Digitally-mediated team communication in pandemic times and beyond

With the coronavirus pandemic, there is an immediate need for children's health and mental health services to adopt digitally-mediated communication methods in their practice. In addition to remote intervention for the individual child, digital technologies can be used to facilitate communication between professionals, for the purposes of clinical guidance and support, assessment and case management, and sharing of clinical health information.

However, organisational aspects of service provision often escape evaluation. Little is currently known about the use of digitally-mediated team communication, especially in services for children and young people.

We are currently piloting a digitally-mediated model for an early intervention multidisciplinary team response to social, emotional and mental health needs in primary school settings in a rural county (SOcial eMotional and mEntal Health service using technOlogy in Wiltshire: SOMEHOW). The SOMEHOW project brings together a virtual multidisciplinary team working for different organisations via videoconferencing technology, who formulate specialised strategies for school staff and parents/carers to use at school and at home. In the UK, the national strategic picture for piloting digitally-mediated team communication in pre-pandemic times was for healthcare service efficiency, as well as having potentially broader impacts such as linking to the climate change agenda. 

Until now, there has been some resistance to using digital communication technology in health and mental health services (e.g. Maguire et al., 2018; Cartwright et al., 2005). Resistance can be seen at the individual professional level, in the wholly valid concerns, assumptions, and communication preferences; as well as at the organisational level, in navigating change in complicated healthcare systems. This regional pilot project which aims to gather evidence about the perceived advantages of digitally-mediated ways of working is timely in the light of this global pandemic. The SOMEHOW project demonstrates that it is possible for virtual teams to have meaningful, high quality discussions, and it is possible for virtual teams to maintain professional relationships and work together in supporting children's social, emotional and mental health. Reflecting on this pilot project using a conceptual framework of communication in virtual teams (Marlow et al., 2017, p.576), we make the following observations and recommendations. 

Communication quality and information sharing

Professionals in the SOMEHOW project who self-identified as 'technology averse' were surprised how well and how quickly they have been able to adapt to a digitally-mediated way of working. The Covid-19 emergency has forced all professionals to adapt and it is possible that despite initial concerns about the usability of technology and the inevitability of technological glitches, others might feel just as accepting and positive about the processes and quality of information sharing online as the SOMEHOW professionals. It seems that the visual element of video calls is particularly valued for communication quality. Furthermore, designated roles for team communication (i.e. chair and note-taker) have been deemed essential, as well as a coordinator to schedule the virtual meetings, ensure the discussion is task-oriented, and provide technological support. 

Navigating the processes and pragmatics of information sharing online is not a simple task, especially for multidisciplinary teams with different communication platforms and systems of information governance. Security, confidentiality, and consent and assent processes are all matters to be taken seriously. Our own experience suggests that, following the selection of a digital communication platform based on the criteria most relevant to the team (e.g. security, quality, user-friendliness, cost) – which in most cases will be predetermined by the information governance team(s) – the pivotal step is to co-produce an agreement of personal information sharing with the professional team, supported by the data protection officer. This agreement, and the co-production of it, can go some way in instilling trust and shared understanding among team members.

Trust and cognition 

Structures to ensure a shared understanding, commitment to goals and staff wellbeing are critical to the functioning of virtual teams as with any other team. This includes documentation such as information sharing agreements, terms of reference and, in some cases, service-level agreements. But it also includes a responsibility to consider the working day for individual professionals. Back-to-back communication via digital technologies, although possible and highly efficient, can adversely affect individual professionals. An unforeseen consequence in our pilot project, was the elimination of professional reflection time as a by-product of reducing travel time.

Virtual teams are often highly diverse. For example, the SOMEHOW team is made up of professionals from the Behaviour Support Service, Child and Adolescent Mental Health Service, Educational Psychology Service, Specialist Special Educational Needs Service, and Speech and Language Therapy Service. Many of the activities typically required to develop relationships and shared 'mental models' in a new virtual multidisciplinary team (e.g. an initial face-to-face meeting) are not necessary for the single agency professional teams transitioning to a virtual context in these extraordinary times, whereas other factors such as predictable and timely team communication will be helpful for maintaining trust.

Satisfaction

"I suddenly see a huge advantage to SOMEHOW!" (professional's evaluation). 

Is the shift from resistance to unexpected reliance on digital communication technology, too little too late for the current pandemic? Will exposing professionals to digital communication technologies, in a time of restricted choice, lead to sustained satisfaction, openness, and recognition of the opportunities amidst the challenges of integrating technology into service provision? And will the rapid development of more conducive organisational structures bring about advancements in digitally-mediated mental health service provision in the future? My research is indicating that professional teams can make best use of digital communication technologies in the current climate, and that there will be a surge in research effort to evaluate team satisfaction and performance in models of digitally-mediated team communication, from coordination in single agency teams to multidisciplinary team collaboration.

- Lauren Jones

PhD Researcher

https://www.bath.ac.uk/projects/the-somehow-project/

References

Cartwright, M., Gibbon, P., McDermott, B.M. & Bor, W. (2005). The use of email in a child and adolescent mental health service: Are staff ready? Journal of Telemedicine and Telecare, 11(4), 199-204.

Maguire, D., Evans, H., Honeyman, M. & Omojomolo, D. (2018). Digital Change in Health and Social Care. London, UK: The King's Fund.

Marlow, S.L., Lacerenza, C.N. & Salas, E. (2017). Communication in virtual teams: A conceptual framework and research agenda. Human Resource Management Review, 27(4), 575-589.