Chapter 5.docx

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Western University
Health Sciences
Health Sciences 3040A/B
Shannon Sibbald

Health Sciences 3040B: Health Management Chapter #5: Teams and Team Effectiveness in Health Services Organizations Introduction • Teams represent the dominant way that work gets done in organizations • Teams need to be highly functional for us to reap the rewards that teams potentially bring • HC is simply too complex for it to be dependent on a single individual • Composition of teams is usually multidisciplinary because innovation is dependent upon people with multiple skill sets (moon landing) • Effective patient care and management are dependent upon teams • Lessons learned from one type of team are often applicable to other types of teams Types of Teams in Health Care • Teams are groups, but not all groups are teams • Have a defined purpose, membership, or composition, structure, specific processes, and leadership • Need to be aware of informal groups and their influence on the organization Informal Groups • Not formally established or sanctioned by the organization, but often form naturally by individuals in the organization to fill a personal or social interest or need • Can become so powerful so as to undermine the formal authority structure of the organization • A factory group was able to direct the pace of work, the amount of daily and weekly production, the amount of work stoppage, and allocation of work among members • Groups may initiate changes to improve working conditions and may evolve into more formally sanctioned groups • Important for managers to be aware of the existence of informal groups in the organization and the roles they play, whether positive or negative Formal Groups • Teams are intact social systems with boundaries, interdependence among members, and differentiated member roles or structure • Task-orientated with specific purpose • Operate within an organization context and interact with a larger organization or organizational subunits A Typology of Teams in Health Care • (1) Function or purpose (2) Decisional authority (3) Temporal nature (4) Time and space (5) Diversity (6) Accountabilities (7) Membership fluidity and boundary permeability Function or Purpose: Why a Team? • A team is the most appropriate vehicle for accomplishing a complex task • Have the potential to create synergy among its members (productivity exceeds sum of individuals) • Innovation can result from interplay of ideas among members (happens during evaluation) • Can be a source of empowerment and satisfaction, can lead to lower turnover, absenteeism, and greater communication to the goals of the organization • Bring in diverse expertise and perspectives from multiple disciplines • Instances exist where the use of teams may diffuse talent in an organization (can time be better spent other than the team?) • Also require infrastructure and process changes to function effectively, which can increase costs and stress if they are initiated in an organization unprepared to meet the challenges of working with teams • Work teams: are groups of people responsible for producing goods or providing services • Directed at the primary mission and objectives of the organization, may be directed by supervisor or managed themselves • Treatment teams, research teams, home care teams, etc. • Usually ongoing and relatively permanent in nature, can be multidisciplinary, multiple levels of the HCO, also referred to as “microsystems” • Work teams do the fundamental work of the organization • Support teams: enable others to do their work, and serve many functions such as quality improvement, strategic planning, and search committees hiring new employees • Parallel teams: typically composed of people from different work units or jobs who carry out functions not regularly performed in the organization • Limited authority, make recommendations to people higher up (HC example is CQI) • By nature multidisciplinary, may be temporary or permanent • Project teams: usually time limited, producing one-time outputs (planning a new hospital) • Management teams: coordinate and provide direction to the subunits under their jurisdiction • May exist at many levels (board, senior, etc.) and come from multiple levels of hierarchy Decisional Authority • Refers to the continuum of roles that teams may play in decision making • Final DM authority rests with senior management or a specific person or team higher in the hierarchy • The role of a team should be absolutely clear, particularly the role that it plays in decision-making Temporal Nature • The use of time-limited teams is becoming more common in large part because of the rapidity of change and the need to respond quickly (influenza outbreak that affects certain parts of a hospital) Time and Space • Teams can communicate and work efficiently over any distance with communication technology • An additional potential benefit of virtual teams is the potential to store and make accessible to team members relevant date from medical records and other sources • With advances in telemedicine, teams can also obtain specialized advice from experts at any distance • Recent study found that a virtual health care team reduced emergency room visits by high-risk diabetes patients • Virtual teams require additional rules and guidance, may have to involve the inclusion of people outside of the HCO, such as patients • Modified measurement and control systems need to be put in place to ensure that performance is effectively monitored Diversity • Managing multiple viewpoints and worldviews and the conflicts that may result from interactions among diverse team members • Diversity in professional backgrounds is often used when discussing teams in HC • There is diversity based on age and generation (making different generations work together), gender diversity (correlated with social status, woman – nurse), diversity in hierarchical level (team composition), consumer and professional diversity (consumers as team members, may feel inferior with lingo and background), and demographic and cultural diversity Accountabilities • May be internally, externally, or both accountable • Task-team may be accountable to a manager (internal) who is accountable to someone else (external) • Team communication, coordination, outcomes, and discipline become the responsibly of team members, largely eliminating the need for external team management (should strive for this) Membership Fluidity and Boundary Permeability • Liability of fluidity can be the lack of cohesiveness among team members • Takes time to reorient team members and it can be a while before a new member makes a significant contributions • Good thing is it can have new ideas come into the team that keep align with external management, but new people may want to change things where older members may get pissed off • Some teams have specific core membership that is sustained over time (BOD) • Work in an ER is highly standardized, and the professionals who work in these settings are highly trained in the roles they play Understanding Team Performance • Everyone in a health care organization is a member of a team, and in most cases, employees are members of multiple teams, some of which may overlap in membership • An informed patient would prefer a nursing unit that has the attributes of a strong team • Health care entered the era of accountability just recently • Much attention is given to assessing the quality of clinicians through review of credentials and past work experience • Groupthink – disastrously poor advice may be generated and acted upon by a team of highly talented and skilled individuals A Model of Team Effectiveness • A manager cannot always control events that may reduce team cohesion, such as turnover among team members • Vital to understand and anticipate how uncontrollable factors may affect team performance – negative impacts may be minimized • Uncontrollable factors may be positive as well – recession will lead to lower turnover, sustaining cohesion • Figure 5.1 Team Characteristics • Team size has an inverted U-shaped relationship to effectiveness so that too few or too many members may reduce performance • Teams should be staffed to the smallest number to accomplish the work (rule of thumb) • Smaller teams are less cumbersome, fewer social distractions, lower incidence of social loafing (benefitting from everyone else’s effort) • Overstaffed/large teams: may perform work lackadaisical manner, competition/jealousy may arise, may distance themselves from the team’s efforts and lack commitment to the team • Subgroups may isolate themselves from one another as well • Diversity in a team is particularly desirable when the work is complex and has a limited time span • More effective teams were composed of members who had a balance between industry and team experience; too much of either created conflict and decreased the ability of the team to seize new growth opportunities • Diversity can promote quality and a competitive advantage (can deal with all sorts of patients) • Broader perspective  superior problem analysis and solutions, and good from a legal aspect (employment opportunity law) • Tenure diversity (length of time been on team), new people need to be taught team norms (regulate behavior) • Certain skills need to work positively within the group to have an effective team Status Differences • Measure of worth conferred on an individual by a group (status) • High-status people tend to take over majority of the role, have more say in decision-making, have more communication • This makes low-status people feel like their role is diminished and not that important, making their morale lower and satisfaction worse • Sometimes lower status wont challenge higher ones and higher ones wont listen • In HC there is an authority gradient between doctors, doctors and nurses, social workers and so on • Counterproductive
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