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Enacting 'team' and 'teamwork': Using Goffman's theory of impression management to illuminate interprofessional practice on hospital wards

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  • Lewin, Simon
  • Reeves, Scott

Abstract

Interprofessional teamwork is widely advocated in health and social care policies. However, the theoretical literature is rarely employed to help understand the nature of collaborative relations in action or to critique normative discourses of teamworking. This paper draws upon Goffman's (1963) theory of impression management, modified by Sinclair (1997), to explore how professionals 'present' themselves when interacting on hospital wards and also how they employ front stage and backstage settings in their collaborative work. The study was undertaken in the general medicine directorate of a large NHS teaching hospital in England. An ethnographic approach was used, including interviews with 49 different health and social care staff and participant observation of ward-based work. These observations focused on both verbal and non-verbal interprofessional interactions. Thematic analysis of the data was undertaken. The study findings suggest that doctor-nurse relationships were characterised by 'parallel working', with limited information sharing or effective joint working. Interprofessional working was based less on planned, 'front stage' activities, such as wards rounds, than on ad hoc backstage opportunistic strategies. These backstage interactions, including corridor conversations, allowed the appearance of collaborative 'teamwork' to be maintained as a form of impression management. These interactions also helped to overcome the limitations of planned front stage work. Our data also highlight the shifting 'ownership' of space by different professional groups and the ways in which front and backstage activities are structured by physical space. We argue that the use of Sinclair's model helps to illuminate the nature of collaborative interprofessional relations within an acute care setting. In such settings, the notion of teamwork, as a form of regular interaction and with a shared team identity, appears to have little relevance. This suggests that interventions to change interprofessional practice need to include a focus on ad hoc as well as planned forms of communication.

Suggested Citation

  • Lewin, Simon & Reeves, Scott, 2011. "Enacting 'team' and 'teamwork': Using Goffman's theory of impression management to illuminate interprofessional practice on hospital wards," Social Science & Medicine, Elsevier, vol. 72(10), pages 1595-1602, May.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:10:p:1595-1602
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    Cited by:

    1. Neuwelt, Pat M. & Kearns, Robin A. & Browne, Annette J., 2015. "The place of receptionists in access to primary care: Challenges in the space between community and consultation," Social Science & Medicine, Elsevier, vol. 133(C), pages 287-295.
    2. Ella Ottrey & Judi Porter & Catherine E. Huggins & Claire Palermo, 2019. "Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account," Nursing & Health Sciences, John Wiley & Sons, vol. 21(1), pages 78-84, March.
    3. Tomazos, Kostas & O'Gorman, Kevin & MacLaren, Andrew C, 2017. "From leisure to tourism: How BDSM demonstrates the transition of deviant pursuits to mainstream products," Tourism Management, Elsevier, vol. 60(C), pages 30-41.
    4. Leigh, Jadwiga, 2017. "Recalcitrance, compliance and the presentation of self: Exploring the concept of organisational misbehaviour in an English local authority child protection service," Children and Youth Services Review, Elsevier, vol. 79(C), pages 612-619.
    5. Reiss, Michael & Greene, Carolyn A. & Ford, Julian D., 2017. "Is it time to talk? Understanding specialty child mental healthcare providers' decisions to engage in interdisciplinary communication with pediatricians," Social Science & Medicine, Elsevier, vol. 175(C), pages 66-71.
    6. Skyberg, Henriette Lund & Innvaer, Simon, 2020. "Dynamics of interprofessional teamwork: Why three logics are better than one," Social Science & Medicine, Elsevier, vol. 265(C).
    7. McKnight, Jacob & Nzinga, Jacinta & Jepkosgei, Joyline & English, Mike, 2020. "Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya," Social Science & Medicine, Elsevier, vol. 245(C).
    8. Xyrichis, Andreas & Lowton, Karen & Rafferty, Anne Marie, 2017. "Accomplishing professional jurisdiction in intensive care: An ethnographic study of three units," Social Science & Medicine, Elsevier, vol. 181(C), pages 102-111.
    9. Caronia, Letizia & Saglietti, Marzia & Chieregato, Arturo, 2020. "Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction," Social Science & Medicine, Elsevier, vol. 246(C).
    10. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.

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