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The traditional meeting won’t cut it when it comes to creating a resilient and healthy team culture at PCNs. Effective team working requires the right types of team get-togethers, as psychologist Dr Craig Newman explains.
PCN teams face an unusual organisational challenge. They need to form as a team within the PCN but also team with the surrounding practices they serve. Practicalities often add to this challenge. That’s because PCN teams are often disparate, working in a fashion that tends to be away from each other despite a shared organisational identity. And the relative infancy of PCNs adds further complexity, especially in the context of long-established general practices.
But regardless of these obstacles, PCN teams have the same shared needs as every other team.
All teams need spaces that support connections. Those spaces must accommodate activities that meet the needs of the team. Those needs are multiple: functional, practical, logistical and psychological, so team members feel valued, connected and cohesive.
A team space
In a previous PCN Pulse article, I wrote about the five dysfunctions of teams and how this is both a threat and/or opportunity for PCN development alongside practices. These same principles apply within PCN teams themselves, and leaders must strive to build a thriving team culture alongside meeting the network’s aspirations for performance.
If ‘space’ is defined as a physical place where teams and staff can meet and work alongside each other, this can be a challenge for PCN teams to achieve. A team might have a physical space for some people while others work remotely or across practice sites. Some PCNs have failed to recruit PCN staff because no estates can house them.
But space can be seen more creatively. It is empowering to think of team spaces as physical or virtual spaces where PCN team members can meet and collaborate.
These spaces can include meeting rooms, breakout areas, or even virtual collaboration tools such as Zoom or Microsoft Teams. The space itself is less of a challenge. What matters most is how the space is used because this underpins whether a team can thrive.
So, how can PCN teams find the best space to encourage a healthy culture?
What is a team space?
It is critical for PCN team leads to consider the nature and purpose of team spaces rather than simply finding space for the team to meet. It can help to think about these spaces from the ground up, firstly recognising that spaces of all types are environments – and environments, when designed well, will invite the outcome you desire for the team.
It is helpful to be mindful of the types of environments that influence PCN culture: physical, virtual and social. Be thoughtful about each.
Find physical spaces that meet the needs of the meeting type (see below) you intend to meet. A physical space conducive to teamwork, communication, and collaboration can enhance the team’s culture.
Virtual space is crucial for communication and collaboration in a remote working environment. A virtual space that provides multiple communication channels such as chat, video, and audio can enhance the team’s culture (don’t be afraid to use chat apps such as Slack or WhatsApp to create a sense of connectedness – but restrict it to work hours).
A social space can enhance team culture. It provides an environment for team members to interact outside of work-related activities. This is different from meeting outside work. Instead, it is valuing social interaction in work time.
The function of a team meeting
Within these spaces – and ideally matched to them – are the activities. That is, the different types of meetings.
Meetings are an important part of any PCN’s operation. They allow PCN teams to discuss issues, share updates, and make decisions that impact patient care. However, not all meetings are created equal. Some meetings have a more significant impact on PCN culture than others.
I often refer to these meeting types as ‘loud’ because they are the most referred to, most booked in, and most attended. These function-driven meetings tend to dominate PCN teams and wider NHS teams. They include clinical meetings, MDT meetings, operational meetings and (sometimes) strategy meetings.
They are the meetings where work is done, but they don’t forge a culture. For that, there needs to be a space where the team works on being a team. Unfortunately, these types of meetings are often acknowledged as missing.
So what do those types of meetings look like? There are three spaces for PCNs to consider:
1. Team building spaces
PCN teams can create spaces that support a sense of community and establish positive relationships among team members. These meetings can involve activities such as icebreakers, team-building exercises, and brainstorming sessions. They might also include retreats and team coaching. Social Identity Theory suggests that people identify with a group when they feel a sense of belongingness and similarity with other group members. In short, community supports retention and performance.
2. Communication spaces
These are designed to facilitate communication among team members. These meetings can be used to actively look for better ways to communicate and to address themes the team might be avoiding or struggling to talk about – especially around confrontation. PCN staff work disparately across settings. So, it is critical to have a meeting focused on keeping each other up to date, naming issues and discussing what is not known. The book The Surprising Power of Liberating Structures by Lipmanowicz and McCandless can help leaders design these spaces in a creative, playful, and impactful way.
3. Teaming spaces
It can be helpful for PCN teams to actively share problems. A teaming space is where problems are raised, and the ‘team’ look to solve them together. This draws on the collective experience of the network. Inviting safe critique of PCN approaches and seeking ideas on different ways of working is proven to support both performance and staff retention via the experience of psychological safety.
Creating the right culture
‘How much and how often?’ is a common question. The answer is something akin to the length of a piece of string. The question ‘how much do you need it?’ should be asked and answered in a teaming space on a regular basis.
We tend to recommend two hours per month for team-building. The appetite and need for other spaces are rooted in the complexity of the PCN, the longevity of staff, the current culture and the scale of the challenge. The more a team connects, builds communication and teams around a problem, the quicker the specific needs of a PCN will be revealed.
Based on my experience of primary care, if I were to offer one golden nugget of advice, it is to give yourself permission to create these spaces. It is not a luxury to spend time on a team’s culture – it is critical.
Give yourself permission
The challenges of staff retention, burnout and coping with high levels of change are common in primary care. In addition, there is often a culture clash between networked practice sites (with each other) and the emerging PCN team tasked to span them all. The PCN team need a healthy culture of their own to survive and grow.
Normalise the investment in culture. Make it clear that the culture is one that invests in connections, builds safe communication and invites collaboration around shared problems. If you do this, staff retention, poor performance and burnout should be less of a risk.
Discard notions of ‘not enough time’ and trust that, when you achieve cohesion, more gets done and it gets done more effectively. Psychologists refer to it as the Gestalt effect, meaning that the sum output of a connected and effective team will always be more than that of individuals who work alongside each other.
It starts with a booking link in everyone’s calendar. Why not set one up now?
Dr Craig Newman is an award-winning clinical psychologist and team coach who specialises in developing NHS teams and leaders, particularly in primary care. He authored the book ‘Leading Primary Care: Resilience, Team Culture and Innovation’. He is CEO of both a team development service Aim your team and an NHS burnout prevention not-for-profit Project 5.