teamwork - ndcpd.org · • teamwork is more efficient than a number of individuals working...

Teamwork33rd Annual ND Association of Community Providers Conference

Karen L. Zimmerman, MSN, RNChief Nursing Officer / Vice President Patient Care ServicesApril 2019

A team can make or break a business! Whatever that business is!

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"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don’t play together, the club won’t be worth a dime."

~ Babe Ruth ~

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What is a team?

Group versus TeamA group is a collective of mutually independent individuals with separate goals who are brought together by common interests and experience. Even though everyone shares information and resources with other group members, each member is responsible for their own work.

• There are two types of groups:• formal group, created by the management to perform a

particular task• informal group, formed naturally by employees for

different reasons

A team is an interdependent group of individuals who share responsibility and are focused on a common goal. People in a team have a mutual understanding with other members. By working together, they tend to maximize each other’s strengths and minimize weaknesses. Unlike a group, where each member is expected to contribute separately, the most important characteristic of a team is synergy: the whole is greater than the sum of its parts.

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Group versus Team

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Group versus Team

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Geese - Why do they fly in a “V” formation?

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Lessons from Nature

7 Lessons from Geese

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• Sharing a common goal• Increasing visibility• Having humility to seek help• Empowering others to lead• Always recognize great work• Offering support in

challenging times• Staying committed to core

values and purpose

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• A team broadens what individuals can do• Several heads mean a wider range of ideas• Teams have a great array of talents and skills• Team members learn new skills from their

colleagues• Teamwork is more efficient than a number of

individuals working separately• Teamwork provides relief when someone is

having a problem• Team workers are more effective• A team member has more ownership of what

they are doing• Good teams can build leaders• A shared vision keeps everyone moving

forward

Team Advantages

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• Team decision-making takes longer• Team effort can be wasted effort• The team's success may hang on the

work of the least effective team member (only as strong as the weakest link)

• A team might gain momentum in the wrong direction

• The work of team can bog down in interpersonal issues, resentments, and blame

• Team members may be reluctant to tell others about their unsatisfactory work

• Lost motivation for lack of individual recognition

Team Disadvantages

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How many of you work in the same vicinity; are called a team; but are really a group of individuals who work in the same department?

Being on a team does not mean you function as a team.

How many of you

work in a team?

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Building a GREAT Team

Building a GREAT Team

• Start with the best people you can find

• Choose team members that will be a good fit

• Look for team members with a diversity of backgrounds and perspectives

• Look for team members with a commitment to the concept of working as a team

• Look for team members committed to the team's vision

• Find people with a sense of humor

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• Start with the vision• Build team bonds• Make sure that the concept of a team is

absolutely clear• Involve the team in jointly planning functionality

and individual responsibilities• Address personal issues• Establish team norms• Hash out the logistics of working as a team• Start the team with a doable task that requires

teamwork• Review both successes and failures to learn for

the future• Provide both individual and team support• Give people something extra for working as a

team• Reward accomplishments like crazy

Building a GREAT

Team

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Stages of Team Development


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Forming stage

• The forming stage involves a period of orientation and getting acquainted. Uncertainty is high during this stage and people are looking for leadership and authority. A member who asserts authority or is knowledgeable may be looked at to take control. Team members are asking such questions as “What does the team offer me?” “What is expected of me?” “Will I fit in?” Most interactions are social as members get to know each other.

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Storming stage

• The storming stage is the most difficult and critical stage to pass through. It is a period marked by conflict and competition as individual personalities emerge. Team performance may actually decrease in this stage because energy is put into unproductive activities. Members may disagree on team goals, and subgroups and cliques may form around strong personalities or areas of agreement. To get through this stage, members must work to overcome obstacles, to accept individual differences, and to work through conflicting ideas on team tasks and goals. Teams can get bogged down in this stage. Failure to address conflicts may result in long-term problems.

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Norming stage

• If teams get through the storming stage, conflict is resolved and some degree of unity emerges. In the norming stage, consensus develops around who the leader or leaders are, and individual member’s roles. Interpersonal differences begin to be resolved, and a sense of cohesion and unity emerges. Team performance increases during this stage as members learn to cooperate and begin to focus on team goals. However, the harmony is precarious, and if disagreements re-emerge the team can slide back into storming.

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Performing stage

• In the performing stage, consensus and cooperation have been well-established and the team is mature, organized, and well-functioning. There is a clear and stable structure, and members are committed to the team’s mission. Problems and conflicts still emerge, but they are dealt with constructively. The team is focused on problem solving and meeting team goals.

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Adjourning stage

• In the adjourning stage, most of the team’s goals have been accomplished. The emphasis is on wrapping up final tasks and documenting the effort and results. As the work load is diminished, individual members may be reassigned to other teams and the team disbands. There may be regret as the team ends, so a ceremonial acknowledgement of the work and success of the team may be helpful. If the team is a standing committee with ongoing responsibility, members may be replaced by new people and the team can go back to a forming or storming stage and repeat the development process.

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Team Destroyers

• A self-centered ego

• Lousy communication between team members

• Pathetic leadership

• Apathy

• Blind vision

• Blurry design

• A paralyzed plan

• An orchestra that only has soloists

• Personal stubbornness

Destroyers of a Team

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Roach, Dale. (n.d.) 9 Basic Things That Will Destroy Teamwork. Retrieved from https://likeateam.com/9-basic-things-that-will-destroy-teamwork/

Destroyers

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Jealousy – This emotion seems to raise its ugly head whenever a new team member is hired into the group that may seem to be more qualified. Go out of your way as team leader to let the other team members know how much their work is appreciated

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Destroyers

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Cynicism – Some people are just negative by nature. Others might feel that the institution cannot possibly prosper. Efforts must be made to emphasize the institution’s positive achievements to the group. Do not hesitate to confront any openly cynical individual and demand their behavior change at once.

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Destroyers

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Lack of confidence – Some team members may lack confidence in themselves and view attacks on their opinions as personal attacks, therefore; when statements such as “are you saying my years of experience does not count” occur, STOP any discussion like this immediately and in a private one-on-one meeting, patiently point out the defensive behavior.

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Team Dysfunctions

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Five Dysfunctions of a Team

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By Patrick Lencioni

Lencioni, P. (2002). The Five Dysfunctions of a Team. San Francisco, CA: Jossey-Bass.

“Stems from an unwillingness to be vulnerable within the group. Team members who are not genuinely open with one another about their mistakes and weaknesses make it impossible to build a foundation of trust (p. 188).”


Dysfunction 1

Absence of Trust

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“Failure to build trust is damaging because it sets the tone for the second dysfunction: fear of conflict. Teams that lack trust are incapable of engaging in unfiltered and passionate debate of ideas. Instead they resort to veiled discussions and guarded comments (p.188).”


Dysfunction 2

Fear of Conflict

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Dysfunction 3

Lack of Commitment

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“A lack of healthy conflict is a problem because it ensures the third dysfunction: lack of commitment. Without having aired their opinions in the course of passionate and open debate, team members rarely, if ever, buy in and commit to decisions, though they may feign agreement during meetings (p.189).”


Dysfunction 4

Avoidance of Accountability

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“Because of this lack of real commitment and buy in, team members develop an avoidance of accountability. Without committing to a clear plan of action, even the most focused and driven people often hesitate to call their peers on actions and behaviors that seem counterproductive to the good of the team (p. 189).”


Dysfunction 5

Inattention to Results

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“Failure to hold one another accountable creates an environment where the fifth dysfunction can thrive. Inattention to results occurs when team members put their individual needs (such as ego, career development, or recognition) or even the needs of their divisions above the collective goals of the team p. 189).”


Overcoming the Dysfunctions

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• Conduct a team assessment and share the results

• Share personal histories; identify the single most important contribution each member makes to the team, as well as one area to improve or eliminate for the team; personality profile; and 360-Degree feedback — the key of which is to divorce it entirely from compensation and formal performance eval.

• Leaders need to demonstrate genuine vulnerability first, and create an environment that does not punish admissions of weakness or failure.

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• Acknowledge that conflict is productive, and that many teams have a tendency to avoid it. Assign a team member to be “miner of conflict” — who extracts buried disagreements and sheds the light of day on them — during a meeting. Interrupt and remind one another in real time to not retreat from healthy debate when they start to feel uncomfortable.

• It is key that leaders demonstrate restraint when team members engage in conflict, and allow resolution to occur naturally.

• Don’t let the debate become personal.

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• At the end of a meetings, review key decisions made during the meeting and what needs to be communicated outside of the meeting about those decisions

• Use of clear deadline for when decisions will be made — ambiguity is the worst enemy of commitment, and timing is one of the most critical factors that must be made clear. Brief discussion on contingency and worst-case scenario allows overcoming their fears.

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• Teams that avoid accountability encourage mediocrity, miss deadlines and key deliverables, create resentment among team members who have different standards of performance, and place an undue burden on the team leader as the sole source of discipline.

• Publication of team goals, who needs to deliver what, and how everyone must behave in order to succeed.

• Regular progress review.

• By shifting rewards away from individual performance to team achievement, a team is unlikely to stand by quietly and fail when a peer is not pulling his weight.

• Teams that are not focused on results, rarely defeat competitors, lose achievement-oriented employees, encourage members to focus on their own career and individual goals, and are easily distracted.

• Make results clear, and reward only those behaviors and actions that contribute to those results.

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Lessons from Football

What do football teams do that most teams don’t?

1. Huddle2. Debrief

What do hospitals do before a surgical procedure? We take a time out. Why?


Why is a huddle important?

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• Personal contactUnites a group of people (team

building)

• Instructive (motivational and provides clarity) Each person then knows and

understands what is going on and what his/her role is.

• Facilitates problem solving

• Accountability

• Builds culture (creates unity and feeling of oneness)

• Provides a forum to celebrates success

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Why is a debriefing necessary?

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• Debriefing is an important strategy for learning from defects and for improving performance. It is one of the central learning tools in simulation and is also recommended after a real-life emergency response.

• Its goals are to discuss the actions and thought processes involved in a particular patient care situation, encourage reflection on those actions and thought processes, and incorporate improvement into future performance.

• Aids in identifying aspects of team performance that went well, and those that did not. The discussion then focuses on determining opportunities for improvement at the individual, team, and system level.

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Team Member Roles

Roles of Team MembersWithin the boundaries of a team, each member of the team assumes a role. These roles can be the following –• The summarizer – this individual urges the group to

acknowledge consensus and reach a decisions well as they might be seen as the “energizer bunny”.

• The Orienteer – This individual prevents the team from wandering too far from the topic.

• The Fact Seeker – This individual tests the reality to make sure the decision the team is about to make is doable.

• The Initiator – This individual gets the team started on the right foot by always beginning discussions with the question “How should we approach this task?”

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Roles of Team Members

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• The Harmonizer – This individual realizes that conflicts is inevitable and that if left unresolved, it is the biggest barrier to a team’s achieving health and success.

• The Analyzer – This individual watches for changes in the vital signs of the team and brings these changes to the attention of the team.

• The Gatekeeper – This individual is concerned primarily with team communication and participation.

• The Encourager – This individual builds and sustains the team energy by showing support for everyone’s efforts, ideas, and achievements.

Why are roles important?

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Once team members assume these roles, then it

opens the way for increased productivity and

overall unity and task completion.

Depending on the amount of team members

involved, team members may assume more than

one role within the team dynamics.

Helping your Team Succeed

Tips for Helping Your Team Succeed

• Ensure the team understands the goals• Create an environment where it is safe to take reasonable risks

• Communication is open, honest, and respectful• Team members have a strong sense of belonging to the group• Team members are viewed as unique people

• Creativity, innovation, and different viewpoints are encouraged• Team is able to constantly evaluate itself• Team agrees upon how to resolve conflict and issues between members

• Participative leadership is practiced• Members of the team make high quality decisions together

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References

BelievePerform. (N.D.). Debriefing in sport. Retrieved from https://believeperform.com/performance/debriefing-in-sport/

Daskal, L. (2015). Lessons from geese: a better way to lead. Retrieved from https://www.lollydaskal.com/leadership/lessons-from-geese-a-better-way-to-lead/


Patient Safety Primer. (2019). Debriefing for clinical learning. Retrieved from https://psnet.ahrq.gov/primers/primer/36/debriefing-for-clinical-learning


https://believeperform.com/performance/debriefing-in-sport/

https://psnet.ahrq.gov/primers/primer/36/debriefing-for-clinical-learning

teamwork - ndcpd.org · • teamwork is more efficient than a number of individuals working...

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