forming effective teams
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Forming Effective Teams(Rebecca) Suzie Miltner, PhD, RNAssociate ProfessorSchool of Nursing
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Objectives Describe characteristics and dynamics of
effective teams. Identify barriers and facilitators to
teamwork in healthcare settings. Understand factors that contribute to
conflict and how to resolve that conflict within groups.
Healthcare is complex….
How can we fix it?
Quality Improvement offers a systematic, data-driven, iterative, problem solving process that can be adapted to local context.
QIAll of this happens in the context of the team.
5 observations about teams…from Ed Salas1. Most organizations want a culture of
collaboration2. Organizations are using teams more
than ever3. Many teams perform sub-optimally4. What happens in leadership teams can
permeate the organization5. Patient safety demands reliable,
adaptive, self-correcting teamsFrom Eduardo Salas, PhDDepartment of PsychologyRice University
Is Teamwork Important?
We think so… Improves the quality and safety of care.
May improve coordination of services
Increases professional satisfaction
May maximize resources (more efficient delivery of care)
What is a Team? “A group of people organized to work
together.”1
“A group of people with a full set of complementary skills required to complete a task, job, or project.”2
“A team is a small number of people with complementary skills who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable.”3
1http://www.thefreedictionary.com/team2http://www.businessdictionary.com/definition/team.html3Katzenbach, JR, and Smith, DK. (1993). The discipline of teams. Harvard Business Review. 162-171.
TeamsTeams differ in terms of their purpose, size, membership, experience, level of authority, history and chemistry.
Interestingly, to be effective, teams do not necessarily have to have a long history of working together, or have members who even like each other.
Working Groups Purpose is usually the same as organizational
purpose Strong, focused leader who delegates work Individual work products and accountability
Team Team has specific purpose that may be different
from organizational goals Collective work products with individual and team
accountability Performance measurement based on collective work
products
Working Group or Team?
Katzenbach, JR, and Smith, DK. (1993). The discipline of teams. Harvard Business Review. 162-171.
Teams in HealthcareWidespread adoption
Classification of teamsTemporal stabilityAuthority differentiationSkill differentiation
Team Formation
Forming
Storming
NormingPerforming
Tuckman’s Model for Small Group Development
• Orientate team • Establish meeting
roles and responsibilities
• Conflict or polarization around interpersonal issues
• Realize that the task is more difficult than expected
• Reinforce ground rules and team building
• Resistance is overcome
• Cohesiveness develops
• Worked through all of the personal/team issues
• Concentrate on the team goals
• Establish new objectives
Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399.
Principles of Team Based Health CareShared goals
Clear Roles
Mutual Trust
Effective Communication
Measurable Processes and Outcomes
Conceptual Model of Teams
InputsStructure
CompositionLeadership
ProcessesConflict
CommunicationCognitions
OutcomesSatisfactionPerformance
Viability
Team Input: StructurePooled interdependence
Sequential interdependence
Reciprocal interdependence
Team Input: Composition and RolesTask Roles: Conscientiousness
Social Roles: Extraversion
Social Roles: Agreeableness
Team Input: LeadershipDirective
Transactional
Transformational
Empowering
Leadership
A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves.
Lao Tzu
Team Process: ConflictRelational Conflict
This is problematic for team conflict Have to develop mutual trust and respect Sometimes this is not possible
Team Process: ConflictRelational Conflict
Task Conflict Some task conflict is necessary to improve
Too litt
le
conflict
Status
quo
Optimal conflict
and ideas
Too much conflictPoor team function
Productivity
Conflict
Team Process: CognitionsShared mental models
Transactive memory systems
Shared Mental Models “Our aim is to
reduce wait times in the specialty clinic.”
“Everyone has a part in making this happen.”
Transactive Memory Systems “The expertise in
clinic flow is in the clinic manager and triage LPN.”
We don’t have to know all the details, but we need to know who does know that.
Team Process: Cognitions
Barriers to Team SuccessTeam Dysfunction
MistrustLack of commitment and accountability
Poor resource allocationCommunication and collaboration
Disruptive behavior
Facilitators for Team Success Goals/aims/objectives are clearly defined. Members are selected for skill and team
competencies. Every team member has a role and
participates. Team develops mutual respect and trust. There is effective management of the team.
Ground rulesCommunicationRole expectations
7 drivers that influence team effectiveness: Seven “C’s”
Capability (right people with the right KSAs) Cooperation (right attitudes and willingness) Coordination (demonstrate teamwork
behaviors) Communication (effective with each other) Cognition (shared understanding) Coaching (team members demo leadership
behaviors Conditions (have favorable conditions such as
resources, culture, and senior leadership)From Eduardo Salas, PhDDepartment of PsychologyRice University
Exercise
• Form three groups of 7-8 people.• Select one penguin to portray.• Read the scenario and make a plan.• Remember to stay in the voice of your penguin.
The Empowerment ParadoxI could
delegate more if
you took the
initiative
Empo
wer
men
t Pa
rado
x
Delegate to the entire team!
Ask what I can do and delegate to me!
LeadersTeam Members
What can YOU do to create more effective QI teams?
IAD Interprofessional
team VA TAMMCS model
used Executive sponsor Data collection Unit Leaders
involved
Mobility Interprofessional
team VA TAMMCS model
used Executive sponsor Data collection Unit Leaders
involved…sometimes
A Tale of Two Projects
Effective Team Meetings
Team ground rules
Team roles
Timed agenda
Minutes or other meeting record of events/discussion
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Setting Team Ground Rules1. Attendance: What are the attendance requirements for team
members?2. Participation: What are the team member expectations for
participation? 3. Interruptions: How will interruptions during the team
meetings be handled? 4. Preparation: What level of preparation is expected for team
meetings?5. Timeliness: What are the expectations for meeting start
times, what type of preparation is expected?6. Conflict: How will conflict between team members be
resolved?
IAD Team Ground RulesAttendance Any time you must miss, provide any homework or assignments to team leader. Do not send substitute if you can not make it. Communicate to team leader if unable to attend. No more than 3 meetings missed.Participation All team members are expected to fully participate and contribute. Try to direct discussion to those who may have not been able to contribute to help
include them. Be detailed when needed or concise when needed to get the points across.Interruptions Anybody can call a safe moment to refocus or redirect conversation. One voice at a time. Remain civil at all times.Participation Be honest at what you can get done.Conflict Resolution Call a safe moment to stop the escalation.. Commit to resolve. We all need to self reflect to prevent conflict in the future.Timeliness Everyone’s time is valuable so be on time to meetings and completing assignments.
Mobility Team Ground RulesAttendance No guidanceParticipation No guidance Interruptions No guidance Participation No guidance Conflict Resolution No guidance Timeliness No guidance
Team Members and Their Tasks
Facilitator/Leader More coach than boss Ensure participation by all Guides discussion
Recorder Records what is being discussed and writes on board
Time Keeper Keeps the group on time
Observer Reflects on the process of the team at close
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Questions?
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