Teams are the units of delivery: why they can stall in the NHS

1. Lack of shared purpose

When team members lack a shared understanding of the new team’s purpose and its shared outcomes, they revert to their individual departmental priorities. Collaboration becomes surface-level, the team loses momentum. There is fragile buy-in and its existence destabilises.

For example, in EPR (Electronic Patient Record) implementation programmes, each function may be responsible for specific outputs: IT leads focus on infrastructure, Transformation does staff engagement. Without a shared understanding of overall outcomes they share collectively, each group drives toward its own priorities and outputs. This can lead to fragmented progress and a piecemeal approach to delivery.

2. Being protective of very localised delivery approaches

Each function brings its own approach to delivering work – shaped by years of silo working, which some departments may have even optimised. If they can’t let go of their individual delivery methods, however, and build a shared approach, there will be confusion both inside and outside the team.

For example, in one NHS trust, the IT team might have built a strong record of delivering programmes through a structured process: acquiring a sponsor, defining a clear scope, exploring system capabilities, and delivering the system in a project cycle. Meanwhile, the Transformation team might focus on facilitating the delivery by bringing together different groups of people to co-create. Tensions could stem from a lack of understanding of each other’s delivery principles. When each team feels their way is the “right” one, creating a unified way of delivering work that builds on the strengths of all becomes difficult.

With a lack of clearly defined methods for receiving, prioritising and delivering work, processes remain uncoordinated and legacy channels and ad-hoc requests based on personal relationships will continue to exist. This can lead to duplication of work and effort and missed opportunities for collaboration.

3. Lack of trust

The impact of deep-rooted departmental boundaries doesn’t disappear just because people are put together in a team with a new name. Historic ways of working, old tensions, assumptions of how others work (accumulated from previous encounters) along with entrenched hierarchies – such as clinical and operational teams vs non-clinical teams such as transformation – can influence the group dynamic and how people relate to one another. This can erode trust over time, weakening the very foundation of effective collaboration.

4. Insecurity about role and relevance

In newly formed multidisciplinary teams, individuals may bring different skills, experiences and approaches. Without a clear understanding of what each team contributes, people can feel uncertain about their role or threatened by others’ expertise – potentially creating unsurfaced tensions: “If you’re doing that, what’s my job now?” This lack of clarity can lead to insecurity and limited appreciation of how capabilities could complement and build on each other. This often plays out through subtle behaviours – turf-protecting, resistance to change, or questioning the value others bring. These may rarely surface directly but they can quietly stall progress. 

5. Organisational structures and processes reinforcing the status quo

Factors outside the team’s control can also influence its success. After all, these teams still operate within the wider organisation – and within the NHS system itself – where legacy governance, funding models, and reporting lines often prioritise departmental accountability over shared outcomes. This can pull teams back into the old world ways of working that they aim to challenge.