Since most of us in rehabilitation work in interdisciplinary teams, we all have an idea of what they are. Good team functioning like love is a many splendored thing and like love is hard to define. However, we do know when we feel it. This chapter will discuss a variety of suggestions for individual staff members in a team to help strengthen and maintain their team and describe group activities that they can support and encourage. It will also discuss several ways of more formally training the staff as a whole in group functioning.

Nancarrow et al. [1] in a recent study have discussed the concept of interdisciplinary team working and after an exhausting literature review and a large qualitative study of interdisciplinary primary care teams concluded that characteristics of effective teams included positive leadership and management attributes; communication strategies and structures; personal rewards, training, and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles.

In addition, Lemeiux-Charles [2], Strasser [3], and Butt and Caplan [4] have discussed the various kinds of teams and their functions, processes, and development, but for purposes of this chapter, we will assume that the practical suggestions given here will apply to most teams.

It’s easy to assert that interdisciplinary teams are important in rehabilitation units because most rehabilitation units have them in some degree of functionality. Perhaps more importantly, accrediting agencies like the Joint Commission on Accreditation of Healthcare Organizations and the Commission on the Accreditation of Rehabilitation Facilities as well as administrative agencies such as the Department of Veterans Affairs require them. However, there are more compelling reasons why the team concept has been embraced by the rehabilitation community.

“Rehabilitation, by virtue of the complexity of the disability, the variety of disciplines involved, and the relatively long-term interaction of staff with patients, makes a persuasive argument for the necessity of a team approach” [5]. Research supporting team effectiveness bears out this necessity Nancarrow et al. [1], Lemeiux-Charles and McGuire [2], Cashman et al. [6], Strasser et al. [7]. Strasser et al. [7], for example, using a cluster randomized trial of 31 rehabilitation units, showed that stroke patients treated by staff who participated in a team training program were more likely to make functional gains than those treated by staff receiving information only. Lemieux-Charles and McGuire’s review of the literature on team effectiveness concludes that “the type and diversity of clinical expertise involved in team decision making largely accounts for improvements in patient care and organizational effectiveness. Collaboration, conflict resolution, participation, and cohesion are most likely to influence staff satisfaction and perceived team effectiveness” [2].

Additionally, many medical, nursing, rehabilitation therapy , and behavioral approaches won’t work unless most of the staff cooperates. It’s easy for one staff member to feel that they have a “special” relationship with patients and try to sabotage any intervention, but with consistent messages from the rest of the staff, such sabotage will not be as effective. Furthermore, surveys of 287 rehabilitation staff in five different facilities about which types of situations are most discomforting and difficult to manage found that the most troublesome situations involved other staff [8]. Additional surveys on 269 rehabilitation staff in three additional facilities confirm this finding.

Even though it has been shown that there are no consistent stages of adjustment to disability, there is some qualitative evidence that the process of rehabilitation does have different stages [9]. Such a theory of stages of rehabilitation implies (and has been demonstrated in one center) that different approaches are more helpful at different stages and that different staff may be more liked and/or appreciated at different stages. For example, Nelson [9] found that in the acute phase, patients report needing nurturing, touch, and support, while just before discharge, a tough love approach emphasizing independence is more effective. Different staff may be better suited by discipline and personality to provide these services.

Socializing new employees and students is another important team function. Orienting new folks offers the opportunity to increase the comfort and skill of the new people which some unpublished data suggests can lead to less turnover, but also to help each experienced staff member feel better about what they themselves do. New staff learn the culture, how to feel more comfortable around disability, where the lunchroom is, how to treat other disciplines and patients, how to be one’s own discipline, etc., by observing how their mentor accomplishes these activities and how they are treated by other disciplines.

The main principle here is to see the team as a unit. Team morale and a unified approach may be more important to good treatment than an individual staff person’s feelings.