood to emerge from the notion of universal truth. However, holistic truth is an attempt to draw the sting of relativism by accounting for the diversity of truths-in-the-world while universal truth is seen as an outmoded attempt to establish epistemological security that has resulted in problematic consequences for domains popularised by the new narratives of ecology, anti-racism, feminism, psychotherapy, info-technology and mysticism. Furthermore, the way in which knowledge bases and activities were organised can be seen to be one of the ways through which this failure has reproduced itself through social practices. Consequently, we may understand how attempts to ameliorate the organisation and practice of knowledge have provided for the emergence of the multidisciplinary approach that can be understood in terms of the theoretical context described. Kline (1995: 1) recognises this in her introduction to the book Conceptual Foundations for Multidisciplinary Thinking within which she states:

The intellectual system erected largely in the western world since the Reformation is enormously powerful and productive. Although we may have much yet to learn, the scientific approach to knowledge since the time of Galileo has provided the human race with a far better understanding of our world and of ourselves than was available to any previous society. This gain in understanding has arisen primarily from two sources. We have adopted what we loosely call 'scientific methods,' and we have broken the intellectual enterprise into larger and larger number of parts (disciplines and research programs). We have created working groups of scholars who study each of the parts in as 'scientific' a method they can bring to bear. However, there is a near total absence of overview of the intellectual terrain.

Despite the euro-centric assumptions of this statement, the questionable portrayal of progress and the categorisation of Western knowledge as indicative of a scientistic form of life, it displays an initial assumption through which the merits of multidisciplinarity has been substantiated. In terms of Kline's work, multidisciplinarity is a systems solution to the lack of a holistic approach to the present intellectual terrain. The systems analogy is one familiar to students of Parsonian fimctionalism (Parsons 1956). This analogy was adopted by structural functionalism from cybernetics, a sub-discipline of engineering, in order to illustrate the way in which social systems exhibited forms of complexity characterised by self regulating tendencies in the form of positive and negative feedback mechanisms and self sustaining replicating processes. The adoption of such an approach will, in terms of the humanist march of progress thesis adopted by Kline, improve our lot. The differences between disciplines are viewed as inhibitors to a fuller understanding of the world and our place in it. In short Kline seeks to indulge in some 'knowledge engineering' through which the separateness of disciplines is overcome. This, she argues, involves the construction of a multidisciplinary discourse through which disciplines can effectively engage with each other. The benefits of such a strategy, she argues, would ultimately be more effective solutions to human problems.

Kline proposes some rules of multidisciplinary thinking (1995:274). She suggests that in order to achieve multidisciplinarity a discourse must be established, a set of language games with rules and practices formed, and cognitive engineering (i.e. the development of various schemata, cognitive aids and logic) in the form of what are described as 'sysreps' (1995:30) initiated. The notion of 'sysreps' is understood as a series of system representations. That is to say devices, which may be heuristic in form, which can be operationalised as a means of establishing the cognitive basis for a desired discursive framework to take root. In essence, Kline is proposing a new grammar or categorial order through which the marriage of intellectual work and human 'progress' can be reinvigorated for the good of humanity (Kline 1995).

These ambitions are no doubt worthy and laudable. However, we are being presented with a categorial order, a set of concepts and practices that are, like a grammar, constructed according to rules and theoretically devised conventions. Furthermore, Kline's categorial order describes intellectual endeavour in terms of'parts' and 'wholes' and is indicative of a systems approach. That is to say, Kline views knowledge as a set of systems. Different disciplines are conceptualised as systems of knowledge that we do not or cannot always perceive in terms of a meta-system or an overall view. She argues that one of the reasons for using the system concept is due to its existence (i.e. use) in many branches of scientific endeavour (Kline 1995:15). Knowledge in the form of disciplines is, according to Kline, in the business of making truth assertions and the system concept is central to establishing 'truth'. Indeed the whole process of making truth assertions is viewed as essentially systemic in nature. Therefore, the rules of multidisciplinarity (the grammar or categorial order) must take account of the way in which systems are used as a tool for establishing 'truth'. Kline refers to the practices of classification and the formulation of rules and testing as examples of the ways through which disciplines deal with systems in the process of establishing truth claims (1995:199,200). According to Kline, this is done by using systems as a mirror with which to compare assertions to the systemic model. In this sense truth assertions, as Popper (1959) noted, can only be disproved rather than proved and for Kline this is representative of the systemic approach to constructing knowledge. Kline continues by noting that disciplines, as distinct systems, produce 'truth' but not the whole truth. Thus, her categorial order for realising multidisciplinarity, once 'run' like a software program on the hardware of the human brain and society, must integrate the various disciplines' approaches to similar phenomena in order to achieve holistic explanation and understanding.

Having covered these points we can now understand how multidisciplinarity is viewed as a solution to the problem of compartmentalised knowledge and other 'inefficiencies' within the socio-technical plenum. To this extent whilst I do not wish to provide a full discursive genealogy of multidisciplinarity it is worth noting, in theoretical terms, the orientations and assumptions which characterise this particular discourse.

We may view it as a systems theory application to a myriad of social, interactive and (other) phenomena. It can be understood as a form of synecdoche i.e. the application of general schema to particular circumstances. Furthermore, Kline's project is explicitly discursive and concerned with engineering language games and cognitive competencies that will facilitate the objective of realising multidisciplinary knowledge construction, pedagogy and the establishment of the 'whole truth'.

Having delineated some of the discursive characteristics of the concept of multidisciplinarity I will now seek to review some of the ways in which this concept was married to notions of teamworking within social care and health settings.

Bringing the Multidisciplinary into Team

The application of the concept of multidisciplinarity to team practice can be viewed as an adaptation of some of the principle theoretical concerns that Kline advances. It is through the breaking down of barriers between disciplines that the grail of holistic truth can be sought. In terms of working in the best interests of the client, the orientation to holistic truth can be seen to be tied to the notion of providing holistic solutions in meeting clients needs and organising structures for meeting such objectives. One of the ways in which this was considered to be possible was by conflating the concept of the 'team' together with the concept of multidisciplinarity. My concerns are not with the history of social/care work as such, but lie in the theoretical (and hence discursive) recommendations and descriptions of how multidisciplinary social work and health care teams are organised and how they function. The discursive link between multidisciplinarity and team working is characterised by three concepts that are central to this process. These are knowledge, communication, interactional structures and roles. I will now consider each of these in turn.

Knowledge

The notion of there being specialised species of knowledge is one that is difficult to pin down in theoretical terms. However, important social theoretical notions of 'knowledge' have included an array of concepts provided through the work of Michael Foucault (1976) and, more recently, Bourdieu's concept of cultural capital and embodiment (1990). Alongside these concepts we may place the Schutzian notion of the 'stock of commonsense knowledge', although 'knowledge' can also be understood as a set of ideas which have powerful explanatory force. Kline's (1995) concern with developing a grammar for multidisciplinarity as a means of reaching the goal of more 'holistic truth assertions' can be seen to be mirrored in theoretical commentaries of multidisciplinarity with respect to social work and care practice. Thus, the identification of 'knowledge' and 'disciplines' is also a crucial starting point for those wishing to apply a grammar of multidisciplinarity to rearranging the organisation of social work as a means of improving decision making and ultimately more efficiently meeting the needs of clients. 'Holistic truth' is viewed as approximating to a reservoir of multidisciplinary knowledge which can be tapped to provide holistic solutions to social work organisation and practice.

The identification of professions with access to a privileged 'knowledge base' or a 'specialised form of knowledge' is one which is confirmed within much sociological literature (e.g. Foucault 1973, 1976). The emergence of social institutions is also viewed as an important historical development in accounting for the emergence of professions grounded on claims to privileged sources of knowledge. As Clarke (1994:14) states:

... such (institutional) developments emphasised the necessity of creating recognisable clusters of professional 'expertise' for welfare services, especially given the relative lack of relevant training and qualifications. Equally, the expansion and creation of nationally organised frameworks for service delivery created the conditions for further professional development.

In the case of social work, for example, the 'growth of an expertise' (Sapsford 1995:23) has been located in terms of historical processes and the professionalisation of various activities within the rubric of 'social work'. However, social work (as an example of the relationship between profession and knowledge) has been seen as a case study for the examination of the formation of a diverse knowledge base drawing from a number of different sources. Whilst 'doctors' and 'nurses' are viewed as conforming to a 'medical model', social work, according to Butrym and Horder (1983:10):

...relies for its theoretical base on knowledge borrowed from a variety of disciplines, particularly the Social Sciences...(Others) fail to appreciate the intellectual autonomy, creativeness and challenge in the selection and application of knowledge.

Changes in social work have shifted from specialist social work to generic social work and the profession is now being challenged by the growth of care management. However, such changes will not be focussed upon although from a historical approach they are important. Despite these changes, the connection between social workers (as professionals) and a knowledge base is viewed as tremendously important. More recently Coulshead (1991:8) states:

Social Work theory... should serve the following functions: it should provide some explanation for the complexities we observe in our practice so that out of apparent chaos we might expose patterns and regularities in behaviour and situations: it should therefore help us to predict future behaviour, and how the problem or condition could develop and what might be the effect of planned change.

Clearly the claim being made here is that social work knowledge should draw upon theoretical principles and a knowledge base, established through observational criteria, which can provide for predictability. Thus, the validity of social work 'knowledge' is achieved through its perceived accuracy and utility in predicting events. To this extent, social work knowledge is being contextualised in terms of scientistic aspirations. However, in recent years the notion of 'multidisciplinarity' has been invoked as a means of providing more informed and sensitive care for clients. The notion of multidisciplinarity is, as we have seen, derived from a number of theoretical ideas in the human sciences. Kline (1995:2) describes multidisciplinary study as that which:

...examines the appropriate relationships of the disciplines to each other and the larger intellectual terrain.

From a social work point of view the construction of a knowledge base from various sources perhaps makes the adoption of a multidisciplinary approach within social work discourse a logical development. Echoing Kline's conceptualisation of multidisciplinary study, the HMSO Report of the Working Party on Social Workers in Local authority Health and Welfare Services (HMSO 1959) states:

In view of the fast growing complexity and scope of modern knowledge no one can profession dealing with a range of human needs can make exclusive claim in relation to others, each has its essential functions as well as its necessary overlap with others.

Furthermore, the appropriation of 'multidisciplinary work' within social work terminology is not only viewed as a means of providing a more holistic view with which to inform social work practice. Indeed it is viewed as a means of dealing more effectively with 'clients needs' which, being 'subjective phenomena', are met more effectively by a diverse body of knowledge rather than monolithic models of social behaviour. As Hey and Marshall (1979:25) state:

The contributions of a number of different professions are called for if citizens are to obtain the individual services they need and if the services are to be delivered in co-ordinated and sensible ways. Close collaboration between professions is often necessary if effective help is to be given.

It is from this position that the notion of 'multidisciplinary teams' was derived. This was seen to be a means of realising some of the objectives and considerations mentioned previously. In short, multidisciplinarity was viewed as a means of establishing a holistic approach to social welfare knowledge construction and practice utilising the institutional vehicle of the 'team' contextualised within the discourse of group organicism.

Despite this a more thorough going conceptualisation of professional knowledge is not forthcoming. Critiques of the psychological base of much social welfare knowledge (Sapsford 1995:39) and concerns with the way in which it deploys a pathological model of explaining social problems, the actual 'use of this knowledge' within team practice is left, largely, to theoretical speculation. Furthermore, from an ethnomethodological point of view such speculation and theoretical inference serves to miss the interactional 'what' of multidisciplinary team practice (Housley, 1999).

Communicative and Interactional Structure

The social organisation of multidisciplinary teams is seen to be crucial if the objectives discussed above are to be brought bare on the business of meeting clients' needs. According to Evers (1981:209) one of the principles of these teams was to function in a way where:

...collaboration was seen to be achieved through mutual accommodation and exchange of information amongst a company of equals, each contributing on the basis of their authoritative knowledge and expertise...

This process of collaboration and communication is seen to be of prime importance to the decision making process within teams. Indeed, social work discourse notes the problems of differences in 'status' between professions. Questions of status have been discussed by a number of social work and health commentators (e.g. Donnison 1977, Salvage 1985). The problem of differential status is understood to be connected to the different status of different modes of expertis...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Acknowledgements
• Dedication
• 1 Bringing the Multidisciplinary into Team
• 2 The Multidisciplinary Team, Method and Meetings
• 3 Respecifying Multidisciplinary Social Work Meetings
• 4 Role as an Interactional Device in Multidisciplinary Team Practice
• 5 Knowledge and Display in Team Meetings
• 6 Narrative, Extended Sequences and Talking Team Work
• 7 Team Members' Perceptions and Theorising Team Structures
• Bibliography
• Index