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Dysfunctional teams

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Dysfunctional teams

  1. 1. Breakdown within the Healthcare Team Amalia Cochran, MD, FACS, FCCM
  2. 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. 3. Systematic sources of preventable patient harm  Lack of resources  Malfunctioning technology  Poor communication  Administrative failure  Disregard for safeguards and checklists  Dysfunctional teams!
  4. 4. Is this your team?
  5. 5. Or is this your team?
  6. 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. 7. Characteristics of a dysfunctional team
  8. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 18. Team Competency Outcomes
  19. 19. Relatively unique challenge in healthcare re: teamwork…
  20. 20. Facilitating “teaming” in Healthcare
  21. 21. Conceptual Model of Team “Scaffolds”
  22. 22. Attributes of team scaffolds
  23. 23. How can we build a more functional team?
  24. 24. Little things matter  Starting off meetings  “Good things”  Icebreakers may seem silly, but…
  25. 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. 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. 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

Editor's Notes

  • Team STEPPS framework includes a clear chain of command, situational awareness, shared mental models for communication
  • Frame the work
    Make it safe
    Build facilitating structures
  • ×