SHARON BELL BUCHBINDER,
R.N., PH.D. TOWSON
U N I V E R SI T Y
JON M. THOMPSON, PH.D.,
JAMES MADISON UNIVERSITY
What is a Team?
A team is a group of people, with
complementary skills who are
committed to a common approach for
which they hold themselves mutually
accountable, working together to
achieve a common goal.
What is a Team?
Because the health care needs of
patients cut across an
organization’s different disciplines
or functions, it is important that
inter-disciplinary clinical teams be
set up to ensure the delivery of
safe, effective, and timely care.
Short vs Long Term
In addition, teams can be organized to address a
short-term, quality assurance problem, such as
“Why did Mrs. Jones fall out of bed?” or long-
term problems, such as preventing harm to all
patients in all aspects of care.
Task forces require teamwork, focus on a specific
agenda, have a limited term of tenure, and
disband when a report or book is issued.
Committees usually have a person for whom this
area is their full-time job, but representatives of
multiple disciplines, and areas of the organization
are required to examine problems and to implement
organizational policy decisions.
Even when members change, the committee lives on.
Teamwork in Healthcare Organizations
Hospitals grew out of religious orders and nuns
and monks provided healthcare to the poor.
Prior to the late 1700’s and early 1800’s, medical
training was an apprenticeship and there were no
university trained nurses.
The U.S. Civil War and the Crimean War fueled the
development of the nursing profession with
training in hospitals.
As the field of nursing evolved, nursing education
moved out of strictly hospital training programs
into university-based settings.
The American Medical Association (AMA) was
formed in 1842 to discuss the appalling lack of
quality in US medical schools and their products—
In 1910, Abraham Flexner, working at the Carnegie
Foundation, published Medical Education in the
United States and Canada, calling for dramatic re-
organization of the US medical education system.
The University of Chicago founded the first
program in health administration in 1934 under
the leadership of Michael M. Davis.
Davis used the expertise of medical, social service
administration, and business faculty to create an
interdisciplinary model of education for healthcare
Formal teamwork educational training for
physicians and nurses is rare.
Conflicts between physicians and nurses are often
due to physicians refusal to embrace teamwork.
The Institute of Medicine has recommended that
healthcare organizations develop effective teams.
Clinical vs. Managerial
Physicians and nurses work from a clinical
framework, advocating at the individual level for
patients and families.
Healthcare managers are trained to look at
population level and organization-wide issues.
To engage medical staff, managers need to
promote alignment between hospitals and
physicians through the use of shared goals,
especially patient safety.
Understanding physicians and promoting
interdependence on trustworthy teammates is
critical in achieving safe, effective patient care.
Benefits of Effective Teams
Teams that are empowered to be innovative and
rewarded for performance:
improve coordination and quality of care,
use of health care services more efficiently,
increase job satisfaction among team members,
increase patient satisfaction, and
Service Line Teams
Specialized hospital services can benefit from
“service line” team approaches that show:
increased trust among staff,
shared goals, and
greater patient satisfaction.
Higher Level Managers
For this audience, the answer lies in the bottom line:
increased job satisfaction, and
decreased nursing turnover.
Teams and Turnover
Nursing turnover costs are around $65,000/RN.
Retention of nursing staff saves:
the costs of using agency or traveler nurses,
replacing lost nurses and training new ones,
and loss of productivity from burdening the remaining staff.
Effective teamwork can mean lower service costs
in the millions of dollars.
The Costs of Teamwork
Costs of teamwork include:
Meeting time, along with a place to meet and food
the costs of trying to arrange a time that’s
convenient for most of the participants, and
opportunity costs, i.e, how that time might have
been better spent.
Additional Teamwork Costs
Hard-to-measure interpersonal costs associated
with having to work with other people, develop
mutually respectful behaviors and trust,
risk-taking associated with letting go of one’s turf,
potential embarrassment of looking bad in a
resistance to organizational change.
Forming: getting oriented to the team goals and
each other, finding out what the tasks are, and who
they will be working with.
Storming: intragroup conflict, attempts at
dominance, passive-aggressive behavior, along
with information withholding, and other forms of
resistance to team tasks and goals.
Performing: peace breaks out and team members
actually begin the work at hand, have open
dialogue with one another, and share information
to accomplish the team’s goals.
Adjourning: team members have worked together
over a long period of time, have developed respect
for one another, and like each other as individuals
and the team as a whole and become sad that they
Dysfunctional teams create significant costs to the
organization in terms of human resources and
These costs mean that teamwork may not always
be as efficient as other forms of problem-solving
Efficient team function can only occur when each
carefully selected team member knows the goal(s) of
Without team advocates in each of the areas affected
by decisions, implementing a unilateral decision can
become a healthcare manager’s worst nightmare.
Who’s on the Team?
Questions to can ask when assigned to a team:
What are the goals of the team?
How will they be measured?
What are the short-term and long-term deadlines?
When and where does the team meet?
To whom do I report?
What is my role on the team?
What are my responsibilities in that role?
Good managers don’t mind if a new staff member
makes a list of questions and asks for clarification
Coaching, mentoring, and guiding are all part of
the manager’s role.
Good managers want thoughtful observations
from a new perspective: yours.
Getting the Right Team Members
Real world healthcare management problems are
complex, complicated, and messy.
Tame problems can be defined; wicked
problems are difficult to define and not easily
resolved (Drinka & Clark, 2000). You need to
have every involved area’s input to analyze a
wicked problem, because it won’t be solved by
one person--or one discipline.
Most problems fall across the continuum.
Assessing Potential Teammates
Does this person:
Belong to an area that’s affected by the problem at
Have the knowledge, skills, and disposition to do
the tasks at hand?
What role will this person play on the team?
Assessing Potential Teammates
Have the authority to make decisions and
Follow-through on assignments and tasks and
Think beyond the confines of a department or
Work collaboratively and respectfully with other
Assessing Potential Teammates
Have the ability to defuse tensions and de-escalate
Have a sense of humor?
Have a good reputation within the organization as
a team player?
Myers-Briggs Type Indicator
Myers-Briggs Type Indicator (MBTI) is a paper and
pencil personality inventory used for
understanding differences in team members’
personalities, based on Jung’s theory of
Assesses four domains and four subsets within
those domains on a four-by-four grid.
You’re getting a
what in my HCM
381 class ???
Vertical axis is the Introvert-Extrovert scale;
horizontal axis is the Sensing-Intuitive scale.
Within each of the four quadrants of this grid are
two more axes—the Perceiving-Judging axis and the
Not everyone on the team can be the leader at the
Good followers are needed, too. These people may
be more on the end of the sensing, introverted,
intuitive end of the axis on the MBTI, rather than
the extroverted end.
Not everyone in the workforce population is
suited, by their personality type, to function well
on a team.
Team Member Selection
Judicious use of the MBTI can assist in the
assessment of a person’s leadership versus
Oftentimes, experience and the oral history of the
healthcare organization where you work is the best
predictor of selecting good team members.
Frequent, positive communications improve team
interactions and increase trust.
Organizations that empower their employees
promote employee job satisfaction.
Communication & Trust
Nurses who feel they have:
access to opportunity,
open communication with peers and managers,
and trusted their managers were more likely to be attached to
their organizations and have higher job satisfaction.
Honest, Safe Dialogue
Healthcare managers should facilitate open, safe,
and honest dialogue between management and
care production teams and within the teams
The process should involve care production team
members in process improvement.
To improve relationships between team members
and nurse managers, more training is needed, both
in the clinical and relationship management
Diversity training has to be part of team and
The patient-centered care model must emphasize
caring for patients and 360 degree feedback, where
nurses and technicians evaluate each other, should
be implemented for assessment, communicated to
team members, and used as a management tool for
continuous quality improvement.
Eisenhardt, Kahwajy and Bourgeois (1997) found
that teams with minimal interpersonal conflict
had the same six strategies.
worked with more, rather than less information,
and debated facts;
developed multiple alternatives to enrich the
level of debate;
shared commonly agreed upon goals;
Focus on the Facts
injected humor into the decision process;
maintained a balanced power structure; and
resolved issues without forcing consensus.”
By keeping the focus on the facts and not on
personalities, and communicating in an open,
honest, and safe forum, the teams were able to have
fun and be productive.
Crew Resource Management
Crew Resource Management (CRM), in the high-
stakes airline industry, has been developed to
address attitudes, change behavior, and improve
Sexton, Thomas and Helmreich (2000) have
applied crew resource management research to the
hospitals, where stakes are also high, and lives
depend on the smooth functioning of the
Senior surgeons were least likely in favor of
teamwork and flat hierarchies.
Medical staff responded that teamwork was
imperative, but that they were not encouraged to
report safety concerns.
Doctors and nurses differed widely in their
opinions regarding teamwork.
Almost three-quarters of surveyed intensive care
physicians reported high levels of teamwork with
nurses, but less than half of the nurses felt the
These results point to the need for a more realistic
appraisal of safety concerns, improved
communication between team members, and
enhanced team training for healthcare
professionals, in all disciplines and specialties.
Managing Healthcare Teams
Healthcare teams often fail due to resistance to
organizational change and lack of effective
Effective leadership includes fostering good
At the first meeting, the leader should obtain names,
all phone numbers, email addresses, and any other
way the team members can be contacted.
Guidelines for Teamwork
One of the things a team leader can do to facilitate
good communication early in the life of the team,
is to establish guidelines for expected behaviors,
processes, and outcomes in a written document.
Guidelines for Teamwork
Does not have to be complicated and can be used
as a 360 degree evaluation tool for the performance
of individual members of the team.
Helps avoid the social loafer or free-rider
syndrome, where a member of the team does
nothing, but gets credit for the work done by
To attain top performance the team leader must
who the teammates are,
what they need, and
have the ability to build consensus.
Team Process: The How To’s
Maginn (1995) recommends that the team leader
go around the table and ask each person his or her
ideas about the problem.
Acknowledge each idea, recording it as the team
Wait for people to respond to the question—and to
Don’t interrupt, and don’t let others interrupt a
person when he/she has the floor.
Team Process: The How To’s
Ask critics for ideas and suggestions, getting those
negative comments out on the table so they can be
The team leader should remain calm, open-minded,
At the end, the team leader should thank everyone
for their thoughtful comments, and summarize what
she heard and ask for clarification.
Next Steps: Homework
Who is willing to do what task, research?
What process is should be used for reporting to each
The team leader should send a summary of the
meeting to everyone on the team, and include a list
of steps that need to be taken before the next
Communication that includes everyone is critical for
buy-in and cooperation.
Bring reliable information to the team.
Accurate data and demonstrated skill at your work
informs the team members that you are competent
Do what you say you are going to do! (Maginn,
Maginn’s (1995) strategies for conflict resolution:
Bargaining: If the choices are equally good, then
bargaining can be a good tool; if the choices aren’t
equal, then it may not be a good tool.
Voting is democratic, but also bears the weight of
potentially taking a team to the incorrect choice.
Problem solving means taking time to answer the
“what if” scenarios of each alternative. “If we do
this, then that might happen.
Research is safe, but you may have time-pressures
that preclude the team from doing an in-depth
Third-party mediation is probably a win-win,
especially if the third-party is the boss.
Alternatives are listed, the pros and cons of each
alternative are provided, and the assessment plan
for each alternative is in place.