Exploring the dynamics influencing team functioning of the district clinical specialist teams in KwaZulu-Natal.

Abstract

Introduction: Since 1994, South Africa embarked on a decentralization of the health system, with the adoption of the Primary Health Care approach as a central strategy for delivering health services via a District Health System. The District Clinical Specialist Teams (DCSTs) were part of a PHC re-engineering strategy and were introduced concomitantly during the first phase of implementation of the National Health Insurance (NHI). Background: DCSTs were conceptualised as a multi-disciplinary team aimed at strengthening the quality of care and health outcomes for mothers, newborns and children. They were meant to first function as a team and second as individuals within their respective disciplines. Methods: This was a descriptive exploratory qualitative study with the following objectives: to explore understandings of the construct teamwork in relation to the DCSTs; to explore influences on team functioning of DCSTs; and to explore team effectiveness (i.e. team performance and viability) within DCSTs. The study was guided by an adaptation of the ecological framework for analysing work-team effectiveness by Sundstrom et al. Study findings: DCST members from four KZN districts were included in the study. Two district directors and one provincial specialist were also interviewed. The DCSTs constructed the concept of teamwork in their context as having a common goal and each person in the team having their own roles and responsibilities contributing towards the common goal. Cooperation and interdependent collaboration were identified by the DCSTs as key features of teamwork. Joint planning, delegation of activities and mutual accountability were identified as important components of teamwork within the DCSTs. Factors influencing team functioning were reported to be external (i.e. those related to the organizational context), those related to team boundaries, as well as internal (i.e. those related to team development and individual attributes). Team effectiveness explored factors related to team performance and team viability. Discussion: With teamwork being viewed internationally as an important strategy for delivering quality healthcare services, concerted efforts should be made at all levels to strengthen teamwork interventions within the health system. The organizational context within which DCSTs are functioning exerts influence in a variety of ways. The DCSTs, being an inherently hierarchical multi-disciplinary team, present important dynamics that require a change of culture and commitment at various levels. Limitations of the study included limited achievement of data saturation and limited exploration of the broader health system context and its influence on team dynamics. Recommendations included strengthening of supervision and leadership, implementation of teamwork strengthening interventions, as well as establishing a platform for regular feedback, monitoring and evaluation of the DCST innovation.