TEAMWORK week 7 – 2022
We should start out the question of – What is a team. A team is a group of
people, with complementary skills who are committed to a common
approach for which they hold themselves mutually accountable, working
together to achieve a common goal. This is the technical definition of the
team but if you think about the team is really defined by the outcome.
Teams can be set up in many different ways; they can be set up for short
time working on short-term projects, or they can be set up to work on longterm projects. Some teams are put together to work on certain tasks such
as product design. You have many different team structures as well,
made up of many of the same type of individuals or backgrounds, such as
engineers or they can be made up of people with a variety skill sets. One
thing to note today especially in healthcare, is that teams do a lot more work
in a virtual environment. Task forces and Committees are also important
team functions but they have limited scope.
The Challenge is that formal teamwork educational training for physicians
and nurses is rare. Developing teams and facilitating team activities are
recognized competencies for healthcare managers. However, there is little
formal preparation in teamwork in undergraduate and graduate healthcare
management education programs (Leggat, 2007) This is still a very relevant
and useful article to review. This article has an excellent table of the
competencies for managers.
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-
7-17 .
Inherently there are conflicts between physicians and nurses and these are
often due to physicians refusal to embrace teamwork. It can be very difficult
for people who have been training and educated in the system that rewards
independence to work together with others. What works when putting teams
in healthcare is that physicians and nurses work from a clinical framework,
advocating at the individual level for patients and families. Healthcare
managers are trained to look at population level and organization-wide
issues.
The benefits of effective teams are numerous. Teams that are empowered
and tend to be innovative and rewarded for performance, improve
coordination and quality of care, increase job satisfaction among team
member’s, increase patient satisfaction, and increase productivity.
The following are the stages of Team formation. It is important to note that
although teams development follows a typical pattern it does not always
exhibit equal weight on each development stage.
Tuckman’s Stages:
Forming: getting oriented to the team goals and each other, finding out
what the tasks are, and who they will be working with.
Storming: intragroup conflict, attempts at dominance, passive-aggressive
behavior, along with information withholding, and other forms of resistance
to team tasks and goals.
Norming: team members actually begin working together and agreeing on
things. Expectations and roles become codified, either informally or
formally.
Performing: peace breaks out and team members actually begin the work
at hand, have open dialogue with one another, and share information to
accomplish the team’s goals.
Adjourning: team members have worked together over a long period of
time, have developed respect for one another, and like each other as
individuals and the team as a whole and become sad that they are
disbanding.
What are some of the things you need to think about as a manager when
you’re asked to develop or start up a new team?
Make sure you understand what are the goals of the team are? This is very
important because it will be your job to make sure others understand it as
well. The next thing to look at is how you are going to measure your
progress and what metrics you will use to do that. I think easily obtainable
accurate does everybody believe in them these are the questions you’ll need
to make sure you get answered. Do you have any deadline for a decision in
other words is there a drop-dead date? The timeline for decision will
determine how quickly to develop the team.
It’s very important you understand the venue and process the team go as
they work together. It’s important to have a place that is comfortable and
contributes to the team working together develop trust and building
relationships.
You need to ask a few operation questions as well. Where are you going to
meet? Who’s really in charge? You need to define roles and responsibilities
of each member and of the team as a whole. If there is a reporting structure
or a report out structure you need to be aware of that understand how often
that needs to be done.
Most of all understand that as a good manager you should not mind if a new
staff member makes a list of questions and asks for clarification and
direction. You’ve done your homework you will have the answers to your
steps questions.
How do you choose the team? It’s important you understand what your
objective is because it is from that mission that you will determine what
skills and competencies you need to have on the team. As you choose the
team you need to make sure that individuals are also people come to a
conclusion and make decisions. Not only do they need to work together they
need to come to an answer together. And you can follow through on
assignments and tasks, work collaboratively, show respect, they need to be
able to handle conflict or at least help avoid conflict, and they need to have a
sense of humor to avoid creating a stressful team atmosphere or to defuse
one that might occur. They also need to be able to listen and work in areas
that they may not be the expert.
Choosing team members is not an easy tasks nor is it one you should take
lightly. You do want to choose individuals with good emotional intelligence.
People emotionally in tune with others can read emotions within
nanoseconds. Women and physicians scored higher on EC scale, i.e. the
ability to read other people’s emotions. In this way a team member can
catch others’ member’s moods and avert potential disruption from
unengaged members. Emotionally aware team members can change an
organization’s emotional environment and improve the quality of employees’
and patients’ lives by helping others to become “infected” with positive
emotions.
In 2006, Goleman moved to the terminology Social Intelligence (SI) to
separate out the last two components of emotional intelligence and social
awareness and began using the term “social facility” instead of social skills
(Goleman,2006).
Decision Making
Teams improve the decision making of the even the most capable individuals
except if the team is in conflict or lacks spirit, then decisions are adversely
affected. One of the reasons teams improve decision-making is that it works
out some of the biases we have that are based on our own experiences and
knowledge levels. The team that is functioning properly, will debate the
issues and work through the inherent biases we have in our perspective.
This is where teams become very effective. There is a management article
that relates to the Hedgehog and Fox’s and without going into much detail,
It basically says is when it comes to decisions Fox’s make better decision
makers for reasons which can insight into, by reading the book or also by
reading essays on the matter such as the following;
https://assets.press.princeton.edu/chapters/s9981.pdf or this
http://www.foresightguide.com/hedgehogs-and-foxes-two-personalitytypes neither / not to be confused with Aesop’s Fable
Team Building Skills
What are some of the things you can do to help maintain an effective team?
Let’s take a look at a few of the teambuilding skills.
Listening: Team members should have the ability and eagerness to listen
to other team members. Members should allow other team members to
freely express their opinion.
Questioning: It is extremely crucial for all team members to ask questions
to understand what is going on in the project to function properly.
Persuading: Team members should have the right to encourage, defend or
rethink their ideas for the teamwork to be successful.
Respecting: All members should respect each other’s ideas. This builds
trust.
Helping: It’s very crucial for all team members to contribute to the overall
goals and to help each other achieve.
Sharing: All information that might affect he project should be shared.
Factors Affecting Team Development
• 10 or fewer members per team. There is no magic number for team
size of most research shows that the most effective teams are
anywhere between three and seven members.
• Members volunteer to work on the project. This basically shows a
desire or passion to work on whatever issue the team has as an
objective.
• Members work in the project from day one to completion. Consistency
helps to develop cohesiveness and works to strengthen trust so it is
important to maintain the members of the team for as long as
possible.
• Members should be assigned full time. It is very difficult to get a staff
member to work on a team if they have to go back to their full day’s
work as well.
• The organization should facilitate and encourage trust.
• Members report directly to the project manager. Reporting directly to
the project manager helps avoid political games and reporting
information to other higher-ups who may have a vested interest in the
outcome of the team’s decision
• All relevant knowledge areas are represented on the team. When you
develop a team and come to the point we believe you have everybody
you need on that team that represents the knowledge base necessary
to make informed decisions, it is at that point you should ask one
more question and that should be in – am I missing anybody.
• Members should be able to easily communicate with each other
Team Effectiveness
To make sure the team remains effective you have to make sure it’s working
well together and that means watching out for signs of trouble or potential
disruption.
• Is there anger on the team – directed at who?
• Are members contributing their best?
• Member/s report back covertly on team progress
• Sr. Management influences the Team leader indirectly!
• One person on the team is seen as too connected to Management and
people won’t speak up!
• Agenda is already set and all new ideas are squashed as they come
up!
Groupthink
Groupthink can become a major problem especially for teams that have
been going on for more than a while. Groupthink can be especially
dangerous when he team is making decisions that the organization needs to
conduct its business. A few years and years ago I believe it was Leon
Panetta when he was running the CIA had to address the usual groupthink.
The group of analysts had missed a major message coming from the Middle
East and the problem was that even though some analysts saw the issue
they didn’t feel confident that they were right because they can’t believe
what the rest of the group was thinking. And as you can see it can be
dangerous response to working together over a period of time. The
following links to an article discussing group think and it impact on the
decisions in political arena. https://www.brookings.edu/opinions/thedanger-of-groupthink/
Some symptoms of group thinking are:
Illusions of invulnerability: when the team feels itself invincible and acts on
that way.
Diminished critical thinking: when group members discuss a few appeasable
solutions and ignore any other solution that seems unsatisfactory at the
outset.
Reducing Outside Influence: when the group considers any outsider
opposing their solution as an enemy and sabotaging aims.
Direct Pressure: when a member question the direction of the team or their
solution, extensive pressure is applied on him to dissent.
Decision Making Process:
Complex problems require group decision making so use a variety of
specialists to get the collective wisdom of all team members including
Customers and stake holders. Use group decision making when it will
improve the quality of decisions taken. When low probability of acceptance
among managers exists if one person will make the decision, so strong
group commitment to the project is needed. Team leaders should take care
that each person gets an equal share in the conversation like regulating the
time with a timer. Important to re-evaluate the decision taken and if
something goes wrong, the project team can learn from its mistakes.
Major Sources of Conflicts with Teams
In project definition: the major sources of conflicts in this phase can be
priorities, assigned resources, scheduling and distribution of workloads.
In the planning stage: the major sources of conflicts in this phase are still
priorities, scheduling, procedures and technical problems.
Execution stage: problems in this stage arise from schedule delays,
technical problems also and staff issues between team members. Milestones
are hard to reach in this stage.
Delivering stage: scheduling delays remains the most source of problems.
Technical problems are very hard to find because all technical requirements
are defined in the early stages work.
Functional Conflicts
There are times when healthy debate is important. Teams need to make
decisions in need to come to some conclusion that is workable to meet the
goal of the team and the organization. To do this sometimes means they
have to debate issues work through the pros and cons and find a logical
reasonable solution that they can implement or suggest for implementation.
NOT ALL CONFLICT IS BAD:
As long as the objective of the project and its goal is common to both ends,
such as taking care of the patient, then the conflict is functional. This is
known as shared vision.
The absence of conflict may represent a problem where team members are
suffering from self-doubt and wants to preserve the team harmony, hence
no constructive debates occurs. Team Leaders can cure this problem by
interjecting into the discussion, people with opposing views.
Team Leaders should have good listening skills and prepare certain answer
to explain their views if they were challenged on their ideas or disagreed
upon.
Dysfunctional conflicts
On the other hand there are times when conflicts create dysfunction and
cause disruption in an otherwise healthy process. When these arise with the
team leader needs to address these quickly. Here are some ways that a
leader needs to intervene.
Arbitrating the conflict: proposing a solution in which its main goal is
selecting the best interest of the project or a solution that is against both
parties.
Controlling the conflict: controlling the conflict could be done by either
arranging for both parties not to work together or using humor to end the
conflict.
Accepting the conflict: when the conflict rises to a degree where it is
uncontrollable, so the manager has to accept it until the end of the project.
Eliminating the conflict: if the conflict escalated to a point where it is
intolerable, then the manager removes one or both ends from the project.
Mediating the conflict: It is the case where the manager tries to
intervene and proposes a common solution and suggests alternatives to end
the conflict.
Summary
Now that you have read the chapter and reviewed the materials through the
lecture notes I like to go over a few notes on what makes teams special.
Teams when done and developed well of one of the best ways to improve
organizational productivity. Good teams don’t just happen, they can be built
and there are a number of research articles on how to develop winning
teams. Ineach one you will find similar elements of success.
Teams in general basically work well together when they have the same
objective’s, and they enjoy or are driven by what they do. In healthcare it is
hard to put together a team that all have the energy and drive at the same
level, but they usually do have the same overall vision. An example would be
driving towards high-quality patient care. A strong vision is an important
ingredient for team success, but it should be coupled with confidence to
think differently about potential solutions. Members who choose to be on
your team should be continuous learner’s people who want to find the
answers to the problems at hand.
It is important to have people that ask a lot of questions and team dynamics
need to support that perspective. (see groupthink). It cannot be a team led
by one individual. That is why facilitation is such an important aspect of
team management. Leading members to contribute and submit the work
necessary but not directing them towards any particular solution.
Leadership and management of the team member’s strategic direction and
egos is critical for you to get the full impact of the team approach.
As you manage the team what happens if you find some members just are
not contributing to the effort. Well, if that’s the case, you may end up having
to remove or replace that team member but before you do that I suggest
going back to the formation of the team and what was the criteria used to
choose your team members. Was it title, role, specialty or some other
expertise or was it simply you chose people you felt were easy to work with.
The reason to reflect on the process for choosing members is to see if there
might be a way to improve the effectiveness without changing members at
this time. Also, this helps you to make sure you don’t repeat the same
mistakes again. As part of the follow-up process once you do determine to
add new team members should follow the next few steps before moving on;
so first you reassessed member selection, next you determined needed
capabilities thirdly if need be you replace the members and lastly you need
to support the team and focus on building trust and relationships across the
members.
So what you have the team members selected you need to make sure they
understand what they’re trying to accomplish as a team this is critical to the
overall success. In addition, they need to also understand what it is they are
not focusing on, what is not in the scope. You want the team focused on the
mission and the objective and it is important to maintain that limit on the
scope.
As healthcare moves to a collaborative multidisciplinary cross service line
model, the development of teams and the ability of these teams to be
effective becomes even more important. Let’s summarize the most
important aspects of team development.
First make sure you have a clear goal and you can measure your progress
with data that matters for the team members. Make sure you have members
selected for their abilities and competencies that they will bring to the team.
In healthcare we have many independent experts and they may not
contribute if they are used to doing it on their own even if they were stars in
their field and the area they worked in. Next make sure they are all
working towards the same goal. As a leader of the team or manager
developing this is your role to make the message clear and make sure
everyone understands it. Monitors the team’s progress and dynamics so you
can alternate members if need be or discuss with members their attitude
and perspective or remove a member that is not effective or that is
contributing negatively the team outcome.
Most of all an organization has to support the teams process, from not only
the top but also at the department level as well. Remember each team does
not have a hierarchy. All members are working with each other for the good
of the mission ejected team. And finally make sure the team is all in the
same page throat the entire process and that you put together a group of
people that you truly believe in the best group to achieve the company’s
objectives. Don’t forget to let them know that you selected them for their
skills and abilities and their team approach to solving problems.
It would be nice if we could select staff who had a lot of solid team
experiences but that is not an easy task in healthcare. Most clinicians and
physicians as well as managers do not get training in team-based endeavors
even though as an industry we are fully dependent on the team approach to
successfully deliver high-quality effective low-cost services.
I am recommending the following books to read for more understanding of
how to be effective while working with teams but I have also included a book
on negotiation. I include this book because to be effective and teamwork
means you have to be able to listen process the information and determine
what your objectives are. Negotiation is a skill that helps you manage that
process. Not only do we not get good foundational learning on teambuilding
we also do not get much if any education or training in negotiation skills. I
believe it’s important to understand how to negotiate as an ingredient for
successful teambuilding.
• Tom Peters article
http://tompeters.com/columns/dont-let-project-teams-becomecommittees/
• Emotional Intelligence: Why It Can Matter More Than IQ; Bantam
Books; 10th Anniversary edition (September 27, 2005) Daniel
Goleman. There are other books as well.
• The Manager as Negotiator: Bargaining for Cooperation and
Competitive Gain – David A. Lax, James K. Sebenius
Here is a current ORIGINAL RESEARCH article that talks about the
performance levers for virtual work environment from the Front. Psychol.,
17 February 2021 | https://doi.org/10.3389/fpsyg.2021.624637
“Virtual Teams in Times of Pandemic: Factors That Influence
Performance” by Victor Garro-Abarca, Pedro Palos-Sanchez and Mariano
Aguayo-Camacho