Multidisciplinary Teamwork in a UK Regional Secure Mental Health Unit a Matter for Negotiation?

Abstract

Multidisciplinary teamwork in healthcare is strongly advocated in policy documents and the professional literature, but evidence about its value is sparse. This paper argues that multidisciplinary rhetoric disguises the complexity of the relational processes involved. These processes are explored with reference to a qualitative study, conducted during 2002–2004, of a UK medium secure forensic mental healthcare unit. Although some instructive examples of selective collaboration emerged from the present study, in general, non-medical professionals felt that their capacity to negotiate new ways of working was thwarted by medical dominance. Patients, the recipients of interventions from a range of professions, mostly bracketed them together as an all-powerful ‘they’. Multidisciplinary working promoted only limited partnership in this organizational setting, and became primarily a process through which structural differences were reproduced. The paper draws on insights derived from symbolic interactionist theory to explore the achievement of, and failure to achieve, collaboration across professional boundaries. It will be argued, firstly, that organizational constraints on multidisciplinary collaboration together with actors’ attempts to overcome them can be usefully analysed in terms of a dialectic between role-taking and role-making; and, secondly, that the impact of professional power differences can be understood through analysis of organizations as autopoietic systems.