English

There are few, if any, jobs in which ability alone is sufficient. Needed, also, are loyalty, sincerity, enthusiasm, and team play.

—William B. Given, Jr.

CHAPTER OBJECTIVES

· Define the kinds of teams to be found within the organization: those established for specific purposes, departmental teams, and the greater “team” unified by a common goal or directive.

· Enumerate both the benefits and the disadvantages of the use of special-purpose teams and examine their potential legal pitfalls.

· Establish the characteristics of an effective team.

· Examine the more common reasons for team failure.

· Describe the interactive forces involved in the formation, assembly, growth, and functioning of most teams, including team rituals and the relative strength of group norms and their role in a team’s success or failure.

· Enumerate and discuss the responsibilities of team leadership and explore the implications of leadership style for effective team functioning.

· Suggest how the manager who inherits a team formed under a previous leader can constructively approach the new assignment.

· Briefly consider various means of evaluating and rewarding team performance, recognizing that most evaluation and reward systems focus on individuals, not groups.

KEY TERMS

Team: A group of people committed to achieving common objectives.

Special-Purpose Team: Ad hoc, assembled for a one-time purpose and disbanded when that purpose has been served.

204

Departmental Team: A group of employees and the single supervisor to whom they report.

“The Healthcare Team”: Essentially all those involved in designing and delivering and paying for health care; this is the greater team.

A GROWING NEED FOR TEAMS

As business enterprises of all kinds become more complex, they depend more on the effectiveness of group efforts and cross-functional activities. In health care, no longer do many individuals work as solo practitioners. For example, in the old days an emergency department was usually staffed by a physician and a few nurses and aides. Now an emergency department can feature dozens of different professionals and technicians with diverse skills and experience who work as a team to save lives.

Various healthcare institutions are establishing satellite facilities, developing new services, implementing changes to comply with legal and other mandated requirements, and establishing comprehensive quality improvement programs. In the new healthcare paradigm, cross-functional teams regularly span departmental boundaries, and the third-party payers become senior partners in a healthcare team.

A team is a group of people who are committed to achieving common objectives. An effective team has members who work well together and enjoy doing so and who produce high-quality outcomes. Teams have become the utility vehicles of today’s organizations.

The term “team” is actually representative of several different kinds of collectives, and it is necessary to know at most times the kind of team to which you may be referring. We regularly encounter special-purpose teams, departmental teams, and the greater team.

KINDS OF TEAMS

There are two types of special-purpose teams to be encountered in the workforce. One is characterized by the group that is assembled for a specific purpose, often including people from different departments or disciplines. This kind of team may be ad hoc, assembled for a one-time purpose and disbanded when that purpose has been served, or it may be ongoing with permanent or rotating membership, handling a certain kind of business or problem on a regular basis. These are the teams of

205

The departmental team is a group of employees and the single supervisor to whom they report. Team composition is simple; most people understand that everyone in the group has a job to do and together they accomplish the work of the group. Such a group can operate as a number of individuals doing their jobs, but when these people are united into a true team the potential of the group is expanded dramatically. Much that is said about team building is applicable to forging and maintaining a strong departmental team, a collection of like-minded people who report to the same manager and cooperatively serve the common purpose of the department.

Frequent reference may be made to “the healthcare team,” essentially all those involved in designing and delivering and paying for health care; this is the greater team. At times, the employing organization and all those it encompasses may be appropriately described as a team. Regardless of its kind, composition, reason for being, or degree of permanence, however, there is one significant factor that unites the members of any team: common purpose.

The Project or Employee Team

The organization of a project or employee team can be relatively simple: A decision is made to assemble a number of people with the appropriate knowledge, skills, or experience to undertake some specific task as a group. Most of these kinds of teams include both managers and rank-and-file employees, and because often nonsupervisory employees are the majority of team members, there are potential legal problems depending on the kinds of problems or issues addressed.

Just as important as leadership and cooperation are to the success of any team is sensitivity to potential legal pitfalls. Out of a desire to solicit employee participation, some organizations have discovered that a team can easily stray into questionable territory. There are areas of employee involvement in which teams are seen as intruding on the territory of labor unions, so there is a constant risk that a given employee team could be considered an illegal labor organization under the National Labor Relations Act, infringing on the rights of collective bargaining organizations.

An employee team or committee could be considered an employer-dominated illegal labor organization if the group gets involved in addressing any terms and conditions of employment such as wages, hours, benefits, grievances, or such. A team might also be seen as an illegal labor organization if its recommendations result in management decisions but the group itself has no power to make the decisions.

206

BENEFITS OF TEAMS

Healthcare organizations regularly use teams to handle a wide variety of tasks and problems, taking advantage of the following benefits of teams:

· Greater total expertise. Although team formation is not a panacea, it does serve to expand its collective ability to solve problems. Teams are especially useful in addressing procedures, relationships, quality, productivity, and problem solving.

· Synergy. The total achievements of teams are invariably greater than what can be achieved by members acting independently.

· Improved morale. The motivational needs of affiliation, achievement, and control are often satisfied in the team setting.

· Improved personnel retention. Employees are less prone to leave when they are members of teams, especially teams recognized for their successes.

· Increased flexibility. Team efforts reduce dependence on individuals. Services do not suffer when one member of a team is missing.

DISADVANTAGES OF TEAMS

Teams, however, have their downside. Healthcare managers must also be aware of the occasionally encountered disadvantages of team activity.

· Teams are not always needed. Many situations can be handled as well or better by individuals. Specialists handle specific situations more rapidly and without having to consult others or obtain the approval of other members of a work group. Attempts to introduce work teams in departments where there are no interdependencies are largely a waste of time and effort. However, in most healthcare departments, people do depend on one another.

· Team building requires start-up time. There is always that period early in the life of a team when effort must be invested in team formation but little if anything specific is being accomplished.

· Teams may become bureaucratic. A once-enthusiastic task force can become a self-perpetuating standing committee, and its business often

207

· Teams are not appropriate for all situations. When fast action is required, someone—an individual—must take charge and get things rolling.

CHARACTERISTICS OF EFFECTIVE TEAMS

An effective team can be described as follows:

· It is not always limited to a departmental work group or even an interdepartmental collection of members. As necessary, its members may include vendors, customers, people from other departments, and key support personnel.

· It possesses all the necessary knowledge, skill, and experience required to fulfill its charge and get the job done.

· As a body its members search for excellence in quality, productivity, and customer service. The team removes factors that inhibit quality performance.

· It welcomes innovation, new services, and improved processes and techniques.

· It is democratic. There is an absence of rank or formal authority. It has a leader who refers to his or her coworkers as associates, colleagues, or teammates, not as subordinates.

· It demonstrates effective multidirectional communication and as a group displays openness and candor.

· It remains inspired by a vision of what it is trying to accomplish. Its charge is clear, its goals are clear, and all members are unified in their pursuit.

· It actively constructs formal and informal networks that include people who aid in its mission.

· It possesses power based not on formal authority, but on the credibility the team has earned through performance.

· Its members trust each other and are sensitive to each other’s needs. They understand their roles, responsibilities, and degrees of authority.

· It addresses and eliminates conflict with other teams or nonteam employees through collaboration, coordination, and cooperation.

· It adheres to strict ethical and moral considerations.

· It conveys optimism, and its members have fun serving.

WHY TEAMS FAIL

208

Other factors also contribute to team failure:

· Domination of the team by players possessing higher status or greater knowledge or who are more aggressive. Other problem members include the pessimists, negativists, obstructionists, prima donnas, and goof-offs.

· Lack of organizational support; for example, insufficient resources or time, understaffing, or unpleasant work environment.

· Internal politics, hidden agendas, conformity pressures, favoritism, and excessive paperwork.

· The development within the team of cliques that have the effect of isolating the group from the rest of the organization.

· Destructive competition among team individuals for promotions, merit raises, recognition, and access to superiors.

· Unrealistic expectations, resulting in discouragement in the face of setbacks.

· Disapproval by upper management of a team’s output or lack of action on the team’s suggestions or recommendations. Also, failure of a team to respond to the ideas of its individual members can quickly quench enthusiasm.

· Lack of progress, failure to meet deadlines, setbacks, and bad results, any of which may be disheartening.

TEAM DYNAMICS

Team dynamics refers to the interactive forces brought to bear by individuals singly or collectively in a group activity. The success of group dynamics depends largely on how willing team leaders are to share authority, responsibility, information, and resources. Sharing is a large part of what participative management is all about.

Stages in Team Formation and Development

Stage 1: Confusion

This initial stage represents the transition from a group of individuals to a team. Participation is tentative or hesitant as members wonder what is expected of them.

209

Stage 2: Dissatisfaction

Some members may display negativity, hostility, bickering, or outright resistance. Infighting, defensiveness, and competition are common at this stage because a number of participants have not yet clearly seen themselves as members of the group. Low productivity may persist.

Stage 3: Resolution

If the team is to be successful, group norms and roles emerge once the dissatisfaction is on the way to resolution. Dissatisfaction and conflict diminish, and a sense of cohesiveness starts to develop. Dependence on strong formal leaders decreases. Cohesion is achieved when individual members feel responsible for the success of the team. Productivity attains moderate levels.

Stage 4: Maturation

Productivity is high and performance is smooth. Members have developed insight into personal and collective processes. Team members have learned how to resolve their differences and provide each other with constructive feedback. All of this requires time, and progress is not steady but up and down, in fits and starts. Mature teams usually experience some turnover in membership, mostly planned or expected. Moreover, priorities change, and a host of other variables constantly affect the nature and makeup of mature teams.

Group Norms

Group norms may be functional or dysfunctional. A functional form is evident when team members defend their team and their organization. A dysfunctional form develops when members believe their organization is taking advantage of them and they perhaps believe that teams are being assembled only to squeeze more work out of the participants.

In some dysfunctional forms, members struggle so hard to avoid conflict that team decisions suffer. Some conflict is essential to effective problem solving. Cohesion does not mean the complete absence of differences of opinion, arguments, or disagreements. Members of great teams can frequently be heard debating heatedly among themselves.

At the Marine Corps boot camp on Parris Island, drill instructors turn undisciplined men and women into confident leaders. Their group norms are high. The instructors teach a few key lessons and model the behavior they want:

210

· Do your best, no matter how trivial the task.

· Choose the difficult right over the easy wrong.

· Look out for the group before you look out for yourself.

· Don’t whine or make excuses.

· Judge others by their actions, not their race.

· What additional information do we need?

· What past successes have we had in meeting the wants and needs of our customers?

· What are our strengths, and what needs to be improved?

· What new objectives and strategies do we need?

· How can we provide superior customer service faster or at less cost?

· What barriers do we face, and how can they be eliminated?

· Should we learn how others are doing what we are doing?

It is a team leader’s job to develop people. Members of a work team, like members of an athletic team, have certain competencies, plus the ability to develop additional competencies. After structuring position descriptions and performance standards, a team leader selects the best people for the team and then orients, educates, trains, coaches, and motivates them. When a team is just getting started, ask all members to share a one-word characteristic each wants to see in a teammate and relate a scenario in which someone either possessed or lacked that trait. The story rounds out the understanding of the desired characteristic. If all members share a trait they value, the group will develop common ground on which to function.

Building a team is like converting a group of musicians into an orchestra. The leader must build the team. Team building involves developing relationships, communicating, holding meetings, and interacting on a daily basis. Leaders must create an atmosphere that supports and rewards creativity, openness, fairness, trust, mutual respect, and a commitment to safety and health. There must also be opportunities for career growth. Evaluate your team-building ability by taking the quiz in Exhibit 11–1.

The leader must truly lead the team. With the help of the other team members, team leaders prepare mission statements, set goals, develop strategies and plans, design or improve work processes, facilitate, coordinate, and troubleshoot. Leaders must satisfy the affiliation needs of each team member. All employees want to be accepted by their colleagues. Leaders also encourage team members to train and coach each other.

Exhibit 11–1 Rate Yourself as a Team Builder

Check all of the following that you honestly believe describe you as a team leader:

212

____ My team functions well when I am not present.

____ I hire people who may be able to perform some tasks better than I can.

____ I try to avoid hiring people who are just like me.

____ Each member of my team learns at least one new skill every year.

____ Each member of my team makes at least one suggestion every month.

____ I encourage both differences of opinion and suggestions for improvement.

____ We resolve rather than avoid conflict and problems.

____ Every member of my team can name all our external and internal customers.

____ Every member of my team can state the mission of our organization.

____ Every member of my team knows how our quality program affects our service.

____ Every member of my team follows safety procedures.

____ We prefer team collaboration over individual competition.

____ Every member of my team feels valued and accepted.

____ Our team has a can-do attitude. We strive to produce more than we promise.

____ Our team has a reputation for cooperating with other teams and individuals.

____ Our team attitude is one of optimism and enthusiasm. Negativism is rare.

The following is an example of a simple departmental mission statement:

Our department is committed to providing quality care at low cost to inpatients and outpatients. Staff members maintain their expertise through continuing education and development.

The leader must coordinate team activities. The team or its individual members often participate in cross-functional activities. Team leaders must coordinate these activities with other departments and services. Leaders must also be ready to serve

213

LEADERSHIP STYLE

Study the position descriptions for every job and the performance reviews of each employee, and hold individual meetings with team members. Find out as much as you can about their aspirations, complaints, and suggestions and about how you can make better use of their services. Prepare an inventory chart of the team’s skills.

REWARDING TEAM PERFORMANCE

An increasing focus on teams necessitates changing the way organizations reward people. Traditional reward and recognition systems encourage individual achievement. When traditional merit pay systems are used, team cooperation often suffers. Individual rewards may cause competing employees to withhold information, undermine peers, and hamper cooperation. On the other hand, in the absence of individual rewards there is bound to be some resentment among the high performers, and the slackers have no incentive to improve. This dilemma is resolved by providing for both team and individual rewards. The group recognition builds camaraderie and cooperation. Also, when employees know their performance ratings are affected by the extent to which they display teamwork, the adverse effects of individual rewards are mitigated.

It is recommended that some of the following be included in your team reward strategy:

· Reward employees who participate in group functions such as serving on committees or working with problem-solving groups or task forces.

· Recognize the entire team when goals are met.

· Arrange for a team to present its special projects to other departments or to higher management.

· Bring in doughnuts or pizza or some other snack or refreshment for the team.

· Organize a car-wash day when managers wash employees’ cars.

· Thank the team at a special luncheon or coffee hour.

· Attend some of the team’s committee meetings or problem-solving meetings. Comment favorably and encourage them to maintain their excellent

215

· Display photos of the group in action.

· Broadcast congratulatory news about completed projects, new services, favorable customer comments, or successful cost cutting.

· Spruce up the lounge and provide new amenities, such as a coffeemaker or microwave oven.

· Take practical measures to improve communication systems, and make more information available.

· Eliminate unnecessary meetings and streamline necessary meetings to reduce wasted time.

· Delegate greater authority to the team.

8. How would you suggest that a generally well-functioning team handle a single nonproductive member?

9. What are two significant disadvantages of team action? How can these disadvantages be overcome?

10. What do you believe is meant by the claim that team power is based on credibility? How do a team and its leader go about acquiring this power?

Case: The Quiet Bunch

You learned during your first week on the job as the newly hired admitting supervisor that each departmental supervisor was expected to lead one of the hospital’s numerous quality improvement teams. It came as no surprise that the team to which you were assigned was the team your predecessor, the former admitting supervisor, had served as leader. Your team, you soon learned, consisted of several of your department’s people plus employees from a scattering of other departments.

As you held individual meetings to become acquainted with both your employees (in the admitting department) and other members of your team, you were quickly inundated with complaints and other indications of discontent from both your employees and other team members. There were vocal complaints about the way the department had been run and complaints about the “useless quality improvement team.” From a couple of your employees who served on the quality team, you received complaints about “those who shall remain nameless” who regularly “carry tales to administration.”

You listened to all the complaints. You detected some common themes in what you were hearing, leading you to believe that perhaps some misunderstandings could be cleared up if some of the issues could be aired openly with each concerned group. You scheduled two meetings, one for your admitting staff and one for the quality improvement team. You felt encouraged because a number of individuals had told you they would be happy to speak up at such a meeting.

Your first meeting, held with your admitting staff, was brief; nobody spoke up, even when urged to do so in the most nonthreatening way possible. Your subsequent meeting with the quality team was no better. You got zero discussion going with either group, although before and between the meetings you had been bombarded by complaints from individuals. This left you extremely frustrated because most of the complaints you heard were group issues, not individual problems.

Questions

217

2. Can you suggest what might lie in the immediate past that could have rendered these employees unwilling to speak up?

3. Because you have two groups (with overlapping membership) to be concerned with, where would you initially concentrate your efforts?

4. What might you do concerning the charges that someone is “carrying tales to administration”?

Case: The Weekly Team Meeting

Fourteen people from perhaps seven departments make up the long-standing methods improvement team that you were assigned to take over as leader 3 months ago. It has been the practice to hold a meeting at 3:00 PM every second Wednesday, or perhaps we should say you attempt to hold it at 3:00 because about half of the team members are more than 5 minutes late, and two or three are usually late by 15 minutes or longer. You have found also that roughly half of the group has not completed assignments they were given at previous meetings.

You have made repeated announcements about being there on time, but to no avail. Come the next meeting at 3:00 PM, you usually find yourself and the same few punctual members present and waiting for the latecomers.

Questions

1. What can you do to encourage punctuality at the team meetings?

2. How do you suggest addressing the problem presented by the team members who do not complete their assignments?

REFERENCES

Harrington-Mackin D. The Team Building Tool Kit. New York, NY: AMACOM; 1994.

Kayser TA Mining Group Gold: How to Cash in on the Collaborative Brain Power of a Group. El Segundo, CA: Serif Publishing; 1990.

Montebello AR. Work Teams that Work. Minneapolis, MN: Best Sellers Publishers; 1994.

Sanborn M. Team Building: How to Motivate and Manage People, 2 audiotapes. Boulder, CO: CareerTrack Publishers; 1989.

Umiker W. The Empowered Laboratory Team: A Survival Kit for Supervisors, Team Leaders, and Team Professionals. Chicago, IL: ASCP Press; 1997.

Wellins RS, Byham WC, Wilson JM. Empowered Teams: Creating Self-Directed Work Groups that Improve Quality, Productivity, and Participation. San Francisco, CA: Jossey-Bass Publishers; 1991.