Collaborative teams toolkit mar 2009 dr shabon

Supporting New Leaders in
Developing Collaborative
Teams: A Toolkit

Updated January 2009

Ontario’s Community Ontario’s Community Ontario’s Aboriginal
Health Centres Family Health Teams Health Access Centres
Les centres de santé Équipes de santé familiale Centres Autochtones d’accès
communautaire en Ontario communitaire de l’Ontario aux soins de santé de l’Ontario

Table of Contents
Acknowledgments Pg. 3

Executive Summary Pg. 4

Introduction Pg. 5

Module 1: Leadership

A. Background Pg. 7
B. Leadership Concepts Pg. 7
C. Leadership Styles Pg. 7
D. Leadership Qualities Pg. 8
E. Challenges in Leading Teams Pg. 13
F. Power in Teams and Organizations Pg. 17
G. Leading Change Pg. 19
H. Best Practices in Leadership Pg. 21
Development
I. Resources Pg. 21
J. References Pg. 22

Module 2: Recruitment, Selection and Hiring
Practices that Support Interprofessional Teams
A. Background Pg. 23
B. Hiring Professionals with the Essential Pg. 24
Knowledge, Skills and Attributes
C. Resources Pg. 31
D. References Pg. 31

Module 3: Team Roles and Responsibilities
B. Team Definition Pg. 32
C. Dimensions of Team Roles Pg. 35

Module 4: Interpersonal Communications
B. Communication Styles Pg. 43
C. Active Listening Skills Pg. 45
D. Communication and Conflict Pg. 47
E. Gender and Communication Pg. 47
F. Culture and Communication Pg. 48
G. Giving and Receiving Feedback Pg. 48
H. Resources Pg. 50
I. References Pg. 51
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Module 5: Meetings
B. To Meet or Not to Meet Pg. 52
C. Resources Pg. 59

The information contained in this document is confidential and proprietary to the Association of Ontario
Health Centres (AOHC). Unauthorized distribution or use of this document or the information contained
herein is strictly prohibited. Requests for permission should be addressed to:

Association of Ontario Health Centres
970 Lawrence Ave. West, Suite 500
Toronto, Ontario M6A 3B6
Tel: (416)236-2539
Fax: (416)236-0431
Email: mail@aohc.org

2

Acknowledgments

The development of the training toolkit on the New Leaders in Developing Collaborative Teams involved
many committed and passionate individuals whose support and contribution were vital to the
production of this document. These include members of Davies/Ring Consulting, the Reference Group
and of AOHC Education and Development Team who brought invaluable expertise to the project.

Project Charter Group AOHC Education and Development Team

Michael Barkley Project Director:
Interim Executive Director Roohullah Shabon
Flemingdon Community Health Centre Director, Education and Development

Liben Gebremikael
Executive Director Project Manager:
TAIBU Community Health Centre Carolyn Poplak
Training Manager
Deborah Kanate
Manager
Dilico Family Health Team Team Members:
Sophie Bart
Lynne Poff Centre Development Team Lead
Executive Director
North Hastings Family Health Team Brian Sankarsingh
Clinical Management Systems Lead
Simone Thibault
Executive Director Sandra Wong
Centretown Community Health Centre Administrative Assistant

Davies/Ring Consulting
Lynda Davies
Laurienne Ring

In addition, we would like to thank all AOHC staff for their support and the representatives who shared
their lived examples, experiences, opportunities and challenges that helped bring these training tools to
life.

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Executive Summary
This toolkit is a resource for new leaders (administrative leads, executive directors) and for newly
emerging or emerged community-based healthcare organizations that are still in the process of hiring
leaders and staff, as well as satellite organizations and teams going through high employee and
management turnover. The focus of the toolkit is to provide information and guidance on how to build
and maintain an interprofessional primary healthcare team from the start with a united focus on
collaboration and team work.

This document is divided into five modules identified by the Reference Group as fundamental topics to
support new leaders in the building of collaborative teams. These modules include: Leadership;
Recruitment, Selection and Hiring Practices; Team Roles and Responsibilities; Communications I:
Interpersonal Communications; and Communication II: Meetings.

Each module addresses pivotal questions and provides useful and tangible activities that can be utilized
by new leaders forming interprofessional teams. The modules and activities can be used individually or
as a cohesive whole and each provides a background and a list of references and resources for further
research and elaboration.

For comments on this document and for workshops on team building and collaborative practice, please
contact:

The Education and Development Team
The Association of Ontario Health Centres
416-236-2539 ext. 230
education-development@aohc.org

4

Introduction
The Association of Ontario Health Centres (AOHC) is the policy and advocacy organization for non-
profit, community-governed, interprofessional primary healthcare services. AOHC is the public voice of
Community Health Centres (CHCs), Aboriginal Health Access Centres (AHACs) and Community Family
Health Teams (CFHTs). It believes that effective primary health care should address the social
determinants of health, including social inclusion, access to shelter, education, income and
employment, security, food and stable eco-systems. The Association engages in research, develops
policy and advocates in support of this community-centred primary healthcare model. AOHC’s member
centres are located throughout Ontario and AOHC works directly with communities that want
community-centred primary health care.

An initial comprehensive study on interprofessional care in the CHC sector was funded in August 2004
by the Primary Care Health Transition Fund (PCHTF). The study was developed based on the CHC
experience and used both quantitative and qualitative approaches to collect and analyze information
that would contribute to improving the effectiveness of primary health care teams. In 2007, AOHC
published the research document Building Better Teams: Learning from Ontario’s Community Health
Centres: A Report of Research Findings based on its innovative research done in the CHC sector. In
addition, a toolkit was developed in order to put the research findings into practice. Effective
workshops to support and strengthen teamwork among CHCs based on the research findings and
subsequent toolkit have since been successfully implemented across the sector.

The research and workshops provided on teamwork and collaboration prompted discussion by new
AOHC member organizations wishing to form collaborative teams. Some of the new leaders and
steering committees of over 21 CHCs, 28 satellites, and many emerging CFHTs requested support on
how to start an organization from scratch with strong interprofessional teams made up of members
willing to commit and advocate for collaboration. While Building Better Teams provides excellent
resources and tools on how to work with already established teams; emerging organizations were
looking for support on how to lay the groundwork to develop an interprofessional primary healthcare
team practicing within a collaborative framework. Leaders were also requesting guidance on how to
implement this framework even before the team (and often before the executive director) is hired.

Questions raised by new leaders included: What leadership concepts are relevant to leading
collaborative or interprofessional teams? What are the essential knowledge skills and attributes
required for a person to work effectively within an interprofessional team? How do I recruit team
players? What are the roles and responsibilities of team members? How do we communicate efficiently
and effectively from the beginning?

A Reference Group made of both new and seasoned leaders representing AOHC members was
developed to guide AOHC’s Education and Development Team in addressing the issues and concerns
faced by new leaders in the building of collaborative teams. We acknowledge that CHCs, CFHTs, and
AHACs have similar functioning in terms of team work and team development. And so, this toolkit was
developed to support all AOHC member organizations in developing strong teams from the start.
Davies/Ring Consulting, part of the collaborative effort behind the Building Better Teams toolkit, co-
authored the five modules presented in this toolkit. This toolkit is a starting point for new leaders.

A Note on the Terminology:

We are seeing a transition in the literature on collaborative care from the use of the term
interdisciplinary to interprofessional. Building Better Teams acknowledged the distinct use of the two
terms in 2007,1
Interdisciplinary implies a deeper degree of collaboration between team members. It implies an
integration of the knowledge and expertise of several disciplines to develop solutions to complex

1
Davies Lynda, Ring Laurienne. Building Better Teams: A Toolkit for Strengthening Teamwork in
Community Health Centres: Resources, Tips, and Activities you can Use to Enhance Collaboration, June
2007. Toronto: Association of Ontario Health Centres. Pg. 2

5

problems in a flexible and open-minded way. This type of team shares ownership of common goals and
has a shared decision-making process. Members of interdisciplinary teams must open territorial
boundaries to provide more flexibility in the sharing of professional responsibilities in order to meet
client needs.

Interprofessional is the term used more recently and is seen as best reflecting a practice that promotes
the active participation of several healthcare disciplines and professions who work collaboratively with
patient-centred care as a focal point. When all members coalesce around the client, professional
paternalism and traditional methods of intervention can be minimized. It includes healthcare providers
learning to work together, sharing in problem solving and decision making to the benefit of patients.

The term interprofessional has entered the primary health care field and is now being utilized by
organizations to define teams of mixed health-care professionals working collaboratively under a unified
vision to help improve the delivery of care and health outcomes. We acknowledge that interprofessional
refers to all team players from the management, clinical, administrative, and health promotion fields.
According to the Health Force Ontario website,2 interprofessional care is defined as:

The provision of comprehensive health services to patients by multiple health-care
professionals who work collaboratively to deliver the best quality of care in every
health care setting. Interprofessional care encompasses partnership, collaboration
and a multi-disciplinary approach to enhancing care outcomes.

The term interprofessional has been used throughout this document.

2
http://www.healthforceontario.ca/WhatIsHFO/AboutInterprofessionalCare.aspx
6

MODULE 1
Leadership

A. Background

Leadership in organizations is “the ability to influence, motivate, and enable others to contribute toward
the effectiveness and success of the organizations of which they are members.”3 In community-based
primary health care, staff members may be leaders in developing programs that are responsive to
community and client needs, lead the implementation of changes that are expected to improve client
access or health outcomes. They may provide leadership in group processes such as developing
stronger interprofessional teams.

This module provides you with ideas for developing your leadership and those in your teams. The
questions addressed here include:
 What leadership concepts are relevant to leading collaborative or interprofessional teams?
 What qualities or styles are important for leaders?
 What skills do team leaders need?
 What are the particular challenges in leading interprofessional teams?

B. Leadership Concepts

Over the last decade, there has been a deepening understanding of leadership concepts applicable to
leadership in general and to leading in team and collaborative settings. Leadership is now viewed as
actions that integrate personal style factors such as our strengths and self awareness with factors
related to the situation or environment we find ourselves in. Whether you have formal or informal
leadership responsibilities, you will find leadership concepts that can help you to consider the kind of
leader you are—or want to become.

Past models of leadership often reinforced leadership as a stereotypical set of charismatic, assertive
qualities that were innate. We know now that people from a wide variety of backgrounds, disciplines,
organizational positions and possessing a variety of personal qualities can learn to be effective leaders.
Learning has emerged as an important quality that effective leaders share. Leaders are able to learn
their way through new situations.

C. Leadership Styles

Leadership style has popularly been viewed as a combination of personal qualities such as charisma
combined with a management style such as those classified according to the degree of control or
autonomy a manager might display along a continuum of authoritarian, democratic or laissez-faire
leadership behaviour.4 Early ideas about leadership examined the transaction between the leader and
followers. Three newer approaches to leadership styles incorporate broader, more inclusive ideas about
leadership. Those highlighted here are known as transformational, constructivist and situational
leadership.

i. Transformational leadership

Transformational leadership refers to a leadership style that honours human relationships while
achieving organizational goals. This style contrasts with transactional leadership, where the human
relationship between leader and followers was an instrumental one, important in so far as a relationship

3
McShane, S. (2004) Canadian Organizational Behaviour, p.400
4
Shulman, L. (1993) Interactional Supervision. Washington: National Association of Social Workers Press
7

helped the leader to motivate organizational members to achieve organizational goals. Many successful
leaders have rejected the manipulative tendency within this style and favour a more authentic approach
in their interactions. Transformational leadership views the relationship as an important end in itself
and acknowledges that “leadership is a relationship.”5 Transformational leaders intend to facilitate each
individual’s growth and development and believe that when individuals are working towards worthwhile
personal goals in concert with shared team or organizational goals, the congruency unleashes powerful
energy that is available to teams and organizations. The transformational leader seeks to inspire others
to work towards shared goals using shared values. Values such as respect, personal integrity, credibility
and trust are viewed as essential qualities in this style, where “the ultimate in disrespect of individuals
is to attempt to impose one’s will on them without regard for what they want or need and without
consulting them. To behave paternalistically toward followers—even for their own good—is to deny
them the basic right of individual dignity.”6 Transformational leadership with it’s respect for people and
emphasis on values such as trust, authenticity, and credibility often resonates with people in the
helping professions due to the congruency with the aims and values of community health initiatives.

ii. Constructivist leadership

Constructivist leadership emerged from the education sector based on learning theories that
acknowledge that everyone - whether student or teacher - learns in context. Learning, including
learning as a member of a workplace community, is affected by social factors such as culture, race and
economic status. Constructivist leadership views colleagues and practitioners as members of a
collective effort, where learning is facilitated by reflecting together and results in shared knowledge. As
in transformational leadership, relationship plays a central role in leadership. Leadership is viewed as
facilitating transformation through “reciprocal, purposeful learning in community.”7 The learning
community becomes the site for change and growth by creating the connections that “form the basis
for reflecting on and making sense of who we are and how we work. Relationships may well be the
most important factor…”8 The constructivist leader builds opportunities for the developing shared
meaning.

iii. Situational Leadership

Situational leadership acknowledges that no one personal style is the right style for all situations or
contingencies. Situational leadership suggests that rather than rely on personal preference, leaders
need to consider situational factors such as the stage of group and team development, experience of
the people involved, and novelty of the situation and adjust their personal style to provide the kind of
leadership best suited to these contingencies. Leaders are effective when they “seek to understand
demands and constraints, and they adapt their behaviour accordingly.”9 This style is also congruent
with team development and the need to draw on the leadership abilities of all team members over time
or in different situations. As teams become more experienced they can become more fluid in their
leadership roles, selecting the person most suited to the situation to lead on a particular initiative.
Opportunities for shared leadership can be personally enriching and a source of developmental
opportunities that help to meet members’ needs for growth and experience.

D. Leadership Qualities

Authors Kouzes and Posner have researched leadership behaviour for over twenty-five years and have
published their results in one of the leading guides to leadership development, The Leadership
Challenge. Their research and recommendations have resonated with many people in the caring
professions.

5
Kouzes, J. and Posner, B. (2007) The Leadership Challenge (4th ed.) p. 27.
6
O’Toole, J. (1996) Leading Change: the Argument of Values-Based Leadership. New York: Ballantine Books. p. 12.
7
Lambert, L.; Walker, D.; Zimmerman, D.; Cooper, J, Dale Lambert, M., Gardner, M., Szabo, M. (2002). The Constructivist
Leader (2nd ed.) Teacher’s College Press, Columbia University. New York, New York.
8
Lambert, Lambert, L.; Walker, D.; Zimmerman, D.; Cooper, J, Dale Lambert, M., Gardner, M., Szabo, M. (2002). The
Constructivist Leader (2nd Ed.) Teacher’s College Press, Columbia University. New York, New York. p. xvii.
9
Yukl, G. (2002) Leadership in Organizations Custom Edition for LT 516. Victoria: Royal Roads University (p. 216)
8

Their results indicate that the qualities most admired in leaders have remained stable across their years
of researching leadership and are validated by the data they have gathered in Canada.

i. Characteristics of Admired Leaders10
 Honest  Cooperative  Fair-minded  Mature
 Forward looking  Courageous  Straightforward  Ambitious
 Inspiring  Determined  Broad-minded  Loyal
 Competent  Caring  Supportive  Self-controlled
 Intelligent  Imaginative  Dependable  Independent

Using these qualities they have generated five practices of exemplary leadership along with
commitments that accompany each practice.

1. Model the Way
This practice is supported by modeling the behaviour you expect to see in others. This includes the
practices of clarifying and articulating your own and the organization’s values.

2. Inspire a Shared Vision
This practice is supported by developing a positive and compelling vision of the future and inspiring
others to work with you towards this vision.

3. Challenge the Process
This practice is supported by facing challenges and leaving the status quo by trying something new,
facilitating innovation taking the risk toward growth.

4. Enable Others to Act
This practice is supported by the skills of collaboration and building trusting working relationships with
others.

5. Encourage the Heart
This practice is supported by recognizing the difficulties along the way and offering genuine caring and
appreciation.

An assessment tool adapted to health professionals from the practices they recommend can be
accessed from http://www.hsc.mb.ca/leadership/?mode=view&id=141

For an assessment from a different perspective, consider the questions in this tool as an example of
how you can introduce a constructivist approach to inquiry, shared reflection, knowledge generation
and meaning making in building a leadership community.

10
Kouzes, J. and Posner, B. (2007) The Leadership Challenge (4th ed). Jossey- Bass (p. 30)
9

ii. Assessment Questions11

1. Do you have opportunities to participate in leadership in this centre (or team)?
2. How skillful do you feel you are in your collaborative work with colleagues? What are
your areas of strength? Areas for growth?
3. Do we work together collaboratively? If so, please offer examples.
4. Are the purpose and core values of our centre (team) clear? How would you
personally describe them?
5. How do we use data to improve client and community outcomes?
6. How do you think we are doing with regard to client or health outcomes? What added
value do we bring to our clients’ lives?
7. Can you think of an occasion when we have posed our own questions and sought our
own answers about practice and effectiveness?
8. Are there other opportunities for reflective practice (such as coaching, writing, and
dialogue) that we might look into?
9. What management actions have encouraged and supported the above work? In what
ways has the Health centre (team) supported our efforts to build leadership capacity?
10. As you reflect upon these questions, are there other comments that you would like to add?

Leadership roles and actions are synthesized from a wide variety of historical and theoretical
perspectives in the list below. The following functions “can be performed by any member of the
organization, but they are especially relevant for the designated leader.”12

iii. The Essence of Effective Leadership

1. Help Interpret the Meaning of Events
Helping people to find meaning in complex events is important, especially when the pace of change is
accelerating and touches every part of our lives. Effective leaders help people to interpret events,
understand why they are relevant, and identify emerging threats and opportunities.

2. Create Alignment on Objectives and Strategies
Effective performance of a collective task requires considerable agreement about what to do and how to
do it. Helping to build consensus about these choices is especially important in newly formed groups
and in organizations that have lost their way. Effective leaders help to create agreement about
objectives, priorities and strategies.

3. Build Task Commitment and Optimism.
The performance of a difficult, stressful task requires commitment and persistence in the face of
obstacles and setbacks. Effective leaders increase enthusiasm for the work, commitment to task
objectives, and confidence that the effort will be successful.

4. Build Mutual Trust and Cooperation
Effective performance of a collective task requires cooperation and mutual trust, which are more likely
when people understand each other, appreciate diversity, and are able to confront and resolve
differences in a constructive way. Effective leaders foster mutual respect, trust, and cooperation.

11
Adapted from: Lambert, L. (2003). Leadership Capacity for Lasting School Improvement. Association for Supervision and
Curriculum Development. Alexandria, Virginia.
12
Yukl, G. (2002) Leadership in Organizations Custom Edition for LT 516 Victoria: Royal Roads University. p. 231-232.
10

5. Strengthen Collective Identity
The effectiveness of a group or organization requires at least a moderate degree of collective
identification. In this era of fluid teams, virtual organizations, and joint ventures, boundaries are often
unclear and loyalties divided. Effective leaders help to create a unique identity for a group or
organization, and they resolve issues of membership in a way that is consistent with this identity.

6. Organize and Coordinate Activities
Successful performance of a complex task requires the capacity to coordinate many different but
interrelated activities in a way that makes efficient use of people and resources. Effective leaders help
people get organized to perform collective activities efficiently, and they help to coordinate these
activities as they occur.

7. Encourage and Facilitate Collective Learning
In a highly competitive and turbulent environment, continuous learning and innovation are essential for
the survival and prosperity of an organization. Members must collectively learn better ways to work
together toward common objectives. Effective leaders encourage and facilitate collective learning and
innovation.

8. Obtain Necessary Resources and Support
For most groups and organizations, survival and prosperity require favourable exchanges with external
parties. Resources, approvals, assistance, and political support must be obtained from superiors and
people outside of the unit. Effective leaders promote and defend unit interests and help to obtain
necessary resources and support.

9. Develop and Empower People
To be successful, a group or organization usually needs active involvement by members in solving
problems, making decisions, and implementing changes. Appropriate skills must be developed to
prepare people for leadership roles, new responsibilities, and major change. Effective leaders help
people develop essential skills and empower people to become change agents and leaders themselves.

10. Promote Social Justice and Morality
Member satisfaction and commitment are increased by a climate of fairness, compassion, and social
responsibility. To maintain such a climate requires active efforts to protect individual rights, encourage
social responsibility, and oppose unethical practices. Effective leaders set an example of moral
behaviour, and they take necessary actions to promote social justice.

With the emphasis on relationships in leadership, there has been attention to the competencies
associated with emotional intelligence as important for effective leadership. The following tool was
designed to assess the emotional dimensions of leadership.

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iv. Leadership Skills: Rate Yourself13

The best leaders have strengths in at least a half-dozen key emotional –intelligence competencies out
of 20 or so. To see how you rate on some of these abilities, asses how the statements below apply to
you. Although getting a precise profile of your strengths and weaknesses requires a more rigorous
assessment, this quiz can give you a rough rating, Most important, we hope it will get you thinking
about how well you use leadership skills—and how you might get better at it. Answer (put a check)
“Seldom” to those statement with which you Seldom Agree “Occasionally “ with which you Occasionally
Agree, “Often” with which you Often Agree and “Frequently” with which you Frequently Agree.

Statement Seldom Occasionally Often Frequently
1. I am aware of what I am
feeling
2. I know my own strengths and
weaknesses.
3. I deal calmly with stress.
4. I believe the future will be
better
than the past.
5. I deal with changes easily.
6. I set measurable goals when I
have a project.
7. Others say I understand and
am
sensitive to them.
8. Others say I resolve conflicts.
9. Others say I build and maintain
relationships.
10. Others say I inspire them.
11. Others say I am a team
player.
12. Others say I helped to
develop
their abilities.
Total the number of checks in
each column:
Multiply that number by X1 X2 X3 X4
Total the score for each column:
Add the 4 column scores to get
your TOTAL Score:

Scoring:
36+ Suggests you are using key leadership skills well—but ask a co-worker or partner for their opinions
to be more certain.
30-35 Suggests some strengths and also some underused leadership abilities.
29 or less Suggests unused leadership abilities and room for improvement.

13
From Goleman, D, (2002) cited in Grossman, S. & Valiga, T. (2005) The New Leadership Challenge: Creating the Future of
Nursing, (2nd ed) Philadelphia, PA: F.A. Davis.
12

E. Challenges in Leading Teams

This section reviews some of the most frequently mentioned challenges found in interprofessional
primary health care practice. These include maintaining a focus on both the task and interpersonal
aspects of team work. Another ongoing challenge for leadership within primary health care teams
include frictions associated with various aspects of power along with the need for frequent change and
adaptation. The module concludes with recommended practices for leadership development.

As teams develop trust and confidence, leadership within teams often becomes more shared, with less
reliance on the formal leader. This can provide great opportunities for enrichment for all team members
and can set the tone for collaborative leadership that utilizes the skills of all members. There are also
challenges for team leadership. Recent research in Ontario community health centres identified five
leadership challenges to primary heath care team work. These were “unfair treatment of certain staff or
projects; closed or unapproachable leadership style; inappropriate workload assignment; lack of
understanding of the CHC philosophy; and ineffective conflict management.”14

Power imbalances and role confusion often emerge in interprofessional teams. In the module on team
work, it was noted that role confusion occurs within teams due to factors such as the overlapping roles
of the professions and the sometimes contradictory messages embedded in policy positions. While it is
promoted as a best practice to develop leaders from within through the use of learning opportunities
and developmental assignments, a potential pitfall is a further contribution role confusion or
perceptions of lack of fairness in employment relations. This was expressed in recent research in the
community health sector where an example was provided where “a Nurse Practitioner in a peer leader
capacity may need to give direction to a Family Physician one hour and consult with the physician the
next hour about a patient.”15

In order to lead teams, effective team leaders are aware of the task, human relations needs and the
situational setting for the team. The following checklist incorporates the leadership dimensions of task
focus, awareness of interpersonal factors and situational elements for the leader to consider.

14
Bickford, J., Belle Brown, J., Moss, K., and Gillis, L. Challenges to Team Work in CHCs in Building Better Teams: Learning from
Ontario Community Health Centres: A Report of Research Findings, June 2007. Toronto: Association of Ontario Health Centres. p.
109.
15
Davidson, B. Leadership and Interdisciplinary Teams: Ontario Community Health Centres in Transition, in Building Better
Teams: Learning from Ontario Community Health Centres A Report of Research Findings, June 2007.(p. 206)
13

i. Effective Leader Checklist16

Please read the statements below. Circle the number that most accurately describes your response to
the statement. Use the following key to respond to each statement.
1. Disagree strongly
2. Disagree to some extent
3. Agree to some extent
4. Agree strongly

1. I avoid taking leadership assignments for which I do not have sufficient task-related knowledge.
1 2 3 4

2. I avoid taking leadership assignments for which I do not have the appropriate leadership style.
1 2 3 4

3. I am motivated to act as the leader for this team.
1 2 3 4

4. I am able to adjust my leadership style to meet the developmental needs of the team at a particular
point in time.
1 2 3 4

5. With a team in the early stages of development, I am a directive and confident leader.
1 2 3 4

6. I come to early team meetings with a clear, written agenda.
1 2 3 4

7. At early meetings, I am able to state the team’s goals clearly.
1 2 3 4

8. Especially at the beginning, I run meetings efficiently.
1 2 3 4

9. Early on, I am comfortable assigning tasks to individuals as necessary.
1 2 3 4

10. Early on, I am comfortable making decisions as needed.
1 2 3 4

11. In early meetings, I work to reduce member anxiety, fears of rejection, and concerns about safety.
1 2 3 4

12. I treat members sensitively and fairly.
1 2 3 4

13. I address members by name and make sure members know each others’ names from the
beginning.
1 2 3 4

14. I try not to put individuals on the spot, especially in early meetings.
1 2 3 4

15. I encourage members to participate, but I don’t demand participation.
1 2 3 4

16
Whelan, S. (1999) Creating Effective Teams A Guide for Members and Leaders. Thousand Oaks: Sage Publications. p. 89-92.
14

16. I give lots of positive feedback to the team and to individuals.
1 2 3 4

17. I facilitate open discussion of team goals, values and tasks.
1 2 3 4

18. I encourage the expression of different opinions.
1 2 3 4

19. When members are having difficulty expressing different opinions, I use methods to elicit opinions
anonymously.
1 2 3 4

20. I facilitate member feelings of competence by providing supervision, training, and education in
task-related activities when necessary.
1 2 3 4

21. I facilitate member feelings of competence by providing supervision, training, and education in
group participation skills when necessary.
1 2 3 4

22. I set high performance standards from the beginning.
1 2 3 4

23. I review quality expectations early and often.
1 2 3 4

24. I review standards for member and leader participation as well.
1 2 3 4

25. Initially, I negotiate with other groups and external individuals for needed resources.
1 2 3 4

26. Initially, I buffer the team from excessive external demands.
1 2 3 4

27. Initially, I scan the rest of the organization to collect information that might be useful to the team.
1 2 3 4

28. Initially, I report team progress to others to ensure that the rest of the organization has a positive
image of the team.
1 2 3 4

29. When members begin to demand more participation in running the team, I slowly begin to
empower them to take it.
1 2 3 4

30. I expect challenges to my authority and see them as a sign of team progress.
1 2 3 4

31. I try not to take attacks and challenges personally.
1 2 3 4

32. I facilitate open discussion and resolution of conflicts that emerge.
1 2 3 4

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33. I encourage the use of effective conflict resolution strategies.
1 2 3 4

34. As the team matures, I increasingly involve members in the leadership function of the team.
1 2 3 4

35. I encourage and support member efforts to share in the leadership function of the team.
1 2 3 4

36. I encourage the team to make any necessary changes in the team’s structure that will facilitate
team productivity.
1 2 3 4

37. When a team is fully functional, I act more as an expert member than as a leader.
1 2 3 4

38. I continue to monitor team processes, especially for signs of regression.
1 2 3 4

39. I ask for organizational support reviews on a regular basis.
1 2 3 4

40. Regardless of the stage of the team, I follow guidelines for effective team membership as well as
the guidelines for effective leadership.
1 2 3 4

Minimum Score: 40
Maximum Score: 160
My Score: ______

16

F. Power in Teams and Organizations

From an organizational perspective, power is “the capacity of a person, team or organization to
influence others.”17 Power in teams is composed of several factors that include the degree to which the
team members are dependent on one another to complete their work, how important the person or
team is to completing needed tasks and the sources of power available to the team. In health-care
teams we often see the manifestation of power in the professional roles of team members, where team
members perceive “that in practice, their profession had less power and therefore a weaker voice in the
organization.”18
Organizational literature considers five sources of power. Some power derives from the organizational
position of the person or team. Examples of this type of power are classified as legitimate, reward and
coercive power. The power from these sources flows from the role or position, regardless of who is the
role.

Legitimate power flows in an organization from the roles people fulfill- that according to documents
such as job descriptions, the person is perceived through mutual agreement to have power to request
actions from other members of the team.

Reward power derives from ability to allocate rewards within the organization. This includes obvious
rewards such as pay as well as promotion, development opportunities, assignments and time off.
Coercive power is the ability to be punitive in the organizational setting through such actions as the
ability to reprimand, discipline or terminate the employment of someone. It is also possible for teams to
apply coercive power, for example by using peer pressure to enforce conformity.

In addition to the power inherent in these organizational or professional roles, people or teams can
acquire power through personal expertise or qualities.
Expert power is found when a person or team builds up valuable knowledge and is then in a position to
influence others. Referent power comes from the high regard held by the person or team which others
can then identify with. Referent power could flow from having well developed interpersonal skills or
being viewed as trustworthy.
Power in organizations is also influenced by factors known as the contingencies of power. Power may
accrue to those roles or people where they cannot be substituted, are central to accomplishing the
tasks, have a high level of discretion about what actions to take or are highly visible.

Tensions regarding power in health care may stem from contingencies of power that flow from the high
regard health services providers are held in by the community as well as the centrality and non-
substitutability of professions roles. There is also a strong historical context to these tensions, where
“gender and social class issues have been factors in the friction and conflict that has existed between
professions until present day.”19

This activity provides an opportunity for you to examine your relationship to power. As a team, you can
reflect on your past experiences with power.

17
McShane. p. 344
18
Bickford, J., Belle Brown, J., Moss, K., and Gillis, L. Challenges to Team Work in CHCs in Building Better Teams: Learning from
Ontario Community Health Centres A Report of Research Findings, June 2007.(p. 109)
19
Hall, P. Interprofessional teamwork: Professional Cultures as Barriers in Journal of Interprofessional Care (May 2005)
Supplement 1: p. 188-196.
17

i. Past Experiences with Power20

Objectives:
1. To revisit experiences with power
2. To distinguish elements that contribute to positive or negative feelings about power
3. To create an initial foundation for further discussions of the concept of power

Materials needed:
Chart paper
Felt pens

Individually write down one example of a time when you observed or experienced power being used in
a positive or productive manner. You may have observed this in person, on television, from afar, or
actually used your power in this way. After you note this experience, write down what it was about this
experience that caused you to remember it as productive and positive?

Then, write down one example of a time when you observed or experienced power being used in a
negative, disrespectful or destructive way. Again, this may have been power observed or experienced
in person, on television or from afar. Note what caused you to remember this experience as negative.

In your [small] group, share the details and reactions to both of these experiences. On one piece of
chart paper, collate the elements that comprised positive experiences. On another piece of chart paper,
collate the elements that comprised negative experiences. Each group will share its thoughts and
listings with the whole group and post. As a whole group, discuss whether the positive or negative
experiences have influenced your current views of power and why that might be.

20
McKinley, L. and Ross, H. (2008) You and Others Reflective Practice for Group Effectiveness in Human Services. Toronto:
Pearson Education.
18

G. Leading Change

Leading change is frequently a challenge for leaders. If you are the leader of a new initiative, health
centre or family health team you are likely leading a change of some kind. The need to respond to
community needs and a rapidly changing policy environment as well as the tremendous challenges to
the health-care system means that change may be occurring at many levels within an organization,
often simultaneously. To help you think about the kind of change you are leading and the supports that
could be used by team members, you can consider whether the change is developmental, transitional
or transformational.21

Developmental change aims to change an existing situation or process through enhancement. This
type of change may seek to improve communication, team work or implement an improvement such as
a new process or technique. In developmental change the goal or desired outcome of the change is
clear. The leader supports developmental change by providing information that shares the rationale for
the needed change and by assisting with the setting of new goals that stretch team members while also
ensuring that the resources and support for meeting the new goal are in place.

Transitional change is characterized by the need to “replace what is with something entirely
different.”22 This order of change requires leaders to recognize that something completely different is
required in order to respond to an opportunity or challenge. Examples of transitional change include the
introduction of new programs or implementing new technologies that are similar to existing ones.
Transitional change may not require high levels of change from the people involved or within the
workplace culture. The leader uses clear communication, participation of the affected people and their
control over the implementation to achieve the desired new state. The leader supports transitional
change by identifying the differences between the existing and desired outcomes. The leader can
facilitate the identification of anything that can be brought forward to serve the new situation, what will
have to be left behind or is no longer needed, and what new components will be created to complete
the new state. This type of change is often implemented with a parallel structure: one to keep existing
operations going and another to manage the stages of planning and implementing the required
changes.

The third type of change is transformational change. This type of change is marked by high levels of
uncertainty and complexity that will require attitude, behaviour and cultural changes from all involved.
The final result or outcome may not be known and the “scope of this change [is] so significant that it
requires the organization’s culture and people’s behaviour and mindsets to shift fundamentally in order
to implement the changes successfully and succeed in the new state.”23 In transformational change,
the result emerges from a chaotic or unstable state. The leader’s role in transformational change is to
monitor all sources of feedback to continually assess the process and direction of the change and adjust
the course to continue in the desired direction. The leader becomes an adept learner to interpret and
act on the feedback and facilitates learning in others.

21
Anderson, D and Ackerman Anderson, L. (2001) Beyond Change Management: Advanced Strategies for Today’s
Transformational Leaders. Jossey/Bass – Pfeiffer.
22
Anderson and Ackerman Anderson, p. 35.
23
Anderson and Ackerman Anderson, p. 39.
19

i. Determining the type of change required24
(Adapted from Anderson and Ackerman Anderson)

Instructions: determine the primary type of change you are leading by answering the “litmus test”
questions listed below. If you answer “yes” to two or more questions for one type of change, then that
is the primary type of change you are facing. Remember to think of the overall change that is
occurring, not the pieces within it. In most cases, all three types of change are occurring, but only one
is primary.

Developmental Change Questions
1. Does your change effort primarily require an improvement of your existing way of operating, rather
than a radical change to it?
2. Will skill or knowledge training, performance improvement strategies, and communications suffice to
carry out this change?
3. Does your current culture and mindset support the needs of this change?

Transitional Change Questions
1. Does your change effort require you to dismantle your existing way of operating and replace it with
something known but different?
2. At the beginning of your change effort, were you able to design a definitive picture of the new state?
3. Is it realistic to expect this change to occur over a pre-determined timetable?

Transformational Change Questions
1. Does your organization need to begin its change process before the destination is fully known and
defined?
2. Is the scope of the change so significant that it requires the organizations culture and people’s
behaviour and mindsets to shift fundamentally in order to implement the changes successfully and
achieve the new state?
3. Does the change require the organization’s structure, operations, products, services or technology to
change radically to meet the needs of clients, the community and policy environment?

Conclusions
1. Which of the three types of change is the primary type required?
2. Which of the other two types of change will also be needed to support this primary type? In what
ways?
3. What leadership skills and strategies will you need to draw upon to lead this change?

24
Anderson, D and Ackerman Anderson, L. (2001) Beyond Change Management: Advanced Strategies for Today’s
Transformational Leaders. Jossey/Bass – Pfeiffer. p. 48 & 49.
20

H. Best Practices in Leadership Development25

As a leader, you will also be interested in supporting the leadership development of others. You may
have responsibilities for contributing to a succession plan or may want to foster the ongoing
development of team members. Ideally, developing leaders within your centre will use a variety of
processes. The practices noted here will help you to plan leadership development for one person or to
create a leadership development program. A comprehensive approach to leadership development would
include:
 Technical knowledge of the field of practice
 Development of:
o Interpersonal judgement
o Self awareness
o Learning ability, to engage in problem solving
 Developmental experiences

A strong program acknowledges that much learning of leadership and management skill occurs through
experience. Developmental experiences should play a central role in your program. These experiences
would be supported by including elements of assessment, challenge and support. Feedback, training
and specific job assignments can also be incorporated.

Coaching and mentoring relationships also play an important role in supporting leadership
development.

I. Resources

Kouzes and Posner have recently published the 4th edition of The Leadership Challenge. More
information about their work, research methodology and companion publications can be found through
their website. A great place to start is with their Recommended Reading page at:
http://www.leadershipchallenge.com/WileyCDA/Section/id-131341.html

The online assessment tool for nurses (suitable for other healthcare professionals) based on their
practices of exemplary leadership is available at:
http://www.hsc.mb.ca/leadership/?mode=view&id=141

Other resources of interest include:
Nursing Leadership Network of Ontario:
http://www.nln.on.ca/
Leadership development for physicians:
http://www.hpme.utoronto.ca/about/conted/plp.htm
Collaborative leadership in public health:
http://www.collaborativeleadership.org/
http://www.collaborativeleadership.org/pages/tools.html

For an excellent summary of leadership theories and contemporary developments, see Chapter One in
Carroll, P. (2006) Nursing Leadership and Management: A Practical Guide. New York: Thomson Delma
Learning.

25
Groysberg, B. and Cowen, A. (2006) Developing Leaders. 9-407-015. Boston: Harvard Business School Publishing.
21

J. References

Anderson, D. and Ackerman Anderson, L. (2001) Beyond Change Management: Advanced Strategies for
Today’s Transformational Leaders. Jossey-Bass – Pfeiffer.

Bickford, J., Belle Brown, J., Moss, K., and Gillis, L. Challenges to Team Work in CHCs in Building Better
Teams: Learning from Ontario Community Health Centres: A Report of Research Findings, June
2007. Toronto: Association of Ontario Health Centres.

Davidson, B. Leadership and Interdisciplinary Teams: Ontario Community Health Centres in Transition,
p. 206 in Building Better Teams: Learning from Ontario Community Health Centres: A Report of
Research Findings, June 2007. Toronto: Association of Ontario Health Centres.

Goleman, D, (2002) cited in Grossman, S. & Valiga, T. (2005) The New Leadership Challenge: Creating
the Future of Nursing, (2nd ed) Philadelphia, PA: F.A. Davis.

Groysberg, B. and Cowen, A. (2006) Developing Leaders. 9-407-015. Boston: Harvard Business School
Publishing.

Hall, P. Interprofessional Teamwork: Professional Cultures as Barriers in Journal of Interprofessional
Care (May 2005) Supplement 1: p. 188-196.

Kouzes, J. and Posner, B. (2007) The Leadership Challenge (4th ed). Jossey-Bass p. 30.

Lambert, L.; Walker, D.; Zimmerman, D.; Cooper, J, Dale Lambert, M., Gardner, M., Szabo, M. (2002).
The Constructivist Leader (2nd ed.) Teacher’s College Press, Columbia University. New York,
New York.

Lambert, L. (2003). Leadership Capacity for Lasting School Improvement. Association for Supervision
and Curriculum Development. Alexandria, Virginia. p. 30.

McKinley, L. and Ross, H. (2008) You and Others Reflective Practice for Group Effectiveness in Human
Services. Toronto: Pearson Education. p. 118.

McShane, S. (2004) Canadian Organizational Behaviour (5th ed). McGraw-Hill Ryerson. p. 400.

O’Toole, J. (1996) Leading Change: The Argument for Values-Based Leadership. New York: Ballantine
Books. p. 12.

Shulman, L. (1993) Interactional Supervision. Washington: National Association of Social Workers
Press. p.228-229.

Whelan, S. (1999) Creating Effective Teams A Guide for Members and Leaders. Thousand Oaks: Sage
Publications. p. 89-92.

Yukl, G. (2002) Leadership in Organizations Custom Edition for LT 516. Victoria: Royal Roads
University. p. 216; p. 231-232.

22

MODULE 2
Recruitment, Selection and Hiring Practices

A. Background

One of the foundations of Primary Health Care Reform in Canada has been a focus on teams of
professionals as the basis of care provision. A recent federal policy paper has suggested that,

A healthcare system that supports effective teamwork can improve the quality of patient
care, enhance patient safety and reduce workload issues that cause burnout among
healthcare professions. (CHSRF, 2006)

There is mounting evidence (Health Force Ontario, 2007) in Canada that an interprofessional care
environment may offer multiple benefits including:
 increased access to health care
 improved outcome for people with chronic diseases
 less tension and conflict among caregivers
 better use of clinical resources
 easier recruitment of care givers
 lower rates of staff turnover

Given the move toward interprofessional teams across the health-care system, education initiatives
regarding interprofessional care are being undertaken within Canadian Colleges and Universities that
provide education for healthcare professionals.(D’Armour, &. Oandasan, 2005).

Future health-care professionals will be required to acquire the knowledge, skills and attributes needed
for interprofessional care. It has been recommended that a set of competencies be developed to guide
the education of health-care professionals. It is hoped that the development of a common competency
framework will provide guidance regarding the knowledge, skills, competencies and attributes required
to practice interprofessional care. (Health Force Ontario, 2007)

In the mean time, new primary health-care teams are forming and health-care professionals are being
hired to work within them. This module is intended to be of assistance to those leaders of primary
health care organizations and/or teams who have the responsibility for recruiting, selecting and hiring
staff members who will contribute actively to the development of effective primary health care teams.
The research on interprofessional teams conducted by the Association of Ontario Health Centres found
that ‘hiring for fit’ was a good practice within community health centres: “the findings emphasized the
importance of making hiring decisions based on the philosophy of the CHC in order to insure a fit with
its values” (Laiken et al, 2007. p. 127)

The questions that will be addressed in this module:
 What are the essential knowledge skills and attributes required for a person to work effective
within an interprofessional team?
 How might a position/job advertisement be written to attract a pool of candidates with the
knowledge skills and attributes required?
 What questions might be asked in an interview that would assist the interview panel to assess
the candidate’s knowledge skills and attributes?
 What questions would assist a candidate with the necessary knowledge, skills and attributes to
demonstrate those?
23

 What types of people might the hiring committee ask the candidate’s permission to speak to as
references? What questions might the references be asked?
 What language in an employment letter might reinforce the importance of interprofessional
care?

The module is not intended to be an extensive resource on general standards of practice for hiring
personnel nor the legal and regulatory aspects of hiring. Those who are seeking general hiring
information are directed, as a starting place to the resource section of this module.

B. Hiring Professionals with The Essential Knowledge, Skills and
Attributes
There is a growing amount of evidence that there are several essential qualities required for people to
participate effectively in interprofessional teams. A recent review of empirical studies (San Martin
Rodriguez et al, 2005) concludes, that in order for a healthcare professional to work effectively as
member of an interprofessional team she/he would need to:
 Be willing to commit to a collaborative process
 Be able to establish relationships built on trust
 Demonstrate skills in interpersonal communication
 Have developed respect and recognition for the contributions of other professions to the team
While a set of competencies has yet to be developed at the policy and post secondary education levels,
there has been a fair amount of work completed, much of it in Canada, to identify and articulate the
essential competencies. The next section outlines one set of suggestions that have been made
regarding the competencies necessary for collaboration.

i. Collaborative competencies26

Describe one’s role and responsibilities clearly to other professions.

Recognize and observe the constraints of one’s role, responsibilities, competence, yet perceive needs in
a wider framework.

Recognize and respect the roles, responsibilities and competences of other professions in relation to
one’s own.

Work with other professions to effect change and resolve conflict in the provision of care and treatment.

Work with others to assess plan, provide and review care for individual clients.

Tolerate differences, misunderstandings and short comings in other professions.

Facilitate interprofessional case conferences and team meetings.
Enter into interdependent relationships with other professions.

Given the importance now placed on interprofessional care and the necessary knowledge, skills and
attributes, an emphasis on these issues during the hiring process is well warranted. Even before the
interviews, some attention to the position/job advertisement can assist your organization in attracting
the most appropriate pool of candidates. An example of an advertisement that contains references to
interprofessional care is in the next section.27

26
Oandasan, Ivy & Reeves, Scott. (2005)
27
This position advertisement was developed following a review of several position advertisements for primary health care teams
posted www.charityvillage. in July /Aug 2008.
24

ii. Job Posting: Registered Nurse

The your organization is an interprofessional CFHT,CHC,AHAC providing access to primary health care
to a diverse group of clients in an urban area that has been chronically under served. We have an
opening for a Registered Nurse (1.0 FTE – 12 month contract). The Registered Nurse (RN) reports to
the Executive Director.

Responsibilities:
 Delivering comprehensive nursing care in a primary care family practice setting as established
by the standards of nursing practice of the College of Nurses of Ontario.
 Provides safe and competent care through the application of nursing knowledge, the technical
aspects of professional practice and the demonstration of compassion, professionalism and
critical thinking.
 Responsible to provide a variety of modalities of client care (telephone assessment, home visits,
group education sessions, well baby clinics, geriatric assessments, diabetic teaching, pregnancy
planning and contraception, immunization, counseling and program development)
 Responsible for assessment, nursing diagnosis, integrated care plan development,
implementation and evaluation of nursing care.
 Responsible for the provision of primary health care services through effective collaboration with
the other members of the health care team.

Qualifications:
 Registered with the College of Nurses of Ontario.
 Bachelors Degree in Nursing required.
 Current Basic Cardiac Life Support (BCLS) and Cardio-Pulmonary Resuscitation (CPR) certificate
required. Advanced Cardiac Life Support (ACLS) Certification will be considered an asset.
 Experience working in a family practice or primary health care setting required.
 Minimum five (5) years experience in utilizing the nursing process in planning, implementing and
evaluating patient care.
 Experience in oral/point of care anticoagulation, chronic disease management, telephone triage
and clinical nursing skills required.

Competencies:
 Good attendance and work record.
 Knowledge and proficiency in current, evidenced-based methods and practices of primary care
delivery, with an emphasis on health promotion and risk reduction.
 Superior leadership, organization, research, evaluation, time management and interpersonal
skills.
 Willingness to commit to a collaborative model for the provision of primary health care services
that recognizes and values the contributions of all members of the interprofessional team.
 Proficiency in the use of the computer hardware and software, particularly in Microsoft Word,
Excel and Outlook, knowledge of electronic medical record Excellent verbal and written
communication skills.
 Experience in the development of effective linkages with other health, social service and
education agencies as appropriate.
 Experience in working with a diverse population.

25

 Excellent client assessment skills.
 Ability to function in a multi-tasking fast paced environment.
 Able to work independently and as an effective member of an interprofessional team

Once the applications have been received and a short listing process undertaken, the interviews will
take place. Asking questions of candidates that allow the candidate to present their skills and
knowledge and the interview panel to assess the candidate’s knowledge and skills and ‘fit’ is as much
an art as a science. The questions provided here are meant to be examples that could be used. The
questions can be modified, edited, made simpler or more complex based on your particular context and
needs. It is an effective method to have the hiring committee, which ideally will be made up of a
variety of health professionals (Laiken et al, 2007), spend some time discussing these questions and
deciding together what questions to ask in the interview. You will be able to ask only one or perhaps
two questions regarding the person’s skill in collaboration, so the questions need to be the best ones for
your setting and context. This type of discussion and group decision making models the collaborative
approach to decision making that is most appropriate to fostering effective team work.

26

iii. Suggestions for Interview Questions28

Questions What to look for

Can you tell us about a time when you Look for experience working with groups
were able to gain commitment from or teams and an awareness of the
others and motivate them to work contribution of everyone to the team’s
together to achieve goals work. Look for awareness that people
need to be involved in decisions and
processes that will affect them.

How have you helped/participated in Look for insight and/or understanding
building rapport in teams? from the person as to how she or he has
personally contributed to effective team
work. (perhaps through practices such
interpersonal communication, valuing the
contribution of others, helping to resolve
conflicts)

As the (insert job title) you will need to Look for ability to see both task/activities
take a lead role in (insert key job and processes that would need to take
expectation). How would you see place.
yourself working and relating to other
professions, disciplines, teams and Look for awareness of interdependence
managers within the organization? of people in the organization,
communication, trust building, involving
What strategies would you use to move all those affected in decision making.
forward to meet these expectations?

Two staff people have indicated to you Look for understanding of the importance
that they believe there are some of valuing the diversity of knowledge,
positions within the team that are not as skills and experience in an
respected or valued as others. What interprofessional team
strategies might you use to address
these concerns? Look for problem solving and the
importance of involving the whole team
in resolving the concerns.

What has been your experience working Look for awareness and/or experience in
as a member of a team? Based on these developing trusting relationships,
experiences, what do you think are the establishing good interpersonal
key elements of successful teamwork? communication skills, and a willingness
What are the challenges to effective to address conflict.
teamwork?
Look for knowledge that effective teams
need a shared vision, a common
purpose, open communication, conflict
resolution mechanisms and individual as
well as team accountability.

Can you give an example of how you Look for collaborative communication and
worked to resolve a dispute with another conflict styles, rather than a
provider regarding the care of a client? competitive/win lose style; look for an

28
Thanks to Ms. Lynne Raskin of South Riverdale Community Health Centre Health Centre and Dr. James Read of the Sherbourne
Family Health Team for providing examples of the questions they have used in hiring processes. Their questions formed a starting
point for this guide.
27

appreciation of the other’s role and
accountabilities, look for democratic
rather than hierarchical problem solving
attitudes and skills.

All organizations have a unique culture. Look for an appreciation that trusting
What strategies have you used in the relationships take time and require
past as a newcomer to an organization to mutual respect of each profession’s role.
work through building trust, developing Good communication skills and
relationships and to work effectively demonstrating competence in ones’ own
within a team? profession also enhance trust.

Have the candidate review the vision Look for the individual alignment with
statement for you centre and ask them organization vision and for the
how they would work within the team the knowledge that it takes a team working
centre to make the vision a reality together to achieve a vision with all
member’s contributions valued

iv. Checking References

After the interview you may have 2 or more candidates that you are seriously interested in for the
position. You will want to speak to people who have worked with the candidate. A now common place
method is to speak to a person who has supervised the work on the candidate, a second person who
has worked as a peer/colleague and a third person who has reported to the candidate. This strategy
provides you with information about the candidate from a variety of perspectives. Questions regarding
the candidate’s suitability for working within an interprofessional teams are offered in Figure 4. These
are suggestions only and can be adapted according to your particular needs.

Questions for References
 What were the person’s strengths in working with others? Please give examples if possible.
 What was the person’s contribution to effective working relationships among his/her peers and
colleagues? Please provide an example
 What challenges did the person experience in working with others? Please give examples if
possible.
 Was the person able to learn from the experience and improve their relationships?
 How did this person go about promoting collaborative working relationships with others?

v. Letter of employment

Inserting language regarding the importance of collaborative practice into a letter of employment will
convey the high value placed on collaboration at your Centre. This wording is an example that could be
used or adapted.29

In addition to the duties and responsibilities outlined in the job description, it is
understood that a further job duty is the need for you to work effectively within the
strong team context that exists at (insert centre name). The expectation that you will
work professionally, collaboratively and respectfully with all of your colleagues in the
Centre is as important as your other duties and responsibilities.

vi. Job Descriptions
29
Thanks to Ms. Lynne Raskin of South Riverdale CHC for providing this wording
28

Embedding the concepts of interprofessional care within your organizational culture can be further
assisted by ensuring that job descriptions of all members of your team contain references to the
aspects of the person’s job that relate to collaborative care. There are now over 20 regulated health
professions in Ontario. There are also a variety of unregulated workers such as community mental
health workers, grief counselors, unregulated social workers, peer counselors, health promoters,
community developers, traditional healers and elders that provide needed and often culturally relevant
services in their communities (Purden, 2005).

And in all primary health care settings, administrative, information technology and secretarial staff are
key to well functioning teams. Whatever the positions within your team, which may change over time
depending on the populations you are serving and the needs you identify, every job description can
contain references to interprofessional care. This is a strategy that can remind each team member that
she/he is responsible to participate in establishing and maintaining collaborative relationships with
others. AOHC is not advocating or suggesting a particular type or model for job descriptions. The
following suggestions could be easily added to the job descriptions you are currently using.

Position Responsibilities

As a member of the interprofessional team:
 Communicates effectively with other members of the team
 Collaborates with others through providing appropriate support and consultation to other
primary care staff and participates in chart reviews and collaborative case conferences
 Recognizes and respects the value of each member of the team.

Qualifications
 Knowledge, skills and aptitudes necessary to establish and maintain collaborative relationships
with other members of the interprofessional team

vii. Summary Checklist on Hiring

The following exercise provides a checklist that captures the ideas presented in this module. The
checklist can provide a method for ensuring each of the steps we have suggested has been
incorporated into your processes.

Hiring Checklist
Topic Yes No
Have we included references to experience
with interprofessional collaboration in our
recruitment material?
Have we incorporated questions about
interprofessional collaboration in our
interview questions?
Have we included questions about
interprofessional competencies in our
reference checks??
Have we included competences associated
with interprofessional care in our
position/job descriptions?
Have we mentioned the responsibility to
function effectively as a team member in
our contract letter?
viii. Thinking ahead to Performance Appraisals

29

Each person hired to work within a primary health care interprofessional team will eventually have
regular performance appraisals. New employees usually have a probationary period of employment as
part of their employment contracts. When team members are aware that one aspect of their
performance appraisal will be a focus on their contribution to establishing and maintaining effective
collaboration within their team, the overall effect will be to increase the knowledge, skills and aptitudes
within the entire team. It is beyond the scope of the module to suggest a particular method and forms
for performance appraisals. The intention behind the example30 provided is to assist leaders and teams
to consider the ways in which the knowledge, skills and aptitudes for interprofessional care discussed
throughout the module might be incorporated into your performance appraisals. The suggestions
provided can be modified and edited to fit your particular context.

Performance Appraisal

Instructions: Each person who is contributing to the performance appraisal will rate the employee on
the following dimensions using the rating guide provided at the end.

Interprofessional Team Skills
1. Communicates knowledge and information to other team members
2. Participates in establishing effective team meetings, case conferences
3. Demonstrates accountability to the team by contributing to the team meeting its objectives and
by supporting team decisions
4. Participates in individual work planning as well as team work planning
5. Assists other team members with their growth and development, answers questions and pitches
in to complete the team’s work.
6. Works with team members to resolve conflicts
7. Demonstrates respect for the diverse contributions of team members and their roles
8. Accepts constructive feedback and acts on suggestions for improvement
9. Arrives for work and meetings on time
10. Reinforces and acknowledges positive behaviour, performance and successes of other team
members
RATING SCALE
Excellent: “Role model” or leader in demonstrating this behaviour/action
Good: Behaviour/action demonstrated consistently and effectively
Fair: Developmental Opportunity. Behaviour/action demonstrated with room for improvement.
Specific actions to help employee improve their performance will be developed.
Poor Development is Critical. Behaviour/action is rarely/never/poorly demonstrated;
significantly impacts performance. Specific actions to help the employees improve their
performance will be developed
N/A not applicable
Don’t Know I don’t have enough knowledge to indicate whether behaviour/action is demonstrated

C. Resources

30
Thanks to Ms. Simone Thibault, Executive Director of Centretown Community Health Centre for providing their performance
appraisal tools which were adapted for this module.
30

Community Health Inc. or COHI

This organization owns and administers the quality improvement and accreditation program called
Building Healthier Organizations. (BHO)

The website www.cohi-soci.ca has a section entitled BHO Resource Library that contains many
resources on hiring and related topics.

Under the heading 1.6 Creating a Healthy Workplace, there are resources on Anti-discrimination in
hiring, reference checking, checking of professional registrations, advertising, recruitment, interviewing,
selection, examples of performance appraisal tools and a variety of other HR tools and examples.

Charity Village

This website, www.charityvillage.com, which is used by many non profit groups to advertise positions
also contains a Resource and Library section.

In the Resource and Library section there is a section entitled Management Resources that contains
several resources specific to hiring such as establishing selection criteria, selecting interview questions,
candidate evaluation and human rights legislation in Canada. Other sections of the site contain links to
nonprofit management resources and are worth a browse.

Ontario Ministry of Labour

This website www.labour.gov.on.ca/english/es contains detailed information on the Employment
Standards Act (2000) which enforces the minimum standards that employers and employee must
follow.

D. References

Canadian Health Services Research Foundation (2006) Team Work in Health Care: Promoting effective
team work in health care in Canada: Policy Syntheses and Recommendations. http:/
www.chsrf.ca Retrieved June 23, 2006

D’Armour, D. Oandasan, I. (2005) Interprofessionality as the field of interprofessional practice and
interprofessional education: An emerging concept. Journal of Interprofessional Care Supplement
1 May: p 8-20

Health Force Ontario (2007) Interprofessional Care: A Blueprint for Action in Ontario. http/:www
healthforceontario.ca/IPCproject. Retrieved May 25, 2008

Laiken, M. E., Chatalalsingh, C., Brown, J.B., Bickford, J., Moss, K. & Gillis, L. (2006). Organizational
Support for Interprofessional Teams in Primary Health Care in Building Better Teams: Learning
from Community Health Centres.(2007) Association of Ontario Health Centres. Etobicoke.

Oandasan, Ivy & Reeves, Scott. (2005) Key elements for Interprofessional education. Part 1 The
learner, the educator and the learning context. Journal of Interprofessional Care, Supplement 1.
May: p 21-35

San Martin-Rodriguez, L.S., Beaulieu, M. D., D’Amour, D., & Ferrada-Videla, M. (2005) The
determinants of successful collaboration: A review of theoretical and empirical studies. Journal
of Interprofessional Care Supplement 1 May, p132-147

31

MODULE 3
Team Roles and Responsibilities

A. Background

Members of primary health-care teams are continuing to develop their expertise in team work and
various applications of interprofessional collaboration. Initiatives in health sciences education and
health-care policy now emphasize the need for team work to address the needs of clients and
communities; initiatives that link interprofessional care, collaboration and the ability to work as an
effective team member are well underway. This interest in team work builds on the history of working
in interdisciplinary and multi-disciplinary teams and addresses some of the current challenges to
providing primary health care.

The advantages associated with effective team work in heath care include improvements in patient
care, enhanced patient safety, and a way to reduce some of the challenges in workload that lead to
burnout.31 In community-based primary care, benefits have included “coordinated and comprehensive
client care; appropriate internal client referrals; the sharing and application of professional skills and
knowledge; and staff being aware of, contributing to and directing their client to the various CHC
programs available in the community.”32

As teams come together and attempt to deepen their levels of collaboration, they often begin by
defining personal and team roles and responsibilities. This module asks:
 What are the types of roles within primary health-care teams?
 How can understanding team roles and responsibilities be facilitated?
 What are the challenges for primary health care teams in defining team roles?

B. Team Definition

What is a team? One of the most widely used definitions of teams emphasizes the interdependence of
team members which distinguishes teams from other work groups: A team is a small number of people
with complementary skills who are committed to a common purpose, performance goals and approach
for which they hold themselves mutually accountable.33

Health-care teams will have members with specific functions, such as dietitians, health promoters,
physicians, nurse-practitioners and nurses. Each team will also become established as a team. They will
need to work through team development tasks that help them to operationalize the benefits of working
as a team.

During this forming stage, team members need to articulate their common understanding of what it
means to be a team. A number of tools have been developed to help teams to articulate their common
purpose and state their shared approaches through activities such as developing a team Vision and
Values. In the forming stage, a foundation is set for building trust and confidence in each other so they
can become comfortable with their mutual accountabilities. (For a full discussion of the team
development stages and the tasks of forming, as well as examples of how you can assist your team to
name elements of team practice, please see the AOHC publication, Building Better Teams: A Toolkit for
Strengthening Teamwork in Community Health Centres.)

31
Canadian Health Services Research Foundation(2006)
Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada p. iii
32
Davies, L., & Ring, L., ( 2007) Building Better Team: Learning from Ontario Community Health Centres AOHC (p.7)
33
Katzenbach, J. and Smith, D. (2003)The Wisdom of Teams Creating the High Performance Organization. p. 45.
32

In order to assess the areas of forming, including roles and responsibilities, that would be beneficial to
your team, you can use the survey below to identify areas that require attention. Compiled results can
be shared and discussed as a team.

Team Formation Survey34

In order to determine if your team needs to hold discussions aimed at establishing a clear framework to
guide its operations, would you please respond to the following questions. Remember that this survey is
anonymous.

1. Familiarity: How well do you know the other members of this team? Have you been properly
introduced to them? Do you know their personal goals, likes, dislikes, talents and interests?

1 2 3 4 5
Don’t know Know some things Know others quite well
the others about a few people

2. Goal clarity: How clear are you about the goal of the team?

1 2 3 4 5
Unsure of our goal Somewhat unsure Clear about our goal
about our goal

3. Member profile: How clear are you about other member’s individual skills? To what extent do you
know who is an expert in specific areas?

1 2 3 4 5
Don’t know Know the skills Clear about skills
members skills of some members of all members

4. Rules: Does the team have a set of team rules or norms that members use to govern relations and
meeting management? Does the team use and update its rules from time to time?

1 2 3 4 5
We have We have rules We post our
no rules but don’t use them rules and use them

5. Decision-making options: Has the team explored the different decision-making options and does the
team consciously select the method best suited to each situation?

1 2 3 4 5
We are not Sometimes consider We are always
aware of how we will make conscious about
decision options a decision how we make decisions

6. Clients and services: Has the team created a profile of who the clients are and what services we
provide?

1 2 3 4 5
No profile We are somewhat clear We have a exists
about the profile profile

7. Work objectives and results measures: Does the team have detailed objectives that include specific
results indicators that describe how the team plans to achieve its goal?

34
Bens, I. (2000) p. 43 & 44.
33

1 2 3 4 5
We don’t have We have some objectives We have
either and/or some measures both

8. Empowerment plan: Does the team have a clear picture of which decisions it can make and which
require management approval?

1 2 3 4 5
There is no We are clear about We are clear about how
empowerment some items empowered we are
plan

9. Roles and responsibilities: Are you clear about what’s expected of you and how your role relates to
the roles of other team members?

1 2 3 4 5
I’m unclear I’m somewhat clear I’m totally clear

10. Communication plan: Does the team have a plan that describes who it should communicate with,
when, and how?

1 2 3 4 5
No plans Somewhat planned We have a plan

Comments:

Return the completed survey to:

[Insert contact information]

Team members seek opportunities to define roles and responsibilities during the team formation stage.
Team members “may be unclear about their expectations of each other, and group leader’s
expectations of them; and are probably unsure about the roles each of them will play in the work of the
group.”35 Team members will want to discuss their roles and responsibilities, often with a heavy
emphasis on their tasks. Some people respond to the uncertainty of the forming stage by “want[ing]
every task defined and allocated to someone and their own job, responsibilities and powers clearly
defined.”36 Payne cautions that this is a polarity: there may not be a right answer, rather, the team
needs to find a balance between too much uncertainty or too much constraint leading to unnecessary
bureaucracy. He suggests five categories for considering team priorities, specialization and workload
allocation and notes that in practice these categories are often combined with factors such as
geographic location and team member skills and interests to create a complex system for defining roles
and responsibilities:
 legal requirements
 types of work (for example, group work, cognitive-behavioural therapy)
 service user categories (for example, client problems)
 levels of risk, difficulty or complexity
 organizational or political policies (for example, performance indicators)
C. Dimensions of Team Roles
35
Laiken, M. 1994)
36
Payne, M. (2000) p. 86.
34

Within any system of devising work roles and responsibilities, there are two dimensions that scholars of
teams have observed. Both task roles and maintenance roles contribute to well functioning teams.

i. Task roles

Task roles, sometimes also called functional roles, are the specific descriptions of each team member’s
function on the team. In order to carry out the goal of the team, the team “must develop the right mix
of skills… the complementary skills necessary to do the team’s job”.37 Payne has noted that task
differentiation in health and social services is generally outlined in competency documents, such as
scope of practice statements, legislation or policy documents.38 Position (job) descriptions for each
team member also provide a reference point for discussing task roles within the team. Examples of
typical functional roles in health-care teams are physicians, dietitians, pharmacists, nurses, nurse
practitioners, heath educators or promoters, and social workers or counsellors. Teams may meet as a
functional team, such as a program team, administrative team, clinical team and/or as interprofessional
teams that include a range of disciplines.

Teams that are forming and learning their roles and responsibilities are supported by having some
structure. Structure and somewhat more directive leadership take the place of the trust and confidence
that has not yet been built. The team will need the leader to provide the structure that will allow them
to explore roles and responsibilities while they are learning about each other and the strengths and
skills they bring to the team. Examples of structure that can support teams at this stage include:
 Regular team meetings.
 Discussion at team meetings that helps team member to get to know each other and their
complementary skills.
 Collecting documentation of roles and responsibilities such as position descriptions and scope of
practice statements.
 A team discussion on roles and responsibilities can be stimulated by using an activity such as
the one below.

What I Give, What I Need39

The goal of this discussion is to assist you to understand what each team member’s role is in support of
your team’s vision and goals. First, think of your role and describe what it is that you give to this team-
the complementary skills you bring and what you are willing to contribute. Then, think about what you
need from the team to be effective and achieve the responsibilities associated with your role.

Complete these lines at least 3 times:

I provide this team with…

What I need from the team is…

Facilitate a round where each person provides their replies. Encourage questions and discussion so that
each team member agrees and understands the role(s) of every other team member.
You may want to arrange for the replies to be consolidated into a chart that is circulated to everyone as
reference and can be updated as roles and membership evolve.

What I give to this team What I need from this team

37
Katzenbach & Smith (2003) p. 47.
38
Payne, M. (2000) p. 85.
39
Adapted from Jude-York, D., Davis, L., and Wise, S. (2000) Virtual Teaming: Breaking the Boundaries of Time and Place (p. 31
and 32.)
35

Name:
Role:

Name:
Role:

Name:
Role:

Name:
Role:

Team challenges

You may become aware that something more than clarifying roles and responsibilities through “just
enough” structure and information is required when a team is grappling with some of the challenges to
teamwork that are particular to primary health care teams. Two specific challenges identified in
literature on primary health care teams are role confusion and power conflicts.40

Role confusion

Role confusion occurs when there is ambiguity, lack of clarity and lack of predictability regarding the
outcomes of one’s behaviour and is heightened in new situations where team members are uncertain of
task and social expectations.41 This effect can be pronounced in interprofessional teams where
professional skills overlap.42 A challenge for interprofessional teams is to come to terms with the
multitude of skills now at their disposal. The difficulty lies in making the best use of team members’
skills and reducing the unnecessary duplication. With the current emphasis on interprofessional
education, inclusion and appreciation of diverse skills and the pressing external need for more health-
care practitioners, it is the areas of overlap that often provide the friction in teams. By holding team
discussions with the goal of clarifying roles, the team can:
 Reduce confusion and resulting conflict.
 Reduce unrealistic expectations.
 Make clear overburdened or underworked team members.
 Help to avoid one person being left with all the unpleasant jobs.

You can manage role confusion by:43,44
 Expecting some blurring of roles in the early stages of team development.
 Using role clarification to learn about your team and manage areas of work.
 Anticipating the need to review and adapt roles- conventional views may not always apply
 Finding opportunities for team members to work on collaborative projects where they can
interact
 Convening retreats with role clarification as a focus
Power

40
Payne, M. (2000); Davies & Ring (2007)
41
McShane, S. (2004) Canadian Organizational Behaviour (p. 205)
42
Payne, M. (2000) Teamwork in Multiprofessional Care (p. 89)
43
Payne, M.(2000) p. 88- 91
44
Davies, L., % Ring, L., (2007) Building Better Teams: Learning from Ontario Community Health Centres AOHC p. 130.
36

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