This document discusses the importance of team functioning for patient safety and identifies characteristics of dysfunctional healthcare teams, such as an absence of trust, fear of conflict, and avoidance of accountability. It provides examples of trust-building exercises and a feedback exercise that teams can use to improve dynamics and build attributes like trust, conflict management, and commitment to results. The overall message is that healthcare leaders and members must work to establish healthy, high-functioning teams through activities that enhance attributes like trust, feedback, and accountability.

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

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

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

4. Is this your team?

5. Or is this your team?

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

7. Characteristics of a dysfunctional team

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

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

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

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

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

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

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

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

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

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

18. Team Competency Outcomes

19. Relatively unique challenge in healthcare
re: teamwork…

20. Facilitating “teaming” in Healthcare

21. Conceptual Model of Team “Scaffolds”

22. Attributes of team scaffolds

23. How can we build a more functional
team?

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

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

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

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