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"There was a Big Meeting … and then Everybody Seemed to Pull Together": Clinical Difficulty, Team Functioning and the Role of Interdisciplinary Formulation.
Gracey, F., Henwood, K., Evans, J., Malley, D., Psaila, K., Bateman, A. & WILSON, B.A
Journal of the International Neuropsychological Society 12(S2): 5
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Objectives: To report the findings of a qualitative research approach to the study of psychiatric rehabilitation team functioning when faced with clinical 'difficulty'. To describe the relevance of these findings to practice development in a holistic neuropsychological rehabilitation service. Methods: A social constructionist grounded theory analysis of a psychiatric rehabilitation team's discussions about 'difficult patients' was carried out to develop a theoretical account of team functioning. A case report of service application of this model to facilitate effective teamwork and collaboration with service users in neuropsychological rehabilitation is described. Results: The analysis identified 5 core categories regarding the sharing and shifting of responsibility, client characteristics, and service resources. When discussing 'difficult patients' team members provided accounts of staff, team and organisational difficulty. The grounded theory account highlighted how the team engaged in systemic shifting of responsibility that served to maintain poor team functioning and compromise client rehabilitation. In contrast, when discussing clients described as 'not so difficult' the team described a 'fit' or 'match' between client and service, and within the team. The use of interdisciplinary formulation within a neuropsychological rehabilitation service appears to facilitate collaboration between different disciplines and with the service users. Conclusion: This study models team functioning in response to client 'difficulty'. It is concluded that development of shared understanding is a feature of good teamwork. A formulation-based approach to facilitating shared understanding in neuropsychological rehabilitation is advocated, along with the need for further organisational research within neuropsychological rehabilitation.