1. Breakdown within the
Healthcare Team
Amalia Cochran, MD, FACS, FCCM

2. Objectives
At the conclusion of this session, learners will be able to:
• Recognize the role of team breakdown in patient safety
• Identify characteristics of dysfunctional teams
• Understand structures that can enhance function of non-stable teams

3. Systematic sources of
preventable patient harm
 Lack of resources
 Malfunctioning technology
 Poor communication
 Administrative failure
 Disregard for safeguards and checklists
 Dysfunctional teams!

4. Is this your team?

5. Or is this your team?

6. Taking your team’s temperature
 Do your team members openly and readily disclose their opinions?
 Are your team meetings compelling and productive?
 Does your team come to decisions quickly and avoid getting bogged down by
consensus?
 Do your team members confront one another about their shortcomings?
 Do your team members sacrifice their own interests for the good of the team?

7. Characteristics of a dysfunctional team

8. Absence of Trust
 Conceal weaknesses and mistakes
 Hesitate to ask for help or feedback
 Hesitate to offer help
 Jump to conclusions without clarifications
 Fail to recognize and tap into skills and
experiences
 Waste time and energy managing behaviors
for image
 Hold grudges
 Dread meetings; avoid one another

9. Presence of Trust
 Admit weakness and mistakes
 Ask for help
 Accept questions and input
 Give one another the benefit of the doubt
 Take risks for one another
 Value and access one another’s strengths
 Focus on important issues
 Offer and accept apologies with ease
 Look forward to working as a group

10. Fear of Conflict
 Meetings are boring!
 Back-channel politics and personal
attacks are alive and well
 Controversial and important topics are
ignored
 Opinions and perspectives of team
members are disregarded
 Lots of posturing, interpersonal risk
management

11. Unafraid of Conflict
 Lively, interesting meetings
 Extract and exploit ideas of all team members
 Solve real problems quickly
 Minimize politics
 Put critical topics on the table

12. The Team that Fails to Commit
 Ambiguity about direction and priorities
 Watches windows of opportunity close
 Breeds lack of confidence/ fear of failure
 Revisits discussions and decisions again
and again and again and again and again
 Encourages second-guessing

13. The Committed Team
 Creates clarity of direction and purpose
 Aligns around common objectives
 Learns from mistakes
 Takes advantage of opportunities before
competitors do
 Moves forward without hesitation
 Changes direction without hesitation or
guilt

14. Avoidance of Accountability
 Creates resentment among team members
who have different standards of performance
 Encourages mediocrity
 Results in missed deadlines
 Places an undue burden on the team leader
 “The adult in the room”

15. Holding one another accountable
 Ensures that poor performers feel pressure to
perform
 Identifies potential problems quickly by
questioning one another
 Establishes respect among team members
who are held to the same high standards
 Avoids bureaucracy required to deal with
performance management and corrective
action

16. Inattention to results
 Stagnation/ failure to grow
 Rare “wins” against competitors
 Loses achievement-oriented employees
 Encourages team members to focus on their
own careers and goals
 Easily distracted

17. Focus on collective results
 Retain high-performance, achievement-
oriented employees
 Minimize individualistic behavior
 Enjoy success/ suffer failure acutely and
together
 Benefit from individuals who subjugate
their goals/ interests for team
 Avoid distractions

18. Team Competency Outcomes

19. Relatively unique challenge in healthcare
re: teamwork…

20. Facilitating “teaming” in Healthcare

21. Conceptual Model of Team “Scaffolds”

22. Attributes of team scaffolds

23. How can we build a more functional
team?

24. Little things matter
 Starting off meetings
 “Good things”
 Icebreakers may seem silly, but…

25. Trust-building exercise:
Personal Histories
 Questions:
 Where did you grow up?
 How many siblings do you have, and where in that order do you fall?
 Describe a unique or interesting challenge or experience from childhood
 Debrief as a group: What did you learn that you didn’t already know?
Requires 25-45 minutes

26. Providing Feedback:
Team Effectiveness Exercise
 Have each team member answer (in writing!) these two questions about each
member of the group:
 What is that person’s single most important behavioral quality contributing to
the strength of the team?
 What is that person’s single most important behavioral quality detracting from
the strength of the team?
 Allow for member responses to what people have said about them (Surprises?
Need for clarification?)
 Start with the team leader and work through all team members in turn
 After all input, each member should summarize one or two key “take-aways” that
they are going to work on
Requires 1-2 hours

27. Take-home messages
 Healthy teams are essential for patient safety and delivery of high-value care
 Leaders play a crucial role in team health
 Followers do too!
 Activities and exercises can build team trust….and other aspects of healthy team
function