INTRODUCTION:
In the health care institution nearly all individuals within an organization will belong to one or more groups or teams. A team is a set of people with a range of different skills that will ideally have objectives that contribute to the overall planning of the health care services. They will usually have somebody who is identified as the team leader. The importance of teams that perform well cannot be underestimated. [1] Teamwork is an activity that many people try to avoid in the workplace, but why are we so against it? There are a number of benefits of working in teams for both personally and for organization.
Not only it is a great opportunity for professional development, it is also a means of making your work easier. [2] Effective teams need a shared purpose. Building teams requires a teaming strategy to ensure all members are clear about their role and the team’s purpose. [3] Nursing care is generally provided by nurses working as members of multidisciplinary health care teams. When the health care team demonstrates healthy behaviors (e.g. appropriate leadership, good communication, clear goals), patient outcomes and quality of health care are maximized. There are a little distinguishing between effective team and group.
Groups and Teams:
Group:
A number of people or things that are together or in the same place or a number of individuals assembled together or having some unifying relationships. [4]
Team:
A team is a group of individuals working together with a common purpose, common and clearly defined goals, and an identified process for achieving those goals. Teams are important in providing cost effective high quality health care. When teams work effectively there is a significant difference in the entire work atmosphere. [4]
Types of teams:
Teams are categorized according to:
1. Composition
2. Purpose
3. Function
4. Leadership[4]
1. Composition: Skills, experience, and qualification of members. Ex. Nursing team composed of BSN – RN – PLN.
2. Purpose: The purpose of the team or the kind of work it dose it often indicated by the team’s name. Ex. Surgical team – medical team – X-ray team.
3. Function: Some team function in the community, others in hospitals, and other in emergency situation.
4. Leadership: Leadership in most team can be divided into 3 categories, according to the way in which person become a leader of the team.
• Designated leader: Chosen by the team or by administration usually have clear role and responsibilities. Have more permanent position.
• Emergent leader: Assigned himself as leader, usually have special traits that make him a leader.
• Situational leader: Temporary, according to the situation. [4]
Size of Teams:
Team of four to seven people are the most likely to provide a positive experience for members [4]
Healthy team:
A healthy team is a team in which all members participate collaboratively and work in harmony to achieve the defined goals. Building healthy teams refers to actions that are performed to develop health care teams that deliver high quality health care and maximize patient outcomes. [4]
Where?:
Building healthy teams occurs in all areas of a healthcare organization, including inpatient and outpatient healthcare settings and in organizations that deliver patient care in the home care setting.
Who:
Nursing leaders and managers at all levels of a health care organization (e.g., nurse executives, unit managers) and staff nurses are responsible for building healthy teams.
Why is Building Healthy Teams Important?
• Nursing care provided by teams that are not healthy results in delivery of a lower quality of patient care and poorer patient outcomes compared with care provided by healthy teams
• Nurses functioning as members of healthy teams report higher levels of job satisfaction and lower levels of burnout[5]
Need to Know Before Building Healthy Teams:
Healthy teams require:
· High levels of trust and support
· Clarity of purpose
· Commitment from all team members
· Respect among team members
· Positive attitudes
· Excellent communication
· Diverse talent
· Creativity
· Discipline
· Stability
· Strong leadership[6]
The team leader must:
• Encourage cooperation, loyalty, and trust
• Encourage team members to share information and value the input of each team member
• Foster positive attitudes among team members
• Communicate clearly and facilitate communication in the team
• Establish team values and set norms for the team
• Facilitate the team’s involvement in defining goals and motivate team members to collaborate to achieving those goals
• Stimulate debate in the team to get a variety of perspectives
• Foster problem solving in the team
• Have time management skills and efficiently manage meetings
• Effectively delegate to members of the team
• Provide effective feedback
• Avoid conflicts of interest
• Negotiate with team members to build consensus when making decisions
• Have the skills necessary to resolve conflict between team members
• Evaluate how well the team is meeting goals
• Nurse managers and charge nurses commonly function as team leaders[7]
Indications that a team is unhealthy which include:
• Decreased productivity
• Confusion regarding roles of team members
• Apathy and lack of participation
• Poor communication among team members
• Conflict among team members
• Inequality or perceived inequality among team members
• Team members not valuing the team leader
• Ineffective team meetings
• Failure to achieve team goals
• Low quality of patient care delivered and/or poor patient outcomes [8], [9]
Stages of Team Development
Forming Storming Norming
Performing Ending
· Forming stage: (Immature team):
The first stage of group development is known as the forming stage. The forming stage represents a time where the group is just starting to come together and is characterized with anxiety and uncertainty. Members are cautious with their behavior, which is driven by the desire to be accepted by all members of the group. Conflict, controversy and personal opinions are avoided even though members are beginning to form impressions of each other and gain an understanding of what the group will do together. Some believe this cautious behavior prevents the group from getting any real work done. However, the focus for group members during the forming stage is to become familiar with each other and their purpose, not on work.
Typical outcomes of the forming stage include things like gaining an understanding of the group's purpose, determining how the team will be organized and who will be responsible for what, discussion of major milestones or phases of the group's goal (including a rough work schedule), outlining general group rules (including when they will meet) and discovery of what resources will be available for the group to use. [10]
· Storming stage: (fractionated team):
The second stage of group development is known as the storming stage. The storming stage is where conflict and competition are at its greatest. This is because now that group members have an understanding of the task and a general feel for who they are as a group and who group members are, they feel confident and begin to address some of the more important issues surrounding the group. Such issues can relate to things like the group's tasks, individual roles and responsibilities or even with the group members themselves.
The storming stage is where the more dominant of the group members emerge, while other, less confrontational members stay in the comfort and security of suppressing their feelings just as they did in the previous stage. Even though these individuals stay quiet, issues may still exist. All members have an increased need for clarification. Questions surrounding leadership, authority, rules, responsibilities, structure, evaluation criteria and reward systems tend to arise during the storming stage. Such questions must be answered so that the group can move on to the next stage. Consequently, not all groups are able to move past the storming stage. [10]
• Communication difficulties and struggles about leadership and influence in the team
• Unsure about roles, relationships and accountability
• A gap between initial expectations and reality of the situation
• Dissatisfaction, losing some team members
• Increased concerns for others
• increased listening and options[11]
· Norming Stage : (Sharing Team)
Once a group receives the clarity that it so desperately needs, it can move on to the third stage of group development, known as the norming stage. The norming stage is the time where the group becomes a cohesive unit. Morale is high as group members actively acknowledge the talents, skills and experience that each member brings to the group. A sense of community is established and the group remains focused on the group's purpose and goal. Members are flexible, interdependent and trust each other. Leadership is shared, and members are willing to adapt to the needs of the group. Information flows seamlessly and is uninhibited due to the sense of security members feel in the norming stage. [10]
• Getting organized, developing skill.
• Establishing systems, procedures and ground rules
• Open exchange of feelings, facts ideas and values
• Less dissatisfaction. Less conflict and increase trust and respect[11]
· Performing Stage: (the effective team)
At its peak, the group moves into the fourth stage of group development, known as the performing stage. The performing stage is marked by high productivity. Group members are united, loyal and supportive. Competence in all members is seen, allowing for a high level of autonomy in decision making. Problem solving, experimentation and testing possible solutions are high as group members are focused on task completion and achievement. The overall objective of the group during the performing stage is to complete their mission and fulfill their purpose though goal achievement. [10]
• Members enjoy the experience of being part of a winning team
• Appropriate leadership
• Development of priorities
• High flexibility, sharing, tolerance, and major needs of members are met
• Feel confident about their ability achieves and supports each other’s effort
• Systemically review its goals, or organization and procedures
• Members provide each other with constructive feedback
• Maximum use of energy and abilities (toward goal achievement) [11]
· Mourning Stage/Ending stage :
• Ending with suffering this is a time for celebration, and closure
• Optimistic discussion of future challenges can take place[11]
How to Build Healthy Team:
• Provide structured opportunities for team members to share personal histories and build interpersonal relationships
• Explain and clarify team norms
• Explain the purpose and clearly defined team processes and goals for the team
• Establish guidelines regarding decision making
• Increase appreciation of the diversity of the team
• Negotiate mutually satisfying conflict resolution
• Evaluate how well the team is achieving its goals and adhering to its purpose
• Provide redirection, if necessary
• Revise team processes as needed if goals are not being achieved[12]
Advantages of healthy team:
• High quality comprehensive care can be provided despite a relatively high proportion of ancillary staff.
• Each member of the team is able to participate in decision making and problem solving.
• Each team member is able to contribute his or her own special expertise or skills in caring for the patient.
• Improved patient satisfaction.
• Organizational decision making occurring at the lower level.
• Cost-effective system because it works with expected ratio of unlicensed to licensed personnel. Team nursing is an effective method of patient care delivery and has been used in most inpatient and outpatient health care settings.
• Feeling of participation and belonging are facilitated with team members.
• Work load can be balanced and shared.
• Division of labour allows members the opportunity to develop leadership skills.
• Every team member has the opportunity to learn from and teach colleagues
• There is a variety in the daily assignment.
• Interest in client’s wellbeing and care is shared by several people, reliability of decisions is increased.
• Nursing care hours are usually cost effective.
• The client is able to identify personnel who are responsible for his care.
• Continuity of care is facilitated, especially if teams are constant.
• Barriers between professional and non-professional workers can be minimized, the group efforts prevail.
• Everyone has the opportunity to contribute to the care plan.[13],[14]
Disadvantages of team building:
• Establishing a team concept takes time, effort and constancy of personnel. Merely assigning people to a group does not make them a ‘group’ or ‘team’.
• Unstable staffing pattern make team nursing difficult.
• All personnel must be client centered.
• There is less individual responsibility and independence regarding nursing functions.
• Continuity of care may suffer if the daily team assignments vary and the patient is confronted with many different caregivers.
• The team leader may not have the leadership skills required to effectively direct the team and create a “team spirit”.
• Insufficient time for care planning and communication may lead to unclear goals. Therefore, responsibilities and care may become fragmented.[14]
References:
1. http://businesscasestudies.co.uk/cmi/using-teamwork-to-build-a-better workplace/introduction.html#axzz4LWFytAVO
2. Laura Hutton, behalf of the Australian Institute of Business, [Available from--http://aib.edu.au/blog/teamwork-is-important-in-the-workplace/]
3. Eileen Shepherd, Clinical editor, Work place bullying remains a significant issue for nursing, 30 March, 2015[Available from- https://www.nursingtimes.net/roles/nurse-managers/teambuilding-1-how-to-build-effective-teams-in-healthcare/5083723.article]
4. Nursing help, nursing team and team building, September 11, 2015 [Available from- http://www.nursing-help.com/2011/09/nursing-team-and-team-building.html]
5. HRH, Global resource center, why team work in health care important? [Available from- http://www.hrhresourcecenter.org/HRH_Info_Teamwork]
6. Pamela Mitchell, Matthew Wynia, Robyn Golden, Bob McNellis, Sally Okun, C. Edwin Webb, Valerie Rohrbach, and Isabelle Von Kohorn, institute of medicine cited on October 2012,[Available from- https://www.nationalahec.org/pdfs/vsrt-team-based-care-principles-values.pdf]
7. Sherrie Scott, studioD, the effective qualities of team leader, [Available from- http://smallbusiness.chron.com/10-effective-qualities-team-leader-23281.html]
8. Julie Rains, senior writer, freelans, May 23, 2012, [Available from- https://www.americanexpress.com/us/small-business/openforum/articles/company-culture-2012-10-signs-of-unhealthy-company-culture/]
9. Tony Morgan, symptoms of unhealthy organization, December 18, 2012, [Available from-https://tonymorganlive.com/2012/12/18/10-symptoms-of-an-unhealthy-organization/]
10. Sherri Hartzell, principles of management, [Available from-http://study.com/academy/lesson/stages-of-group-development-forming-storming-forming-performing-adjourning.html]
11. Available from-https://www.mindtools.com/pages/article/newLDR_86.htm
12. Available from-https://www.mindtools.com/pages/article/building-positive-team.htm
13. Lynda Roy, the advantages of team work in today’s health care organizations [Available from-http://work.chron.com/advantages-teamwork-todays-health-care-organizations-5143.html]
14. Faado O, team building: advantage and disadvantages, 4th April 2015, [Available from--http://www.faadooengineers.com/content/2179-team-building-advantages-disadvantages]
Received on 28.09.2016 Modified on 25.10.2016
Accepted on 21.12.2016 © A&V Publications all right reserved
Int. J. Nur. Edu. and Research. 2017; 5(2): 208-212.
DOI: 10.5958/2454-2660.2017.00045.X