HMGT 320 WEEK 3

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L e a r n i n g O b j e c t i v e s

C H A P T E R 6

O R G A N I Z I N G : G R O U P S A N D T E A M S

Coming together is a beginning. Keeping together is progress. Working

together is success.

Henry Ford, founder of the Ford Motor Company

and inventor of the factory assembly line

Studying this chapter will help you to

➤ describe characteristics of groups and teams,

➤ state the purposes of groups and teams,

➤ explain structural characteristics that affect the performance of groups and teams,

➤ explain process characteristics that affect the performance of groups and teams,

➤ recognize helpful and harmful roles played by members of groups and teams,

➤ understand how to make groups and teams effective, and

➤ comprehend how to make group meetings effective.

C o p y r i g h t 2 0 1 9 . H e a l t h A d m i n i s t r a t i o n P r e s s .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

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Here’s WHat HaPPeneD Partners HealthCare had established goals to improve population health and adapt to changing payment incentives. To accomplish these goals, managers organized teams, committees, and other groups of workers. For example, Partners had a strat- egy implementation group and transition teams. When organizing them, managers had to make important decisions about the group and teams to ensure their success. For example, for the strategy group, key decisions probably included the purpose of the group, whom to assign to the group, how much authority it should have, and to whom it would be accountable. Managers, or the group members themselves, had to decide who should chair (lead) the group, how often it should meet, with whom it would communicate, and how it would make its decisions. Managers had to orient new members to their committee roles. Potential conflict among group members (e.g., because of differences in professional viewpoints) could have deterred them from working together. Partners HealthCare’s managers—and the strategy implementation group’s members—had to use group structures and processes to enable the group to perform well. The group was then able to achieve its purpose and help Partners achieve its organization goals. The same was true for the transition teams.

T his chapter, the third about organizing, helps us understand why and how health- care organizations (HCOs) organize people into groups such as teams, committees, huddles, task forces, and councils. As we learned in chapters 4 and 5, organizing

groups is a form of coordination that HCOs use to achieve goals. We saw that Partners HealthCare used these types of groups. It would be hard to imagine how even a small HCO—much less a large, complex one—could succeed without organized groups, teams, committees, and similar organization structures. Although they often are not shown on organization charts, these structures are essential to contemporary organizations—including HCOs. What are some teams, committees, and task forces you have heard of in HCOs?

Managers at all levels of an HCO must create and participate in groups and teams. Top managers must support groups and promote teamwork throughout accountable care organizations, medical practices, health insurance companies, pharmaceutical firms, assisted living centers, mental health clinics, community health alliances, and other HCOs. Managers at lower levels must do the same within their own departments and work sections. When you are a new manager, consider volunteering for teams and committees to become more widely known in your HCO. Working with employees outside your department or work unit will give you opportunities to grow professionally, learn more about your HCO, and develop rewarding work relationships with others. This chapter will improve your teamwork skills, which are important for healthcare management jobs.

You may have belonged to some clubs, teams, groups, and committees that were effective and fun and some that were not. Why do group experiences vary? Good groups and

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teams are not automatically good; they are good because managers created them properly. How can managers do that? In this chapter we learn how, beginning with basic ideas about groups and teams and their purposes. Next, we study how managers create group structures and processes that strongly affect a group’s success or failure. We also examine roles group members perform that may help or harm the group. All these things matter for a group, whether it is a board of directors, a children’s health task force, or an air ambulance team. In this chapter, you will acquire more tools to use when managing HCOs.

This chapter focuses on formal groups and teams—the ones that appear in orga- nizations’ official written documents and are created by top managers. We know from chapter 4 that there is also an informal organization, which includes informal groups that managers do not create. Although this chapter explains what managers can do to create and manage their organization’s formal groups, most of these concepts and methods also apply to informal groups.

gr o u P s a n D te a m s A group is “two or more people who interact with each other and share a common purpose” (Johnson and Rossow 2019, 100). A team is a special kind of group whose members share a common goal and accountability for outcomes and coordinate tasks, skills, and resources interdependently (Griffin, Phillips, and Gully 2017, 254). Teams tend to be smaller than groups. HCOs often have interprofessional teams with members from multiple depart- ments and professions. A committee is a formal group with an official purpose and official relationships with other parts of the organization (Dunn 2016, 357). These terms are not precisely defined and sometimes are used interchangeably when it is not important to distinguish among them (Griffin, Phillips, and Gully 2017). This book uses that approach.

Additional characteristics of groups include the following (Dunn 2016; Griffin, Phillips, and Gully 2017; Johnson and Rossow 2019):

◆ Some have line authority to make decisions; others only make recommendations.

◆ They vary in how much they are self-directed and able to manage themselves.

◆ Some exist within a single functional department of an organization, yet many have members from multiple functional departments (i.e., are cross- functional), multiple disciplines (i.e., are interdisciplinary), or multiple organizations (i.e., are interorganizational).

◆ They exist at all levels of hierarchy, from the board of directors on down.

◆ They may be permanent (standing) for ongoing work, or they may be temporary (ad hoc) for specific, one-time work.

group

Two or more people

who interact with each

other and share a

common purpose.

team

A special kind of group

whose members

share a common goal

and accountability

for outcomes and

coordinate tasks,

skills, and resources

interdependently.

committee

A formal group with an

official purpose and

official relationships

with other parts of the

organization.

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◆ Some exist in a building with members interacting in person, while others (virtual groups) exist in cyberspace with members interacting electronically.

Why do HCOs have groups and teams? Groups can help HCOs do the following (Dunn 2016; Griffin, Phillips, and Gully 2017; Johnson and Rossow 2019):

◆ Combine and coordinate work that is fragmented because of division of work and specialized expertise

◆ Enable workers to grow, try new roles, and develop professionally

◆ Expand workers’ knowledge of their HCO beyond their own departments

◆ Enable workers to share and exchange skills, knowledge, and organization learning

◆ Build commitment (through participation) to solutions, changes, and new plans

◆ Obtain input, representation, and support of stakeholders, interest groups, and constituents

◆ Improve problem solving and decision making by bringing in diverse and necessary input, points of view, experience, and expertise

◆ Strengthen working relationships and camaraderie among employees

Teams are likely to become more common in HCOs because they can help integrate clinical care and coordinate projects. Another reason is the number of workers entering the workforce who like to work in teams and may ask about it in job interviews (Schawbel 2016).

In addition to advantages, groups and teams also pose certain disadvantages (McCon- nell 2018). Starting a team and preparing it to work effectively can require many organiza- tion resources. Group meetings take time and might require workers to be in a conference room rather than caring for patients or doing other essential work. Some teams have too many meetings that last too long. Group decision making is slower than individual decision making. As a result, groups may become stagnant and bureaucratic and thereby impede needed change. A committee might even be known as “the graveyard” if proposals are sent there and never heard of again.

g r o u P s a n D t e a m s I n H e a Lt H c a r e o r g a n I z at I o n s

HCOs have many types of groups, teams, committees, councils, and task forces. The fol- lowing examples illustrate this variety: Population Health Coordination Council, Diversity in Healthcare Group, Board of Directors Planning Committee, Telehealth Installation

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Team, Interdisciplinary Practice Committee, Data Analytics Task Force, Cross-Functional Readmissions Committee, Patient Experience Subcommittee, and Virtual Care Team.

Although groups and teams form in most types of organizations, they seem to be especially common in HCOs. Why? Healthcare is multidisciplinary, involving disciplines such as nursing, pharmacy, occupational therapy, social work, medicine, dietetics, and doz- ens of others. Many disciplines have specialties. For example, nurses specialize in pediatric nursing, emergency nursing, psychiatric nursing, and so forth. C-suite managers specialize in finance, marketing, diversity, operations, patient experience, ethics, and more. In addi- tion, healthcare work is often performed on weekdays and weekends, sometimes in two or three shifts per day and in different locations. Teams overcome this division by coordinating and integrating their work (as discussed in chapters 2 and 5). Managers create groups to coordinate work among many different professions, disciplines, departments, shifts, and locations. For example, Christiana Care Health System in Delaware has an interdisciplinary team that includes a medical director, nurse care coordinators, pharmacists, social workers, and support staff to improve population health (Buell 2018).

As noted earlier—and worth repeating—groups and teams are not automatically good. They become good partly because of what managers do. Managers first create the structures of a group. Then managers and team members create the processes of that group. This chapter explains how. The structures and processes described in the following sections strongly affect a group’s performance and effectiveness.

st r u c t u r e s o f gr o u P s a n D te a m s When you form a group, think carefully about these seven structural characteristics: pur- pose, size, membership, relation to organization structure, authority, leader, and culture. The characteristics are interrelated and affect group performance. Choose them wisely so your group can succeed. These seven characteristics are explained in the following sections (Albritton and Fried 2015; Dunn 2016; Fried, Topping, and Edmondson 2012; Griffin, Phillips, and Gully 2017).

P u r P o s e

Each group must have a clear purpose, which is sometimes called its charge or mandate. This charge will guide the group in many ways, such as determining who should be in the group, how often it will meet, which resources it will need, and whether it is temporary or ongoing. When group members have a clear purpose, they can focus rather than drift aimlessly or shift from one direction to another. With a purpose as a target, a group can also measure progress more easily. A group’s purpose is usually stated (at least in rough-draft form) when people first decide the group is needed. The written statement of purpose usually comes from the manager who formally creates the group and holds it accountable for achieving its purpose.

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Managers should devote careful thought and effort to writing the group’s state- ment of purpose. That effort will pay off later by giving clear guidance to the group and its members. The group should periodically update its purpose, if needed, to reflect changing situations.

s I z e

The size of a group strongly influences how well it performs. In this chapter’s opening Here’s What Happened, for example, managers at Partners HealthCare had to decide how big the strategy implementation group should be to achieve its goals. Pop quiz: What size is best? If you said, “It depends,” you are correct! Bonus question: What does it depend on?

Managers should consider several factors when they determine the size of a group, team, or committee. They must weigh the advantages and disadvantages of a big group against those of a small group. The best size depends on the group’s purpose. For example, the purpose might require certain departments, stakeholders, or others to be represented and able to participate. If the group’s purpose is to coordinate the work of seven departments, then the group should include at least seven people, one to represent each department. The group must be big enough to include members with the needed expertise, such as data analytics or e-health. If the group’s purpose is to advise and make recommendations to others who will then make a decision, a larger number of members will bring a wider range of views and information. To build support for a strategic plan, a large planning group allows more people to participate so that they will be more likely to support the final plan. When a great deal of work must be accomplished, a large group can allocate tasks among more members.

Although big groups offer advantages, they also have disadvantages. Because they have more members than small groups, big groups require more time and effort for all members to become comfortable working with each other. Even then, big groups are hard to manage because there is less cohesion and cooperation among members. Smaller splinter groups and informal groups often emerge within large groups. If this happens, it may signal a need to subdivide a large group into several smaller subgroups, each focused on a part of the full group’s purpose. More time and effort are also needed for large groups to meet, discuss issues, gather input, resolve differences, and reach decisions. Costs rapidly increase in big groups because the salary meter continues to run during meetings and costs for food, supplies, and other resources increase. In large groups, communication and interaction become more formal and controlled and require more administrative support.

These disadvantages of large groups reveal the advantages of small groups. Exhibit 6.1 lists the advantages of big groups and small groups. According to Dunn (2016), four to nine members is a good size for a committee. Dye (2017) says there is no ideal size for a team, but a range of 6 to 11 members is generally appropriate. Jeff Bezos, founder and CEO of Amazon, believes a team should be small enough to feed with two pizzas (Choi 2016)!

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m e m b e r s H I P

The membership (composition) of a group strongly affects the group’s performance. Partners HealthCare had to think carefully about the composition of its strategy implementation group and its transition teams. Managers might choose (or recommend) the members of a committee, team, or council. Alternatively, people in a department, division, or other part of an HCO might choose someone to represent them in a group. For example, the social services department might choose its employee, Olivia, to represent the department on the consumer engagement team. Those who choose or elect members to serve in groups should consider these questions:

◆ Who can provide the pertinent knowledge, skills, and attitudes this team needs?

◆ Who works well with people in groups (or could after training and coaching)?

◆ Who has sufficient time for the team while still doing her regular job?

◆ Who could add diversity to a committee?

◆ Who might grow professionally from group membership?

◆ Who can represent certain stakeholders, constituents, and groups on this committee?

Advantages of Big Groups Advantages of Small Groups

More opportunity to obtain diverse views, ideas, expertise, and input

Easier and faster to reach agreement

More people committed to the group’s purpose and work

Less time needed for members to get acquainted and be comfortable with each other

More stakeholders who feel they have a say and are represented

More group cohesiveness and coopera- tion; time for all members to speak

Tasks and work spread among more people

Less formality, fewer administrative tasks, easier to manage

Better for solving complex problems Less costly

Sources: Dunn (2016); Fried, Topping, and Edmondson (2012); Griffin, Phillips, and Gully (2017).

exHIbIt 6.1 Group Sizes and Advantages

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◆ Who is needed for this team to comply with applicable requirements, laws, and standards?

◆ Who can perform helpful task and maintenance roles and avoid harmful personal roles?

Exhibit 6.2 shows three types of roles that group and team members may perform (in much the same way people perform roles in a movie or school play). When group members perform task roles, they help their group achieve its tasks and purpose. When they perform maintenance roles, they help group members maintain good feelings about the group and about working with group members. In contrast, when group members perform personal roles, they try to fulfill personal needs in ways that may harm the group. Which of these roles have you seen group members perform? Task and maintenance roles increase members’ satisfaction with the group and increase group effectiveness; personal roles do not. When managers pick people to serve in groups, they should consider not only people’s techni- cal skills but also the roles people could contribute to the group. (As a new manager who wants to succeed, be sure you perform task and maintenance roles but not personal roles.)

Managers should also consider the diversity of team membership. Diverse members can bring diverse ideas, viewpoints, attitudes, and values that can lead to innovative solutions to complex problems. When membership is diverse, members may become more aware of biases and limited information that block thinking (Johnson and Rossow 2019). Diversity can help open people’s perspectives to enable better problem solving and decision making.

Although group membership diversity has advantages, it also has disadvantages. Diverse members will have varied attitudes, beliefs, and preferences regarding authority, hierarchy, communication, decision making, and other aspects of group interaction and behavior (Griffin, Phillips, and Gully 2017). This, along with diversity of team members’ ages, education levels, statuses, and cultures, may impede (at least initially) group trust, communication, participation, cohesiveness, and decision making. Thus, a manager who appoints a committee of diverse members should provide sufficient time, training, and activities to strengthen members’ trust in one another and to encourage interaction and communication. (A later section of this chapter, and chapters 7, 8, and 15, all offer ideas for how to do this.) A related factor is group membership duration. Membership should be long enough to allow group members the time and interaction needed to develop trust and cohesiveness (Johnson and Rossow 2019). Then the group can realize the benefits of diverse membership.

r e L at I o n t o o r g a n I z at I o n s t r u c t u r e

Another structural feature of a group is the way it relates to the HCO’s overall organization structure and hierarchy. This relationship affects how the team performs and how effective it can be. A committee that ties into the formal organization at a high level is perceived as more important and powerful than a committee that is accountable to a lower level of the

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Task roles help the group achieve its tasks and purpose.

Role/Function Actions and Behaviors

Leader Leads the group by performing multiple task and maintenance roles

Initiator Suggests new tasks, directions, problems, solutions, procedures

Information seeker Requests relevant facts, opinions, data

Information giver Provides relevant facts, opinions, data

Clarifier Clarifies and explains terms, ideas, issues, opinions, data

Elaborator Explains in depth, giving examples, details, interpretations, implications

Devil’s advocate Argues for alternative choices, raises contrary opinions, forces debate

Evaluator Judges ideas, information, progress, results

Synthesizer Combines and summarizes ideas

Agreement tester States possible agreement, asks if members agree

Energizer Stimulates members, urges progress

Orienter Keeps discussion on track, redirects the group to stay on task

Recorder Takes notes, prepares records

Maintenance roles help group members maintain good feelings about the group and about working with group members.

Role/Function Actions and Behaviors

Encourager Praises others, affirms others’ contributions, recognizes others

Harmonizer Smooths over conflict, reconciles disagreements, reduces stress, eases tension

Compromiser Offers or accepts compromises, admits own mistakes, changes opinion to maintain cohesion

Facilitator Invites participation of members, suggests procedures for discussions, keeps communication open for all

Observer Monitors and comments on feelings of the group and how it functions

Follower Accepts ideas, goes along with the group

Personal roles do not help the group; rather, they help members fulfill personal needs.

Role/Function Actions and Behaviors

Aggressor Attacks others, attacks the group, harshly disagrees

Blocker Opposes the group’s ideas, impedes progress, is overly negative

Dominator Tries to dominate and control the group, asserts authority

Help seeker Seeks help with personal problems, seeks sympathy and support

Recognition seeker Calls attention to self, seeks praise and recognition

Special interest seeker

Speaks up for a different group’s interests

Sources: Adapted from Daft (2016); Dunn (2016); Dye (2017); Fried, Rundall, and Topping (2000); Myers and

Anderson (2008).

exHIbIt 6.2 Roles of Group Members

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HCO. The high-level association will provide more political clout and resources, which could help the group succeed. After all, a group cannot perform well if it does not have sufficient resources and support from higher-level managers. Team members’ main jobs also create links to different departments, divisions, and work units in the HCO’s structure.

When a manager creates a committee, task force, or team, the manager must decide to whom it will be accountable. For Partners HealthCare, the top managers had to decide to whom the strategy implementation group would be accountable (perhaps the chief strategy officer) and to whom it would report its work (perhaps the senior management team).

a u t H o r I t y

When creating a task force, team, committee, or other group in an HCO, managers must decide what (if any) authority the group will have. Will a patient safety team have authority to establish a policy requiring nurses to repeat verbal orders from a physician (to ensure the orders were heard correctly)? Or will the committee only have authority to recommend that policy? Perhaps the committee will only have authority to advise nurses to repeat verbal orders. How about an HCO’s employee picnic task force—how much authority will it have to spend funds? At a healthcare consulting firm, the summer picnic task force wanted unlimited authority, but the managing partner authorized it to spend only up to $2,000; a higher amount would need further approval. Authority might vary over time or because of other factors. For example, a new task force might initially have little authority but be given more authority after it becomes more proficient.

L e a D e r

The leader position—and the person who serves in that position—is yet another structural feature of a group. This position may be called the committee chair, group lead, task force director, team captain, or some other title.

TRY IT, APPLY IT

When you read through the group roles in exhibit 6.2, did it bring to mind people you

know? Do you know someone who is a natural initiator, clarifier, energizer, harmonizer,

or observer? Perhaps you also know a blocker or dominator. To strengthen your under-

standing of roles in groups, try to think of someone you know who could perform each

of the task and maintenance roles. Those are people to have in a group or on a team!

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Suppose the president of a medical group practice in Columbus creates an employee advisory council to inform managers about employees’ concerns. Will the president appoint the council chair, or will the council members elect their own leader? For standing com- mittees that continue for years, how long should someone serve as chair? What duties and authority will the leader have? The more clearly these details are stated at the beginning, the better the group can perform. Depending on a group’s size and purpose, it might have more than one leader. For example, large formal committees and councils might have a chair, a vice chair, and a secretary. The responsibilities of each leader position should be clearly defined and shared with all group members.

Another consideration is who will serve in the formal leader position(s). Imagine a medical school’s ethics council in Miami that has a chair position with designated respon- sibilities. Who should be the chair? Earlier, we learned about task roles, maintenance roles, and personal roles in groups. How well a group leader performs task and maintenance roles will strongly affect the group’s success. Ideally, a group’s formal leader position will be filled by someone with the right knowledge, skills, abilities, and role behaviors.

Besides the formal leader, a group may have an unofficial, informal leader (as we learned in chapter 4). A committee member with high energy who likes to socialize may become an informal leader. So, too, might a team member who has relevant expertise. Suppose a patient care council has 20 members, including 4 nurses. The nurses might sit together at council meetings, text each other between meetings, and let the most experi- enced nurse be their informal leader.

c u Lt u r e

The final structural feature of a group, team, or committee is its culture—the values, atti- tudes, and norms (behaviors) that are considered proper and guide the group’s members. A group might value risk-taking and thinking outside the box, or it might not. A committee should establish its expected behaviors, such as “no side conversations during meetings” and “make new members feel welcome.” Culture may include sensitive issues such as trust, conflict, civility, and respect. A culture that supports collegial disagreement will enable people to safely express different points of view. The culture should fit the purpose of the group and should not strongly conflict with the HCO’s overall culture. For example, if a strategic planning team is to brainstorm new ideas, its culture must not be rigid and sti- fling. Group members must believe it is OK to ask “stupid” questions and suggest “crazy” ideas. A group’s culture will also affect how members feel about being part of the group and whether they continue to actively participate. If a committee’s culture allows physicians to behave in an arrogant manner toward other members, then nonphysicians will not fully participate in the committee.

Managers and group members must decide what the culture of the group should be and then take steps to establish it. The group culture is likely to be based on the group’s

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history, traditions, purpose, and situation, as well as on members’ personalities (Griffin, Phillips, and Gully 2017). If a group establishes and embraces its culture, then those values and norms will strongly influence the group’s effectiveness. More information about this is provided later in this chapter and in chapter 11 on culture in HCOs.

Pr o c e s s e s o f gr o u P s a n D te a m s Besides structure, groups and teams in HCOs must have processes to do their work. Struc- ture only creates a committee; processes make the committee come to life with activity. Listen closely to a team and you will hear the hum of activity; with some teams, you might also hear shouting, cheering, arguing, and other sounds! When you are on a team or com- mittee, think about five processes: developing, leading, communicating and interacting, decision making, and learning. Group leaders and members together create these processes, which all affect group performance. In addition, these processes may affect structure, such as by shaping the group’s culture. The following sections explain the five group processes (Albritton and Fried 2015; Dunn 2016; Griffin, Phillips, and Gully 2017; McConnell 2018; Walston 2017).

D e v e L o P I n g

As Henry Ford’s quote at the beginning of this chapter implies, groups of workers go through stages. Before actually working together, they first come together and then progress toward staying together. Bruce Tuckman incorporated those ideas in a team development model that is still commonly used today (Tuckman 1965; Tuckman and Jensen 1977). The model provides a broad understanding of groups and suggests that groups go through five stages of development: forming, storming, norming, performing, and adjourning. Although it does not portray every group, the model does provide a useful guide for understanding how to manage and participate in groups. The five stages of the team development model involve the following (Dunn 2016; Griffin, Phillips, and Gully 2017; Johnson and Rossow 2019; McConnell 2018):

1. Forming Stage

◆ Members get acquainted, act polite, and try to figure out what is OK and not OK.

◆ Members learn the group’s purpose, roles, and behaviors.

◆ Members reduce barriers with icebreakers (e.g., self-introductions, interviewing and then introducing other members, scavenger hunt, team-building exercises).

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◆ The leader should set a positive tone and stimulate new thinking and motivation.

2. Storming Stage

◆ Members more openly express opinions and argue about the group’s goals, methods, rules, and tasks; conflicts arise.

◆ Some members strive for control, creating conflict.

◆ The leader should demonstrate cooperation and teamwork and emphasize team purpose.

3. Norming Stage

◆ Members figure out how to work together and agree on rules; expected norms (behaviors); a code of conduct; and methods for decision making and cooperating and communicating with each other.

◆ Cooperation increases, conflict decreases, members socialize, and the group feels more cohesive.

◆ The leader should emphasize the group’s goals and purpose.

4. Performing Stage

◆ Members have figured out how to work together and now focus on achieving the team’s purpose and goals.

◆ Members plan how to accomplish goals, divide up work, and assign tasks.

◆ Members perform their tasks, evaluate progress, and make adjustments as needed.

◆ The leader should guide progress toward goals and motivate members.

5. Adjourning Stage

◆ After the group finishes its goals and purpose, members celebrate what they achieved.

◆ If members worked well together, they may mourn the end of their team, feel sadness about not meeting again, and express farewells.

◆ The leader should help members reach closure.

Think about teams or groups you have participated in. Are some aspects of this model familiar based on what those groups did? Managers use this model to understand

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group behavior, realizing that some groups may not go through all five stages or develop in a linear way. For example, some housekeeping workers at a personal care home who already know each other could be appointed to a department task force to create a new work schedule. Because they know each other, they will not have to go through the forming stage. Members may quickly progress to the performing stage. Alternatively, if an ongoing community advisory board expands its purpose and increases its size from 7 to 15 members, it should back up and redo the earlier forming stage.

Many local, regional, national, and global HCOs, such as healthcare systems, nurs- ing home chains, hospital management companies, and pharmaceutical firms, use virtual teams. Managers who lead or serve on virtual teams in cyberspace should be especially sensitive to how members progress through these stages of development. Some group members—particularly those who have not been in a virtual group before—may struggle with getting to know and becoming comfortable with each other if their technology does not allow them to see body language and facial expressions. Members may argue more about rules for communicating and norms for interacting. A section later in this chapter tells how to create effective virtual teams.

Some groups are very diverse with respect to members’ demographics, experiences, cultures, and other characteristics. A new culturally diverse team might experience ste- reotyping, distrust, conflict, and communication problems. Here, too, extra time, effort, training, and support will likely be needed as the team moves through the stages of devel- opment (Griffin, Phillips, and Gully 2017). Managers should provide plenty of time and opportunity—formally and informally, planned and unplanned—for members to become acquainted professionally and personally (Dye 2017). Managers, groups, and teams often do not realize how much time and effort are needed in the forming stage to begin the team building that should continue through later stages.

L e a D I n g

Leading greatly affects group performance. We learned earlier that small groups may have a single leader, such as team captain, committee chair, or task force director. Larger groups may have multiple leaders, including a chair, vice chair, and secretary. These structural positions are different from the process behaviors and actions that leaders actually use for leading. The leader should engage in task and maintenance roles, activities, and behaviors (listed in exhibit 6.2) to lead the group to achieve its purpose and lead members to main- tain good feelings about the group. The leader should explain the group’s purpose and goals, divide up the work, arrange assignments, resolve conflicts, and motivate everyone to help the group succeed. In addition to performing many task and maintenance roles, the leader should interact effectively with each member. This may involve more indirect leadership (e.g., facilitating discussions and resolving conflicts) and less direct leadership (e.g., giving orders).

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Sometimes the leader may let one or more team members lead (Albritton and Fried 2015). For example, the formal leader may let a member with specific expertise (e.g., social media savvy) lead the group when it must handle a specific matter (e.g., a social media problem). This approach strengthens the group by actively involving more members, using their expertise, and enabling them to develop leadership skills for the future. When leading a group, the formal leader must also identify informal leaders and work effectively with them. Chapters 9, 10, and 11 are about leading and offer useful advice about leading groups and teams.

c o m m u n I c at I n g a n D I n t e r a c t I n g

Because group members must communicate and interact with people both inside and outside their group, communication processes are important to the group’s success. Ide- ally, all team members will easily communicate with each other in meetings, one-to-one conversations, and other interactions. However, we know that does not always happen because of biases, communication preferences, personal relationships, differences in age or status, and other factors. If members are not comfortable interacting with each other, then communication can become limited, as shown in exhibit 6.3. In other groups, some members may communicate with one or two other members but not the whole group; this also restricts communication.

Leaders must help their group communicate and interact well so that group mem- bers—and the group itself—can be effective. Too little interaction or communication

exHIbIt 6.3 Limited Communication Among Group Members

Member Member

Member

Leader

Member

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among members will reduce trust, cohesiveness, and eff ectiveness. However, too much interaction or communication could overload group members and cause them to back away from the group.

Effective processes are also needed for the group to communicate and interact with people outside the group. For example, think of a group of hospital staff members who are planning how the hospital should adjust to value-based reimbursement. Th at group must communicate with other people, departments, and groups inside the hospital. In addition, the group will have to communicate and interact with people outside the hospital. Why? To obtain resources, information, and expertise from outsiders and to coordinate its work with other parts of the hospital and with other organizations.

Communication processes must be created by teams and their members. Th ese processes can by enhanced by methods and technologies such as meetings, social media, huddles, conference calls, documents, e-mail, intranets, and blogs. Th e chair of a community health council in Richmond could use multiple processes to help members communicate

USING CHAPTER 6 IN THE REAL WORLD

At Bellin Health Systems, based in Green Bay, Wisconsin, medical offi ce patient care

teams huddle for 5 to 10 minutes each day prior to seeing the fi rst patient. The huddle

includes providers and care team coordinators, as well as a patient access representa-

tive, nurse, and behavioral health consultant if available. A care team coordinator leads

the huddle by quickly discussing plans for the day, scheduled patients and their needs,

potential staffi ng issues, continuity of care, opportunities for extra patients, and avail-

ability of medical records from other facilities. These daily huddles help the team com-

municate and interact to improve team performance and enhance the patient experience

(Bellin Health Systems 2014).

Cone Health and its accountable care organization, based in Greensboro, North Car-

olina, use multiple committees and teams to improve coordination of clinical care. An

operating committee of physicians and managers oversees daily operations. Five sub-

committees guide credentialing, contracting and fi nance, medical management, quality,

and health information exchange. Teams focus on helping providers avoid readmissions,

surgical-site infections, and other problems. The senior vice president for quality and

patient safety at Cone Health believes that clinical integration is about connecting the

people who can improve care throughout the continuum. Teams and committees help

do that (Hegwer 2016).

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C h a p t e r 6 : O r g a n i z i n g : G r o u p s a n d T e a m s 1 4 7

and encourage them to interact. The task and maintenance roles (shown in exhibit 6.2) also can strengthen communication and interaction processes in groups. When members perform those roles (and avoid the harmful personal roles), they improve their group’s communication and interaction. For example, throughout many HCOs, small teams briefly huddle each morning to enhance patient experience, safety, care, and service. In these quick (usually stand-up) huddles, employees discuss the schedule, safety concerns, patient convenience, and related topics. Problems are identified, addressed, and monitored in subsequent huddles. Successes may be quickly announced and celebrated. The Using Chapter 6 in the Real World sidebar gives examples of teams and committees improving communication, interaction, and coordination at two HCOs. Chapter 15 includes more information about effective communication.

D e c I s I o n m a k I n g

How are decisions made in groups you participate in? Do members vote? Does the leader try to build consensus for an idea that everyone generally agrees with? Or perhaps the leader obtains input from members and then makes the decision alone. Decision making in groups can range from autocratic decisions made by the group leader to democratic decisions made by all members. This subject is more fully addressed in chapter 13 on deci- sion making. For now, remember that groups can use various processes to make decisions. A single committee may use different decision processes for different decisions because of different leadership, time urgency, members, and other factors. Each approach has pros and cons. Decision by consensus agreement strengthens group support of the decision. However, more time and discussion are needed to reach a consensus decision than to make a decision by majority vote (or by an autocratic leader). A consensus decision might not be possible for a radical, innovative decision that could be made by a committee chair decid- ing alone after consultative input from the group. Members must use decision-making processes that best fit the group given its goals, time, resources, and members’ ability to make decisions. Group members can become better at making decisions through training, coaching, and experience.

Group members and leaders should watch for two possible problems when making decisions. The first occurs when responsibility for a group decision is spread among group members so that no single individual is accountable. This situation is reflected in the saying “When it is everybody’s decision, it is nobody’s decision.” Knowing they will not be held individually responsible, members might take group decision making less seriously than individual decision making. Thus, group leaders must create and reinforce individual as well as group accountability for decisions, such as by calling on each person to individu- ally state a choice.

Second, groups should strive to avoid groupthink. This is a process in which group members quickly agree without considering diverse ideas and thoughtful analysis; it is

groupthink

A process in which

group members

quickly agree without

considering diverse

ideas and thoughtful

analysis, usually

to maintain group

harmony.

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usually done to maintain group harmony. Groupthink can cause group members to avoid the different ideas, critical thinking, and discussion needed for effective problem solving and decisions (Dunn 2016). It occurs when leaders and group norms (developed in the norming stage) so strongly support group harmony that they block critical thinking and debate. Members think, “We must all get along,” so they do not disagree with each other. Yet, some tactful disagreement is good for organizations to prevent quick, superficial, and ineffective decisions. Groups potentially can make better decisions than individuals because groups bring a wider range of information, experiences, perspectives, and insights to the decision. Groupthink can block these potential benefits, so group leaders should create team norms that support critical thinking and diverse ideas. They should encourage productive disagreement early in the decision-making process.

L e a r n I n g

A final important group process is group learning (Fried, Topping, and Edmondson 2012). The team must learn as a team. That is not the same as individual learning by individual members. The group must reflect on its structure and processes to learn how it is doing as a group. Based on what it learns about itself, the group then can improve its structures and processes.

For example, suppose a safety-net primary care clinic in Chicago appoints a new fundraising committee to obtain $50,000 in donations. The group comprises 13 mem- bers, some of whom do not know the others. The group will have to develop itself, lead itself, communicate within and beyond itself, and make decisions. How well does the group perform all these duties? Kiera feels there is not enough communication between the leader and herself. Travis thinks the group’s members have been blindly guessing how much local businesses will donate rather than carefully analyzing data. Colleen and Taylor feel the group is struggling and might not reach its goal. Group learning is needed. The group should openly discuss its processes and how it is doing. The leader, through discussion or confidential surveys, can ask group members for feedback about the group’s processes and outcomes and seek suggestions for improvement. (The fol- lowing Check It Out Online box describes a group self-assessment survey to help guide group learning.) To overcome weak processes, the group can engage in team-building exercises and training in group processes (e.g., communicating, decision making). The group can reaffirm its norms or, if necessary, return to the norming stage to develop new norms. It might have to change its structures, such as by reducing its size or strengthen- ing leadership authority. People do not automatically work well as a group. They must learn how to work together as a group. The group learning process enables a group to evaluate itself, learn about itself, and then adjust its structures and processes to improve group performance.

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ef f e c t I v e gr o u P s a n D te a m s To create effective groups and teams, managers and groups can establish the structures and perform the processes discussed earlier in this chapter. When necessary, managers and group members can adjust team size, membership, culture, communication, and other structures and processes. These structures and processes that influence a group’s effective- ness are mostly internal to the group.

Factors external to a group in an HCO also influence that group’s effectiveness. These factors outside a group often are still inside the group’s HCO. For example, suppose an HCO in Milwaukee provides outpatient lab tests, medical imaging, and cardiology tests. Within this business, an equipment committee decides which equipment to buy each year. The equipment committee will be influenced by factors outside the committee yet inside other parts of the HCO. The business’s managers, financial situation, political relationships, workload, and competing priorities are in the HCO yet outside the commit- tee and will affect the committee’s performance. The group must monitor and understand these factors. Further, many factors outside the HCO in its external environment will also influence the group’s effectiveness. Recall factors and trends in the environment described in chapter 1, such as customers’ preferences, laws, competitors, and new scientific discoveries. Prior discussion of the com- munication and interaction process said groups interact with their environments to gather infor- mation and resources. That process should also include understanding and adjusting to forces and factors in the external environment that affect the group.

Some HCOs employ consultants to improve effectiveness of groups and teams. For example, to support the developing and learning processes, managers may use consultants for training, coaching, and mentoring to ensure team members have the skills needed to work in groups. Many employees have excellent knowledge and technical skills for their jobs but lack skills for group decision making, communicating, and interpersonal relations. By providing time, funds, and other resources for this, managers demonstrate commit- ment to the group’s success. Going further, Cummings and Worley (2015) explain that organization development (OD) consultants help businesses create effective groups such as self-managed work teams. In these teams, each member can perform most or all tasks performed by the team so each person can help anywhere. The team is designed to manage itself to complete a product or service or a major component of a larger production process;

CHECK IT OUT ONLINE

If you are part of a team or group, consider taking an online

assessment of your group. The MindTools website offers a Team

Effectiveness Assessment with 15 questions (www.mindtools.

com/pages/article/newTMM_84.htm). After answering the

questions, you can click the Calculate My Total button to learn

the results. Then check the brief guide that explains how to

interpret your results to better understand how your team func-

tions and performs. Team members can use this assessment to

guide team learning and improvement. Check it out online and

see what you discover.

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it is the horizontal structure discussed in chapter 5. To shift to this type of organization design and team requires very extensive, ongoing change and redesign of work over months or even years. OD consultants use their expertise to create self-managed work teams by focusing on individual group members, on the group, and on how the group connects with other parts of its organization.

e f f e c t I v e v I r t u a L t e a m s

Creating an effective virtual team is especially challenging because members usually are separated in time and space with less opportunity for communication and interaction. Depending on the technology, they might not be able to see or hear each other. Thus, the processes described earlier in this chapter are harder to perform. Group members may feel only weakly connected to the team. In addition to what has already been stated for effec- tive teams in general, virtual teams should consider the following (Griffin, Phillips, and Gully 2017):

◆ Use appropriate technology for each kind of team task, such as assigning work, writing documents, maintaining files, and conducting meetings. Wikis, electronic whiteboards, collaborative document-editing tools, meeting management groupware, and project management software may be useful.

◆ Establish appropriate degrees of security, access, anonymity, and synchrony.

◆ Spend extra time and effort to create mutual understanding, trust, respect, and collaboration among members.

◆ Emphasize unifying team goals, purpose, values, and expectations.

◆ Involve experienced virtual team members in coaching members with less experience.

◆ When choosing team members, select people with the skills and attitudes that will enable them to succeed on a virtual team.

◆ Early in the life of the team, establish appropriate processes, procedures, rules, and even rituals to ensure proper virtual behavior by members.

g u I D e L I n e s f o r e f f e c t I v e m e e t I n g s

What would groups (and HCOs) do without meetings? Because groups meet often (sometimes too often), managers should do their best to ensure that meetings are

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C h a p t e r 6 : O r g a n i z i n g : G r o u p s a n d T e a m s 1 5 1

worthwhile. Employees gripe about meetings that are pointless, unproductive, and a waste of time. Managers who know how to make meetings worthwhile are rewarded with better results and happier employees. Managers should consider doing the follow- ing, using e-tools to simplify these activities when possible (Dunn 2016; Dye 2017; McConnell 2018):

◆ Before calling a meeting, ensure that a meeting is really needed.

◆ Plan the meeting and its agenda: what, why, who, where, when, and how.

◆ Send participants the agenda and necessary materials a few days early so they can prepare.

◆ Orient new group members before their first meeting.

◆ Arrange for someone to accurately record the minutes (and distribute them later).

◆ Respect people’s time—begin on time, stay on time, and end on time.

◆ Set the tone and state ground rules and etiquette (e.g., listen, maintain confidentiality, avoid blaming, don’t interrupt, don’t have side conversations, be sure to participate, support each other, make decisions by consensus).

◆ State the purpose of the meeting.

◆ Lead the meeting, follow the agenda, and use time wisely to ensure all agenda items are covered.

◆ Respect everyone by leading a balanced discussion, seeking input from everyone, and performing appropriate task and maintenance roles.

◆ Don’t use meeting time for matters that are better discussed by smaller subcommittees or in one-on-one conversations.

◆ Use time-outs, mediation, and separate conflict-resolution meetings if necessary.

◆ End on a positive note, summarize the meeting, review assignments, and thank participants.

◆ Follow through on decisions, assignments, and arrangements for the next meeting.

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M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s1 5 2

A group is two or more people who interact with each other and share a common purpose. A team is a special kind of group whose members share a common goal and accountability for outcomes, and coordinate tasks, skills, and resources interdependently. Managers use teams, committees, huddles, task forces, councils, and other groups to coordinate work, enable workers to grow, build commitment to changes and plans, obtain the input and sup- port of stakeholders, and improve problem solving and decision making. At all levels of an HCO, managers must create, participate in, and support groups.

The success of teams, committees, and other groups requires appropriate group struc- tures and processes. When forming a group, think carefully about seven structural charac- teristics (purpose, size, membership, relation to organization structure, authority, leader, culture) and five processes (developing, leading, communicating and interacting, decision making, and learning). Group development includes five stages—forming, storming, norm- ing, performing, and adjourning. When group members perform task roles, they help their group achieve its tasks and purpose. When they perform maintenance roles, they help group members maintain good feelings about the group and about working with each other. Managers should nurture these roles in groups and discourage members from performing harmful personal roles to fulfill their own personal needs. Group members should peri- odically evaluate their group to identify and resolve possible problems. Virtual teams may need additional considerations, such as cyber ground rules and support for members new to virtual groups and meetings. Groups often have meetings, and leaders and members should follow tips for effective meetings to increase each meeting’s value and outcomes.

o n e m o r e t I m e

FOR YOUR TOOLBOX

• Group structures (purpose, size, membership, relation to organization structure,

authority, leader, culture)

• Group processes (developing, leading, communicating and interacting, decision

making, learning)

• Roles of group members (task, maintenance, personal)

• Team development model (forming, storming, norming, performing, and adjourning)

• Guidelines for effective meetings

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C h a p t e r 6 : O r g a n i z i n g : G r o u p s a n d T e a m s 1 5 3

1. Why are teams, committees, and other groups needed in HCOs?

2. Discuss structural factors that affect the performance of groups and teams.

3. Discuss process factors that affect the performance of groups and teams.

4. Name a group you belonged to that was fun and effective. Which structure characteristics and process characteristics do you think made the group fun and effective?

5. Looking at exhibit 6.2, consider all the task and maintenance roles used in groups. Which of those roles would come easily to you? Which roles would you like to develop in the future?

6. Which of the guidelines for effective meetings discussed in this chapter would come easily to you? Which would you like to further develop for your career?

These questions refer to the Integrative Case Studies at the back of this book.

1. Disparities in Care at Southern Regional Health System case: Suppose Mr. Hank wants to appoint a healthcare disparities committee to advise him on how to reduce healthcare disparities. Decide and describe, in as much detail as possible, what you think each of the seven structural characteristics should be for this committee. For example, write the committee’s statement of purpose. Determine its size. Make up job titles to list members of the committee. Decide what authority the committee should have. Decide and describe the other structures.

2. Managing the Patient Experience case: Decide and describe, in as much detail as possible, what you think each of the seven structural characteristics should be for Mr. Jackson’s multidisciplinary working group. For example, write the group’s statement of purpose. Determine its size. Make up job titles to list members of the working group. Decide what authority the group should have. Decide and describe the other structures.

3. Rocky Road to Patient Satisfaction at Leonard-Griggs case: Suppose the executive director decides to create a team to plan and implement the survey. How could Ms. Ratcliff use the team development model with this new team? Describe problems that might arise during the team development process.

f o r D I s c u s s I o n

c a s e s t u D y Q u e s t I o n s

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Albritton, J., and B. J. Fried. 2015. “Human Resources Management: Practices for Quality

and Patient Safety.” In Human Resources in Healthcare, 4th ed., edited by B. J. Fried and

M. D. Fottler, 503–35. Chicago: Health Administration Press.

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forward.org/Static/images/modules/21/downloadable/Huddles.pdf.

RIVERBEND ORTHOPEDICS MINI CASE STUDY

Riverbend Orthopedics is a busy group practice with expanded services for orthopedic

care. It has seven physicians and a podiatrist, plus about 70 other employees. At its big,

new clinic building, Riverbend provides extensive orthopedic care. Several technicians

provide diagnostic medical imaging, from basic X-rays to magnetic resonance images.

The physicians perform surgery in their own outpatient surgery center with Riverbend’s

own operating nurses and technicians. Therapy is provided by three physical thera-

pists and one part-time contracted occupational therapist. In addition to staff provid-

ing actual patient care, the clinic has staff for fi nancial management, medical records,

human resources, information systems/technology, building maintenance, and other

administrative matters. Occasional marketing work is done by an advertising company.

Legal work is outsourced to a law fi rm. Riverbend is managed by a new president, Ms.

Garcia. She and Riverbend have set a goal of achieving “Excellent” ratings for patient

experience from at least 90 percent of Riverbend’s patients this year.

Ms. Garcia has been cautious about forming groups, teams, and committees be-

cause she previously worked in an HCO that wasted much time with meetings that were

not worthwhile. Yet she realizes that some groups are useful.

mInI case stuDy QuestIons

1. Using information from this chapter and other sources, describe groups, teams, and

committees that Ms. Garcia might want to create at Riverbend Orthopedics. What

would be the specifi c purpose of each group?

2. Explain to Ms. Garcia what could be done to ensure group meetings are worthwhile.

r e f e r e n c e s

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teams-get-more-done.

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Stamford, CT: Cengage Learning.

Daft, R. L. 2016. Organization Theory and Design, 12th ed. Mason, OH: South-Western

Cengage.

Dunn, R. 2016. Dunn and Haimann’s Healthcare Management, 10th ed. Chicago: Health

Administration Press.

Dye, C. F. 2017. Leadership in Healthcare, 3rd ed. Chicago: Health Administration Press.

Fried, B. J., T. G. Rundall, and S. Topping. 2000. “Groups and Teams in Health Services

Organizations.” In Health Care Management: Organization Design and Behavior, 4th ed.,

edited by S. M. Shortell and A. D. Kaluzny, 154–90. Clifton Park, NY: Thomson Delmar

Learning.

Fried, B. J., S. Topping, and A. C. Edmondson. 2012. “Teams and Team Effectiveness in Health

Services Organizations.” In Shortell and Kaluzny’s Health Care Management: Organiza-

tion Design and Behavior, 6th ed., edited by L. R. Burns, E. H. Bradley, and B. J. Weiner,

121–62. Clifton Park, NY: Delmar Cengage Learning.

Griffin, R. W., J. M. Phillips, and S. M. Gully. 2017. Organizational Behavior: Managing Peo-

ple and Organizations, 12th ed. Boston: Cengage Learning.

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18–25.

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Development, 2nd ed. Burlington, MA: Jones & Bartlett Learning.

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7th ed. Burlington, MA: Jones & Bartlett Learning.

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Thousand Oaks, CA: Sage Publications.

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