Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher During your journey through this slide deck of Inter-professional Team Dynamics (with a focus on the geriatric inter-professional team), you will experience: Inter-Professional teams, collaboration, and the benefits to the health care system; Team Dynamics according to psychologist Bruce Tuckman; Five Dysfunctions of a Team according to Patrick Lencioni; and the challenges facing inter-professional teams. As a health care consumer it is important to recognize and be aware of the benefit of inter-professional teams, and the geriatric inter-professional team to the health care system. Most importantly, team dysfunction can compromise outcomes, especially when leadership lets the team down. Building great teams takes good leadership. The leader is most important for building trust, which sets the foundation for the team. For a high performing team to operate members must share successes, failures, strengths and weaknesses in a trustworthy environment. When teams build trust and engage in constructive conflict then there is the potential for building commitment and accountability. Then the team can focus on meeting and exceeding the goals and mission. Lencioni, P. (2002). Learn it-Live it-Love it-Your path for a more informed life! Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher

2. LET’S DISCUSS
Inter-Professional Team
Collaboration
Team Dynamics
Team Dysfunctions & Challenges

3. INTER-PROFESSIONALITY
Process that professionals
develop ways of practicing
Organized to solve, explore a
variety of issues
Optimize client participation
Inter-professional practice
unique characteristics:
codes of conduct, values
ways of working
D’Amour, D. and Oandasan, I. (2005).

4. Nurse
Nurse
Practitioner
Physician
Geriatrician
Physician
Assistant
Social
Worker
Psychologist
Psychiatrist
Pharmacist
Occupational
Therapist
Physical
Therapist
Speech
Therapist
Chaplain
Dietitian
INTER-PROFESSIONAL
GERIATRIC TEAM

6. INTER-PROFESSIONAL
COLLABORATION
In the field of healthcare
effective collaboration and
interaction can have direct
ramifications for patient care
Poor teamwork skills in
healthcare have been found to be
a contributing cause of negative
incidents in patient care

7. A. It increases readmission rates to hospital.
B. It is physician-centered care.
C. It increases the cost of healthcare.
D. It improves the health of populations.
Which statement about
inter-professional
collaboration is true?
D. It improves the health of populations.

8. Storming Norming Performing
Psychologist Bruce Tuckman (1965)
TEAM DYNAMICS

9. Forming
• Members are positive and polite, excitement
• Discussions about how the team will work
• Anticipation and optimism
• Pride in being chosen for the project
• Suspicion and anxiety about the job
• Tentative attachment to the team
• Leadership Style: DIRECTING
Storming
• Stage when many teams fail
• Try to focus on the job without support of
established processes
• Defensiveness, competitiveness, disunity, and
increased tension or jealousy
• Sharp fluctuations in attitude about the team and
the team’s chance of success
• Questioning decisions and decision-makers
• Leadership Style: COACHING

10. Norming
• Hierarchy established
• Team members know each other better, may be
socializing, ask each other for help and provide
constructive criticism
• Friendliness and trust towards other team
members, confidence in the team goals, team
cohesion and spirit, pride and sense of belonging
to the team
• Leadership Style: PARTICIPATING
Performing
• Hard work leads directly to progress towards
shared vision of goal
• Being part of the team at this stage feels "easy"
• Constructive self-change, sense of belonging
• Understanding of each others strengths and
weaknesses
• Self-organization of work
• Leadership Style: DELEGATING

11. Adjourning
• Termination of roles
• Completion of tasks
• Reduction of dependency
• Process can be stressful
• Perspective of the functioning group - this
fifth 'stage' takes us beyond that

13. 5.
Inattention
to Results
4. Avoidance
of
Accountability
3. Lack of
Commitment
2. Fear of Conflict
1. Absence of Trust
Lencioni, P. (2002).

14. ABSENCE OF TRUST
Trust is the foundation
The absence of trust stems from team members’
unwillingness to be vulnerable in the group
For a high performing team to operate members
share successes and failures
share strengths and weaknesses
Lencioni, P. (2002).

15. About disclosure and not about confession
Overcoming the absence of trust requires:
Team members sharing experiences over time
Multiple instances of follow-through
In-depth understanding of unique attributes of
each team member
In building trust leader is most important
The leader must first demonstrate vulnerability
ABSENCE OF TRUST
Lencioni, P. (2002).

16. Team members must constructively
engage in conflict
Express themselves, know that they
have been heard, respected for their
thoughts and beliefs
Heart of how buy-in happens, when
skillfully handled conflict leads to
powerful commitments
The role of the leader: to surface
issues, perspectives, and opinions
FEAR OF CONFLICT
Lencioni, P. (2002).

17. Commitment is a function of two things:
CLARITY = removal of assumptions and ambiguity
BUY-IN = achievement of honest emotional support
Great teams make clear and timely decisions
Leave meetings confident no one harboring doubts
Achieve commitment engaging constructive conflict
Focus on problems not on personalized agendas
LACK OF COMMITMENT
Lencioni, P. (2002).

18.  Dealing with objective issues
precedence over ego conflict
 Members express thoughts, beliefs
creating buy-in & clarity
 Once there is alignment and buy-in
leadership teams drive clarity
 Facilitated by the process of
cascading communication:
taking key decisions and action
items, ensuring a roll out that
includes “why they are
important”
LACK OF COMMITMENT
P. Lencioni, P. (2002).

19. Accountability
Leader holding their direct reports accountable
Peers holding each other accountable
Reminding each other
Commitments
Real or perceived breaches of performance
Behavioral agreements
AVOIDANCE OF
ACCOUNTABILITY
P. Lencioni, P. (2002).

20. Leaders need to model accountability in a different way
Many shy away from dealing with inappropriate
behavioral problems
When leaders confront inappropriate behaviors they are
role-modeling accountability *sets the stage for peer-to-
peer engagement
AVOIDANCE OF
ACCOUNTABILITY
P. Lencioni, P. (2002).

21. Two things get in the way of achieving results:
Self-interest
Self-preservation
Team members who put their individual needs or the
needs of their department above the collective goals
make it difficult to achieve better overall results
Overall team performance should come first
Need connection between self-interest & getting results
INATTENTION TO RESULTS
P. Lencioni, P. (2002).

22. The distractions from collective results are:
1. Personal ego
2. Career development
3. Compensation
4. “My department”
INATTENTION TO RESULTS
P. Lencioni, P. (2002).

23. The role of the leader sets
tone for the focus on results
If team members sense that
the leader values anything
other than results, they will
take that as permission to do
the same for themselves
INATTENTION TO RESULTS
Lencioni, P. (2002).

24. There are five common pitfalls make up team dysfunction
Interrelate and build off one another
Either significantly hamper the success of a team or
paradoxically become foundation for crystallizing to
achieve great results
INTER-PROFESSIONAL
TEAM DYSFUNCTION

25. Testing and Developing
Understanding one’s
professional identity
Likely role within a team
Ideas about related health
professionals
INTER-PROFESSIONAL
TEAM CHALLENGES

26. Invalid assumptions:
May lead to breakdown in
communication + teamwork
May constitute barrier to effective
care
Research suggests:
Students rate communication +
teamwork skills positively
Were favorable about inter-
professional learning
INTER-PROFESSIONAL
TEAM CHALLENGES

27. SUMMARY
When teams build trust and engage in
constructive conflict then there is the
potential for building commitment and
accountability
Then the team can focus on meeting
and exceeding the goals and mission
Lencioni, P. (2002).

28. REFERENCES
P. Lencioni, The Five Dysfunctions of a Team- A
Leadership Fable (Jossey Bass, San Francisco, 2002).
D’Amour D & Oandasan I. (2005). Interprofessionality as
the field of interprofessional practice and
interprofessional education: An emerging concept.
Journal of Interprofessional Care. 19 (Supplement 1):8-
20.
http://www.youtube.com/watch?v=IqpT95TKum
Y&feature=relmfu