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?