This document provides information on forming effective teams in healthcare settings. It discusses the importance of teams and defines what constitutes a team. Characteristics of effective teams include shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes. Barriers to effective teamwork include dysfunction, mistrust, and poor communication. Facilitators include well-defined goals and objectives, selecting members based on skills, having defined roles for each member, developing mutual respect and trust, and effective management. The document also discusses team inputs like structure, composition, and leadership as well as processes like conflict management, communication, and shared mental models that influence outcomes like performance and satisfaction.

1. Forming Effective
Teams
(Rebecca) Suzie Miltner, PhD, RN
Associate Professor
School of Nursing
1

2. Objectives
 Describe characteristics and dynamics of
effective teams.
 Identify barriers and facilitators to teamwork in
healthcare settings.
 Understand factors that contribute to conflict
and how to resolve that conflict within groups.

3. Healthcare is complex….
How can we fix it?

4. Quality Improvement offers a
systematic, data-driven, iterative,
problem solving process that can
be adapted to local context.

5. QI
All of this
happens in the
context of the
team.

6. 5 observations about teams…
from Ed Salas
1. Most organizations want a culture of
collaboration
2. Organizations are using teams more than ever
3. Many teams perform sub-optimally
4. What happens in leadership teams can
permeate the organization
5. Patient safety demands reliable, adaptive, self-
correcting teams
From Eduardo Salas, PhD
Department of Psychology
Rice University

7. Is Teamwork Important?

8. We think so…
Improves the quality and safety of care.
May improve coordination of services
Increases professional satisfaction
May maximize resources (more efficient delivery
of care)

9. What is a Team?
 “A group of people organized to work together.”1
 “A group of people with a full set of
complementary skills required to complete a
task, job, or project.”2
 “A team is a small number of people with
complementary skills who are committed to a
common purpose, set of performance goals,
and approach for which they hold themselves
mutually accountable.”3
1http://www.thefreedictionary.com/team
2http://www.businessdictionary.com/definition/team.html
3Katzenbach, JR, and Smith, DK. (1993). The discipline of teams. Harvard Business Review. 162-171.

10. Teams
Teams differ in terms of their purpose, size,
membership, experience, level of authority,
history and chemistry.
Interestingly, to be effective, teams do not
necessarily have to have a long history of
working together, or have members who even
like each other.

11. Working Groups
 Purpose is usually the same as organizational purpose
 Strong, focused leader who delegates work
 Individual work products and accountability
Team
 Team has specific purpose that may be different from
organizational goals
 Collective work products with individual and team
accountability
 Performance measurement based on collective work
products
Working Group or Team?
Katzenbach, JR, and Smith, DK. (1993). The discipline of teams. Harvard Business Review. 162-171.

12. Teams in Healthcare
Widespread adoption
Classification of teams
Temporal stability
Authority differentiation
Skill differentiation

14. Team Formation
Forming
Storming
Norming
Performing
Tuckman’s Model for Small Group Development
• Orientate team
• Establish meeting
roles and
responsibilities
• Conflict or polarization
around interpersonal
issues
• Realize that the task is
more difficult than
expected
• Reinforce ground rules
and team building
• Resistance is
overcome
• Cohesiveness
develops
• Worked through all of
the personal/team
issues
• Concentrate on the
team goals
• Establish new
objectives
Tuckman, B. (1965). Developmental sequence in small
groups. Psychological Bulletin, 63(6), 384-399.

15. Principles of Team Based Health Care
Shared goals
Clear Roles
Mutual Trust
Effective Communication
Measurable Processes and Outcomes

16. Conceptual Model of Teams
Inputs
Structure
Composition
Leadership
Processes
Conflict
Communication
Cognitions
Outcomes
Satisfaction
Performance
Viability

17. Team Input: Structure
Pooled interdependence
Sequential interdependence
Reciprocal interdependence

18. Team Input: Composition and Roles
Task Roles: Conscientiousness
Social Roles: Extraversion
Social Roles: Agreeableness

19. Team Input: Leadership
Directive
Transactional
Transformational
Empowering

20. Leadership
A leader is best when people barely know he
exists, when his work is done, his aim
fulfilled, they will say: we did it ourselves.
Lao Tzu

21. Team Process: Conflict
Relational Conflict
 This is problematic for team conflict
 Have to develop mutual trust and respect
 Sometimes this is not possible

22. Team Process: Conflict
Relational Conflict
Task Conflict
 Some task conflict is necessary to improve
Optimal conflict
and ideas
Productivity
Conflict

23. Team Process: Cognitions
Shared mental models
Transactive memory systems

24. Shared Mental
Models
 “Our aim is to reduce
wait times in the
specialty clinic.”
 “Everyone has a part
in making this
happen.”
Transactive Memory
Systems
 “The expertise in
clinic flow is in the
clinic manager and
triage LPN.”
 We don’t have to
know all the details,
but we need to know
who does know that.
Team Process: Cognitions

25. Barriers to Team Success
Team Dysfunction
Mistrust
Lack of commitment and accountability
Poor resource allocation
Communication and collaboration
Disruptive behavior

26. Facilitators for Team Success
 Goals/aims/objectives are clearly defined.
 Members are selected for skill and team
competencies.
 Every team member has a role and participates.
 Team develops mutual respect and trust.
 There is effective management of the team.
Ground rules
Communication
Role expectations

27. 7 drivers that influence team
effectiveness: Seven “C’s”
 Capability (right people with the right KSAs)
 Cooperation (right attitudes and willingness)
 Coordination (demonstrate teamwork behaviors)
 Communication (effective with each other)
 Cognition (shared understanding)
 Coaching (team members demo leadership behaviors
 Conditions (have favorable conditions such as
resources, culture, and senior leadership)
From Eduardo Salas, PhD
Department of Psychology
Rice University

28. Exercise
• Form three groups of 7-8 people.
• Select one penguin to portray.
• Read the scenario and make a plan.
• Remember to stay in the voice of your penguin.

29. The Empowerment Paradox
I could
delegate
more if you
took the
initiative
EmpowermentParadox
Delegate to
the entire
team!
Ask what I
can do and
delegate to
me!
Leaders
Team Members

31. What can YOU do to create more
effective QI teams?

32. IAD
 Interprofessional
team
 VA TAMMCS model
used
 Executive sponsor
 Data collection
 Unit Leaders
involved
Mobility
 Interprofessional team
 VA TAMMCS model
used
 Executive sponsor
 Data collection
 Unit Leaders
involved…sometimes
A Tale of Two Projects

33. Effective Team Meetings
 Team ground rules
 Team roles
 Timed agenda
 Minutes or other meeting record of events/discussion
-33-

34. Setting Team Ground Rules
1. Attendance: What are the attendance requirements for team
members?
2. Participation: What are the team member expectations for
participation?
3. Interruptions: How will interruptions during the team meetings be
handled?
4. Preparation: What level of preparation is expected for team
meetings?
5. Timeliness: What are the expectations for meeting start times, what
type of preparation is expected?
6. Conflict: How will conflict between team members be resolved?

35. IAD Team Ground Rules
Attendance
 Any time you must miss, provide any homework or assignments to team leader.
 Do not send substitute if you can not make it.
 Communicate to team leader if unable to attend.
 No more than 3 meetings missed.
Participation
 All team members are expected to fully participate and contribute.
 Try to direct discussion to those who may have not been able to contribute to help include them.
 Be detailed when needed or concise when needed to get the points across.
Interruptions
 Anybody can call a safe moment to refocus or redirect conversation.
 One voice at a time.
 Remain civil at all times.
Participation
 Be honest at what you can get done.
Conflict Resolution
 Call a safe moment to stop the escalation..
 Commit to resolve.
 We all need to self reflect to prevent conflict in the future.
Timeliness
 Everyone’s time is valuable so be on time to meetings and completing assignments.

36. Mobility Team Ground Rules
Attendance
 No guidance
Participation
 No guidance
Interruptions
 No guidance
Participation
 No guidance
Conflict Resolution
 No guidance
Timeliness
 No guidance

37. Team Members and Their Tasks
Facilitator/Leader
 More coach than boss
 Ensure participation by all
 Guides discussion
Recorder
 Records what is being discussed and writes on board
Time Keeper
 Keeps the group on time
Observer
 Reflects on the process of the team at close
37

38. Questions?