Working in “teams” in an era of “liquid” healthcare: What is the use of theory?

Abstract

“Team” is used throughout the healthcare literature as if it had a transparent, single meaning, and in policy documents it has become a mantra. Yet, “team” is a contested and imprecise term, inviting theoretical sophistication. New forms of team working in healthcare contexts can be understood as a complex set of practices and a discourse – both performed, and written and talked about as a supplementary practice.In the context of fluid and unpredictable social conditions, teams are now theorized in terms of contradictory process as well as stable membership. Cultural–historical activity theory in particular provides a rich approach to understanding such process, in an era where the desire for stable networks – a will-to-stability – may be secondary to the need for a will-to-adaptability. A new vocabulary has emerged in theoretical accounts to describe activities of an emergent work order, in terms of a shift from stable “networking” to unstable “knotworking.” However, this conceptual language can be overwrought and may alienate practitioners. Theory can be developed with practitioners themselves to avoid widening the gap between experience and the understanding and explanation of experience. Teams are not problems to be solved but activities to be expanded.