M5 - L1 - Foundations of Teams and Teamwork - Intended 40% reported the presence of essential

Learning Outcomes characteristics that define a true team (West &

At the end of this lesson, the students should be able to: Lyubovnikova, 2013).
 Three essential characteristics are:
 Distinguish the characteristics of true teams from (1) Having clear, shared objectives;
those groups or pseudoteams. (2) Working closely and interdependently;
 Identify the relationship of effective teamwork to and
the provision of patient-centered care and the (3) reflecting, which means the team
provision of patient-centered care and meets regularly and reviews its
optimization of healthcare outcomes. effectiveness.
 Describe the characteristics of effective teams.  Related terms describing the work of healthcare
 Identify factors that contribute to collaborative providers are multidisciplinary teams, and
leadership practices for healthcare teams. interprofessional teams.
 Describe strategies for performance appraisal for
individuals and teams. Healthcare Team Development
 Apply process improvement strategies to  Creating and maintaining an effective team is
individual and team performance. challenging, dynamic, and ongoing.
 All members must be engaged in the process and
M5 - L1 - Foundations of Group Functioning committed to the overall success of the team in
Why is Teamwork important in Healthcare? providing optimal patient outcomes.
 In the complex environment of health care, team  Healthcare leaders and administrators must
members must rely on one another’s expertise to foster this viewpoint and actively cultivate it as
provide optimal patient-centered care. part of the organizational culture and structure.
 In 1999 the institute of medicine (IOM) published  Supporting a sense of community fosters sharing
a report titled “To err is human: Building a safer of information among team members.
health system” (Kohn et al., 1999).  Providing employee development activities on
 The IOM estimated that 98,000 preventable topics such as communication, relationship
deaths occurred annually because of medical building, and conflict resolution fosters
errors. Further studies reported the impact of interpersonal skills needed for collaboration.
these concerns, with 70% of medical errors  Dedicating time for team members to build
attributed to poor teamwork (Studdert et al., trusting relationships helps create an
2002). atmosphere of respect for all members’
 Consequently, improved teamwork and contributions.
communication have become priorities for the
US government and accreditation agencies such M5 - L1 - Roles of Team Members and Group Dynamics
as the Joint Commission for Hospital Roles of Team Members and Group Dynamics
Accreditation Organization (JCHAO) and the  Stereotypes about perceived roles, or other
Agency for Healthcare Research and Quality member characteristics, can be a barrier to
(AHRQ) (AHRQ, 2008; King et al., 2008; Plonien & collaborative practice.
Williams, 2015).  One influence on group dynamics is the
 Interprofessional collaborative practice is not homogeneity versus heterogeneity of group
only a national issue but also was identified a membership.
priority of the World Health Organization (WHO,  Homogenous groups share similar values, views,
2010). and beliefs.
 For example, a group of female healthcare of
The Healthcare Team What is a team? similar age and cultural background is likely to
 Grumbach and Bodenheimer (2004) defined a share similar perspectives.
team as “a group with a specific task or tasks,  On the other hand, a group comprising men and
and accomplishment of which requires the women of different ages and cultural
interdependent and collaborative efforts of its backgrounds is likely to have more diverse
members”. perspectives, values, and beliefs.
 Healthcare services are frequently delivered by  Such differences must be acknowledged,
individuals from different professions. appreciated, and navigated to provide effective
 Traditionally, groups of healthcare personnel are team-based care.
called teams, whether or not they collaborate in  Different perspectives also lead to a wider range
providing care. of solutions in providing patient-centered care.
 One key difference between a healthcare team
and a group of providers delivering care, M5 - L1 - Leadership in Interprofessional Practice
however, is intentional collaboration.
 In contrast, a group of individuals from different Leadership of Healthcare Teams
professions providing care for a patient does not  Any team member can take on the role of leader
(Dufour & Lucy, 2010). depending on the context of the specific patient-
 Although the vast majority of health services care situation.
staff reported that they work within a team, only
  A collaborative leadership style is particularly  Individuals may be reluctant to speak up because
important in healthcare. Effective leaders in of fear of embarrassment and rejection, or
team-based care value all team members’ punishment (Edmondson, 2012).
potential contributions in meeting the needs of  Likewise, team members may not want to “rock
patients and communities (IPEC, 2011). the boat” by expressing differences of opinion.
 Leadership is one of the primary teamwork skills  A person who receives risk in speaking up may
influencing improved team performance remain silent, but the failure to speak up can
(Hjortdahl et al., 2009). have significant consequences in healthcare and
 Specifically, leadership is defined as the “ability affect the well-being of patients.
to coordinate activities of team members by
ensuring team actions are understood, changes Setting Goals and Meeting Objectives in the Context of a
in information are shared, and the team Team
members have the necessary resources” (AHRQ,  One of the key elements of a healthcare team
2010, p. 5 involves clear, shared objectives (West &
Lyubovnikova, 2013). This means mutual goal
Leadership Theory setting so that all team members are working
 Leadership refers to the ability to influence, toward the same purpose.
motivate, and enable others to contribute.  The patient and family are essential members of
 A leader should “inspire, facilitate, and direct the team and should be active participants in
rather than dictate the way in which work is goal setting.
undertaken” (Ellis & Abbott, 2013, p. 96).  The second part of this process is ensuring that
 Effective team leaders fulfill several important mechanisms are in place to assess whether the
roles as they “organize the team, articulate clear patient, family, or team goals are being met; this
goals, make decisions through collective input of includes measuring outcomes and identifying
members; empower members to speak up and process related to patient-centered care.
challenge, when appropriate; actively promote
and facilitate good teamwork; are skillful at M5 - L1 - Shared Problem Solving and Decision Making
conflict resolution” (TeamSTEPPS, AHRQ, 2010,  Two essential components of effective
p. 9). healthcare teams are collaboration and shared
 An individual must adapt his or her leadership decision making process.
style to the needs of the team and clinical task  This means engaging and integrating knowledge
Ezzaine (2012a) described the differences in experience of other professionals as valuable
leadership styles among clinical leaders: contributors to patient-centered or population-
“Authorization leaders like to be in charge, focused problem solving.
expect people to perform as they are told, and  The importance of considering multiple
do not like to be questioned” (p. 265). perspectives can be understood through the
 This style of leadership provides little analogy of a puzzle.
opportunity for group decisions and may be  Each piece is important but only provides a part
appropriate in select clinical situations such as of a big picture. It takes putting all the pieces
managing a cardiac arrest. together to create the entire seamless picture.
 In contrast, a shared leadership style is often  Shared problem solving begins by clearly defining
preferred for clinical leaders (Ezzaine, 2012a). the problem(s) and generating multiple ideas for
team members are engaged in decision making potential solutions.
with shared responsibility by all members.  The team considers the merits of potential
 Effective leaders offer guidance offer guidance options and then comes to a decision about the
rather than dictating how things will be done. plan of action (Cooper-Duffy & Eaker, 2017)
They promote input from team members and
rely on follower participation to accomplish Consensus Building and Motivation
teamwork tasks.  Reaching consensus means coming to an
agreement about a decision.
Organizational, Interpersonal, and Team Interactions.  Establishing consensus is an important step in
planning care.
 Communication is an essential component of  Teams start with a range of ideas and concerns,
effective teamwork. working to refine the plan until it is acceptable to
 The Joint Commission Report (2006) indicated all members.
that communication failures were the underlying  Being able to have productive conversations and
cause of close to 70% of sentinel events. creatively resolve differences supports
 A sentinel event is an unanticipated event collaboration (Gratton & Erickson, 2007).
resulting in serious injury or death of a patient  Having the opportunity to articulate different
(The Joint Commission, 2006, 2013). perspectives as part of the decision-making
 Some communication failures can be attributed process also fosters a great sense of “buy in” for
to fear related to personal interactions and social the team’s purpose, goals, and processes. In
risk, which may hamper collaboration. turn, this shared commitment translates into
 greater motivation to follow through with team  Differences in professional and personal values
decisions. and perspectives may be a source of personal
 When multiple perspectives strengthen team conflict and difference of approaches to problem
knowledge and understanding, effective teams solving.
are able to reach consensus to guide team  Yet another potential source of disagreement is
planning and provision of care. differing views about team leadership.
 Keeping the focus on providing optimal patient  Regardless of the source of differences, “staying
centered care and valuing the integrated focused on patient-centered goals and dealing
collaborative approach enhances team members’ with the conflict openly and constructively
support of group decisions. through effective interprofessional
communication and shared problem-solving
Shared Accountability strengthen the ability to work together and
create a more effective team” (IPEC 2011, p. 24).
 We demonstrate the importance of developing Team members need to find ways to resolve
consensus-based goals and plans to achieve conflict yet maintain shared commitment to
team goals related to provision of care. team goals and mutual respect for differences of
 To “close the loop”, teams need to foster a sense perspective.
of shared accountability to one another, to
patients and families, and to their communities. Resource Management
 This means that all team members are  One of the most challenging resources to
responsible for working interdependently to manage in healthcare environments in time.
achieve team goals. In the absence of a strong  Coordination of optimal care encompasses
sense of shared accountability, providers may not competing demands for healthcare professional
share information or coordinate care efforts. This and for patient availability.
can result in errors or gaps in care and  Consider the example of an inpatient
compromise patient safety and wellbeing. rehabilitation facility.
 All patients must receive at least 3 hours of
Managing Conflict therapy each day from two or more disciplines.
 Interprofessional teams with diverse abilities and  When a patient requires a radiograph or other
areas of expertise provide a more comprehensive imaging procedure, staff must communicate and
plan of care. coordinate efforts to reschedule therapy times to
 Inevitably, there will be different perspectives ensure patients receive their required therapy
about optimal care for specific patients. hours.
 Such differences have the potential to lead to  This can be further complicated by limited
conflict among team members. staffing of one or more disciplines.
 Differences in professional and personal values
and perspectives may be a source of personal M5 - L1 - Team Effectiveness
conflict and difference of approaches to problem
solving. Team Effectiveness
 Yet another potential source of disagreement is  A central element of Interprofessional
differing views about team leadership. Collaborative Practice is working effectively to
 Regardless of the source of differences, “staying plan, deliver, and evaluate optimal patient- or
focused on patient-centered goals and dealing population-centered care (IPEC, 2016).
with the conflict openly and constructively  The following sections differentiate
through effective interprofessional characteristics of effective and dysfunctional
communication and shared problem-solving teams.
strengthen the ability to work together and  Strategies to appraise team performance and
create a more effective team” (IPEC 2011, p. 24). apply process improvement strategies to
 Team members need to find ways to resolve healthcare teams are also presented.
conflict yet maintain shared commitment to
team goals and mutual respect for differences of Characteristics of Effective Teams
perspective.  According to Dawson, West & Lyubovinkova,
2012, three essential practices of effective
M5 - L1 - Conflict and Resource Management healthcare teams are:
Managing Conflict  developing shared objectives,
 working interdependently to achieve those
 Interprofessional teams with diverse abilities and objectives, and
areas of expertise provide a more comprehensive  meeting regularly to review team effectiveness
plan of care.  Of particular importance is having clear team
 Inevitably, there will be different perspectives goals with shared commitment to the goals
about optimal care for specific patients. (Reeves et al., 2010).
 Such differences have the potential to lead to  Members of effective teams respect one
conflict among team members. another’s time and expertise and trust each
member to do his or her part in achieving mutual
 goals (Cooper-Duffy & Eaker, 2017). To work (3) Engage health and other professionals in shared
closely together, there must be good patient-centered and population focused
communication and active engagement among problem-solving.
team leaders and team members as necessary (4) Integrate the knowledge and experience of
elements for collaborative problem solving health and other professions to inform health
(Sooper-Duffy & Eaker, 2017; Reeves et al., 2010; and care decisions, while respecting patient and
Thistlethwaite, 2012) to effectively plan, deliver, community values and priorities/preferences for
and evaluate care. care.
 Effective teams embrace collective and individual (5) Apply leadership practices that support
accountability for achieving their goals and collaborative practice and team effectiveness.
implement explicit plans to evaluate outcomes. (6) Engage yourself and others to constructively
 High-performing teams collect data, encourage manage disagreements about values, roles,
critical appraisal and peer review of their work, goals, and actions that arise among health and
and are transparent about their abilities and other professionals and with patients, families
processes (Ezzaiane, 2012b; Gawande, 2008) and community members.
(7) Share accountability with other professions,
Characteristics of Dysfunctional Teams patients, and communities for outcomes relevant
 There are a number of challenges to developing to prevention and healthcare.
and demonstrating the characteristics of an (8) Reflect on your own performance as an
effective team. Lencioni (2002) identified five key individual, and as a team member, for
characteristics of dysfunctional teams: absence performance improvement.
of trust, fear of conflict, lack of commitment, (9) Use process improvement strategies to increase
avoidance of accountability, and inattention to the effectiveness of interprofessional teamwork
results. and team-based services, programs, and policies.
 At the foundation is an absence of trust that (10) Use available evidence to inform effective
team members will fulfill their roles. teamwork and team-based practices.
(11) Perform effectively on teams and in different
Process Improvement Strategies team roles in a variety of settings.
 The expectation for engaging in process (12) Apply relationship-building values and the
improvement to promote effective team-based principles of team dynamics to perform
care is especially addressed in the Teams and effectively in different team roles to plan, deliver,
Teamwork Sub-competencies (IPEC., 2011, 2016). and evaluate patient/population centered care
 However, few clinical care providers receive and population health programs and policies that
formal training in quality improvement are safe, timely, efficient, effective, and
strategies, or the management of healthcare equitable. (Teams and Teamwork)
organizations, as part of their professional
training. Team and Teamwork Sub-competencies:
 Several approaches have been used to improve 1. Describe the process of team development and
quality and performance in healthcare the roles and practices of effective teams.
organizations including six sigma, lean/Toyota 2. Develop consensus on the ethical principles to
production system, or student’s handwriting guide all aspects of team work.
excellence (Koning et al., 2006; Vest 7 Gamm, 3. Engage health and other professionals in shared
2009). patient-centered and population focused
 A systematic review of implementing various problem-solving.
quality-improvement strategies to address 4. Integrate the knowledge and experience of
common clinical issues revealed improved health and other professions to inform health
processes and outcomes in areas such as clinic and care decisions, while respecting patient and
appointment access hand hygiene compliance, community values and priorities/preferences for
incidence of urinary tract infections, patient falls, care.
and patient satisfaction (Vest & Gamm, 2009). 5. Apply leadership practices that support
 Quality improvement activities yielded changes collaborative practice and team effectiveness.
in both practices and organizational culture, 6. Engage self and others to constructively manage
which in turn led to better health care. disagreements about values, roles, goals, and
actions that arise among health and other
M5 - L2 - Competencies of Teams and Teamwork - Intended professionals and with patients, families, and
Learning Outcomes community members.
At the end of this lesson, the student should be able to: 7. Share accountability with other professions,
patients, and communities for outcomes relevant
(1) Describe the process of team development and to prevention and health care.
the roles and practices of effective teams. 8. Reflect on individual and team performance for
(2) Develop consensus on the ethical principles to individual, as well as team, performance
guide all aspects of teamwork. improvement.
9. Use process improvement to increase
effectiveness of interprofessional teamwork and
team-based services, programs, and policies.
 10. Use available evidence to inform effective decisions while honoring the values of those we
teamwork and team-based practices. serve.
11. Perform effectively on teams and in different  The specific healthcare situation determines who
team roles in a variety of settings. needs to be involved in making care decisions
that respect patient and family priorities and
M5 - L2 - Sub-Competencies of Teams and Teamwork 1-3 preferences for care.

TT1: Describe the Process of Team Development and the TT5: Apply leadership practices that support collaborative
Roles and Practices of Effective Teams practice and team effectiveness.
 The focus of this Sub-competency is for you to be  Most members assumed that the physician was
able to describe how healthcare teams develop responsible for leading the team. In further
and identify the behaviors and practices that discussion, team members realize that they have
characterize effective teamwork. been “deferring” to the physician during
 Collaborative practice entails more than a group meetings and have been reluctant to offer
of individuals simply working alongside one alternative perspectives and solutions to offer
another. Effective healthcare teams must include alternative perspectives and solutions because of
three essential elements: shared objectives, subtle perceptions of differences in status and
working interdependently, and meeting regularly power among team members.
to review team effectiveness (West &  The majority on team members see their role as
Lyubovinkova, 2012, 2013). contributing expertise in support of the
physician’s role as leader.
TT2: Develop consensus on the ethical principles to guide  They have not fully embraced that perspective
all aspects of teamwork. that each of them are empowered partners in
 Members of an interprofessional healthcare this team collaboration process.
team may hold different personal values and  Shared leadership is essential to team
perspectives about certain aspects of patient effectiveness (O’Sullivan, Moneypenny, &
care. Individual healthcare team member values McKimm, 2015).
may also differ from those of the patients and
families on the team. TT6: Engage self and others to constructively manage
 Team members should recognize and respect disagreements about values, roles, goals, and actions that
one another’s individual differences while arise among health and other professionals and with
coming to consensus on how to approach new or patients, families and community members.
recurring patient-care situations that they  There may be situations where team members
encounter. disagree about values, goals, or actions to be
 Demonstrating mutual respect for one another is taken.
a key element in reaching team consensus on  Likewise, there are times when healthcare
ethical issues. professionals disagree with patients and families
about the course of action.
TT3: Engage health and other professionals in shared  For example, patients may have health
patient-centered and population-focused problem solving. conditions that require dietary restrictions such
 The key word in Sub-competency TT3 is as low-salt or low-fat diets for individuals with
“engage”. high blood pressure or cardiac conditions.
 This means actively involving others in making  Patients and families may not adhere to
decisions. recommended dietary restrictions, instead
 Example: Mr. Smith and his family were seriously preferring familiar meals and comfort foods.
considering their options when questions began  When a patient is a resident in a setting such as
to emerge related to their religious beliefs. an assisted living facility, the need to manage
 The family members wondered if the use of these disagreements may become prominent.
mechanical ventilation might interfere with
“God’s will”, and they wondered if it was selfish TT7: Share accountability with other professions, patients,
of them to want to use such interventions to and communities for outcomes relevant to prevention and
extend his life as long as possible. health care.
 They shared their concern with the nurse on the  Effective teams cultivate a shared responsibility
team, who recognized the need to engage other and shared accountability for healthcare
professionals in assisting the patient and family outcomes and prevention.
in making their decision.  A common example in a hospital setting is the
importance of handwashing to prevent the
TT4: Integrate the knowledge and experience of health and spread of infection from patient to patient.
other professions to inform health and care decisions,  It is important to remember that hospital staff
while respecting the patient and community values and that are not the only ones who transmit
priorities/preferences for care. microorganisms and spread infection: patients,
 The TT4 Sub-competency addresses the families, and other who interact with patients
importance of integrating the knowledge and also share this accountability.
experience of other professionals to inform
  All people in the hospital setting should wash TT11: Perform effectively on teams and in different team
their hands before and after any direct contact roles in a variety of settings.
with a patient or his or her environment.
 Through a simple idea, it only takes one person  It is important for each individual to function
to forget to observe this simple practice to effectively as a team member, and different
transmit infection. situations may require different expertise.
 In particular, the specific details of performing a
TT8: Reflect on individual and team performance for given role may vary based on the setting where
individual, as well as team, performance improvement. the case is provided. For example, the physician
 To further illustrate the importance of an is traditionally considered to be the “leader” of
integrated approach to care, subsequent the healthcare team in the hospital setting;
debriefing meetings resulted in several changes. however, this may not be the case in another
 As part of a regular process of reflecting on team setting. Likewise, with the shift to
performance, the fall prevention team decided to Interprofessional Collaborative Practice, the
create a clinical pathway that triggers proactive team leader could be any one of a number of
intervention by the team. professionals.
 The electronic health record includes as “at risk”  Consider the example of a patient receiving
receive a brightly colored arm band and have a healthcare services in his or her home.
sign posted over their bed, identifying the need  Physicians typically do not make house calls, so
for fall precautions. another provider, such as the home health nurse,
 For example, The fall prevention team may take the leadership role in this setting to
collaborates with institutional technology manage and oversee the patient care.
department personnel to incorporate additional  Similarly, in behavioral health, the team leader
team recommendations into the electronic may be the psychiatrist in some settings,
record. Screening documentation that identifies whereas in others an advanced practice nurse or
at high risk for falls automatically triggers social worker may perform this role.
computerized order sets for mobility protocols  The Global Perspectives box illustrates
and pharmacist consultation. considerations for effective performance on a
global team.
TT9: Use process improvement strategies to increase the
effectiveness of interprofessional teamwork and team- M5 - L2 - The Competencies of Teams and Teamwork
based services, programs, and policies.  Apply relationship-building values and the
 In addition to reflecting on individual and team principles of team dynamics to perform
performance, effective teams should explicitly effectively in different team roles to plan, deliver,
implement a quality improvement or process and evaluate patient/population centered care
improvement approach to increase the and population health programs and policies that
effectiveness of teamwork, team-based services, are safe, timely, efficient, effective, and
programs, and policies. equitable. (Teams and Teamwork)
 For example, administrative support would  Team and Teamwork Sub-competencies:
further enhance a culture of patient of patient  Describe the process of team development and
safety and fall prevention. This could take place the roles and practices of effective teams.
by revising institution policies and procedures  Develop consensus on the ethical principles to
related to screening intervention for patients guide all aspects of team work.
identified as being at risk of falling. An additional  Engage health and other professionals in shared
step might be instituting fall risk assessment patient-centered and population focused
competency testing for all staff members. problem-solving.
 Integrate the knowledge and experience of
TT10: Use available evidence to inform effective teamwork health and other professions to inform health
and team-based practices. and care decisions, while respecting patient and
 Effective teamwork requires training and community values and priorities/preferences for
cultivation (Clancy & Tornberg, 2007). care.
 Some evidence-based resources for training  Apply leadership practices that support
healthcare professionals to enhance teamwork collaborative practice and team effectiveness.
include Team strategies and Tools to enhance  Engage self and others to constructively manage
performance and patient safety (TeamSTEPPS). disagreements about values, roles, goals, and
 Frankel and colleagues (2006) further actions that arise among health and other
emphasized the need for such training, noting professionals and with patients, families, and
that care delivered by a group of experts in their community members.
respective professions is not the same care  Share accountability with other professions,
provided by an expert team. patients, and communities for outcomes relevant
 Team STEPPS can be adapted to meet the to prevention and health care.
specific needs of healthcare teams.  Reflect on individual and team performance for
individual, as well as team, performance
improvement.
  Use process improvement to increase
effectiveness of interprofessional teamwork and
team-based services, programs, and policies.
 Use available evidence to inform effective
teamwork and team-based practices.
 Perform effectively on teams and in different
team roles in a variety of settings.

M5 - L3 - Team and Teamwork Case Studies - Intended

Learning Outcomes
At the end of the lesson, the students should be able to:
1. Demonstrate the ability to apply the Teams and
Teamwork Sub-competencies to problem-based
case studies in this chapter.
2. Operationalize the behaviors of Teams and
Teamwork through case study application.
3. Evaluate how the Sub-competencies of Teams
and Teamwork in Interprofessional Collaboration
are demonstrated in the case study discussions.
4. Identify the importance of Interprofessional
Collaboration as it applies to each case.