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Work Team Dynamics and High-Performance Teams
Healthcare Organization and Management · Chapter 7: Team Dynamics and Communication in Healthcare SettingsSection 7.1 · lesson 42 of 10511 min · free with a free account
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In this lesson
Tell teams from working groups and build high-performing healthcare teams.
- Distinguish a team from a working group by goal, interdependence, and mutual accountability
- Describe Tuckman's stages of team development and the manager's task at each
- Explain how norms, roles, and size affect team performance
- Identify the marks of high-performing teams and structural fixes for social loafing and groupthink
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Transcript
Everything said in the video, section by section (1,467 words). Read along, or search it.
Opening Case
A Polite Committee With No Results
Larkfield's falls committee has met every month for two years. Attendance is good, and the discussion is always polite. Pharmacy reports what pharmacy did. Nursing reports what nursing did. Therapy reports what therapy did. And falls on 4 South haven't moved. Farah Siddiqui, the director of quality, sits in on two meetings and asks a blunt question. Is this a team at all?
Definition
Shared Goal, Interdependence, Mutual Accountability
A team is a set of people with three things: a shared goal, interdependent work, and mutual accountability for the result. A shared goal means one result everyone pursues, not several parallel results reported to the same boss. Interdependence means one member's performance depends on another's behavior, so no one can finish the work alone. Mutual accountability means members answer to each other for the result, not only upward to the manager. That's the condition most often missing. A working group shares a manager, a place, or a profession. Each member produces a separate result, and the results are simply summed.
Teams and Working Groups
When Parallel Work Is Fine
Neither form is better. A group of specialists, each managing their own caseload, is a working group, and that's fine. Forcing joint objectives and extra meetings on parallel work adds coordination cost for no gain. So the error runs both ways: treating interdependent work as a set of individuals, and forcing teamwork onto work that's truly parallel. Farah's committee has a shared topic, falls, but no shared goal. Nothing it discusses depends on anyone else's behavior.
Quick Check
A Shared Order-to-Dose Number
Quick check. Pharmacy staff and 4 South nurses are jointly responsible for one number: the time from a medication order to the first dose. Neither side can shorten it alone, and they report it together. What is this group? Pause, and decide. A team. One goal, work that depends on both sides, and members answerable to each other for the shared number. A committee is tempting because it sounds official. But committees are standing bodies that often receive reports and decide nothing jointly. This group has to act together.
Team Types
Five Kinds and How Each Fails
Health care uses five recurring team types, and each fails in its own way. Intact unit teams work together continuously, and they fail through conflict that builds up unresolved. Interprofessional care teams form around a patient and fail at the boundaries between professions. Project teams fail through unclear authority over members' home departments. Committees fail by carrying on after their purpose has expired. And rapidly assembled teams form in minutes around an emergency, with people who may never have met.
Rapidly Assembled Teams
Structure Given in Advance
That last type is distinctive to health care. When Danny calls a rapid response on 4 South, the team arrives within minutes. Grace, from the ICU, has never worked with Danny. There's no time to build trust or norms. What replaces development is structure given in advance: roles attached to positions, not people, a known sequence, and a shared vocabulary. Everything a team like this has, it was given before it formed.
Tuckman's Stages
Forming a Falls Project Team
Back to Farah. She disbands the committee and forms a project team with one job: cut injury falls on 4 South. Ellen Murphy, the charge nurse. Ines Carver, a physical therapist. Karim Saleh, a clinical pharmacist. They own the number together. Teams that last tend to move through stages. Bruce Tuckman named them in nineteen sixty-five: forming, storming, norming, performing. Forming is polite, tentative, and leans on the leader. The manager supplies what the team can't yet make: purpose, roles, and how it will work.
Storming
Surfacing Conflict Without Taking Sides
A month in, storming arrives. Ines wants patients up and walking early. Ellen worries about falls during those walks. The meetings get tense, and for a while the falls number gets a little worse. Performance often dips during storming. Farah's task is to bring the conflict into the open, not suppress it. And she must not settle it by taking a side. That would turn a team problem into a leader problem. Instead she asks each of them what the patient needs.
Norming to Adjourning
Explicit Norms, Performing and Closing Out
Norming is where working agreements settle. The task is to make the norms explicit while they're still forming, because unstated norms are hard to change later. The team agrees: every walk gets a gait check first, and anyone can pause a walk without being second-guessed. Performing is where the team runs with little intervention. Farah steps back, but keeps supplying resources and removing obstacles. In nineteen seventy-seven, Tuckman and Mary Ann Jensen added a fifth stage, adjourning, for teams with an end point. The task then is to close out properly: capture what was learned, and mark the ending. It matters more than managers expect.
Norms and Roles
Task, Maintenance and Dysfunctional Roles
Norms are the informal rules a team actually runs on, and they form whether anyone states them or not. Teams set them in the first weeks, by watching. Does the meeting start on time? Is the senior person ever contradicted? Is a mistake discussed, or quietly absorbed? Roles come in three kinds. Task roles move the work: proposing, seeking information, summarizing, testing feasibility. Maintenance roles keep the group working: drawing in quieter members, easing tension, checking that agreement is real. Dysfunctional roles damage the team: dominating, blocking with no alternative, withdrawing. Most teams have plenty of task roles and too few maintenance roles.
Team Size
Links Grow Faster Than Members
Size pulls two ways. A bigger team brings more expertise, but the possible communication links grow faster than the membership. Five people have ten possible links. Ten people have forty-five. Coordination cost climbs steeply, and participation per person falls. So for decisions, small is usually better. A practical test: can every member state, in one sentence, why they need to be there? Where a big group is unavoidable, use a small core with defined consultation, not a large body that decides nothing.
High-Performing Teams
Six Marks Visible in a Meeting
Months in, Farah's team shows the six marks of a high-performing team. A clear purpose: asked separately, members give the same answer. Defined roles: each knows what they own, and what they don't. Psychological safety: Karim questions Ellen, the senior nurse, in an ordinary meeting, and it isn't an event. A shared mental model. Mutual monitoring. And constructive conflict: disagreement about the work is frequent, and it never turns personal. Each missing trait leaves a symptom you can see in a single meeting. That's why an hour of watching tells a manager more than a survey.
Shared Mental Models
Mutual Monitoring as a Shared Duty
A shared mental model is a common picture of the task, the sequence, and each person's role. It's why an experienced team seems to talk less than a new one, yet coordinates better. Only the exceptions need saying. Mutual monitoring is watching each other's work and speaking up. Framed as a shared duty to the patient, it's welcomed. Framed as checking up on people, it's resented and quietly dropped, until an error three people saw goes unmentioned.
Team Dysfunctions
Loafing, Groupthink and Conformity
Three dysfunctions are predictable. Social loafing is reduced effort when no one's contribution can be identified, and it grows with team size. The fix isn't exhortation. It's visibility: identifiable contributions, and tasks small enough that absence gets noticed. Groupthink, named by Irving Janis in nineteen seventy-two, is dissent suppressed for the sake of consensus. It's likeliest in close-knit teams under pressure with a directive leader. The fixes are structural: the leader speaks last, someone is assigned to challenge, and outsiders are asked in. Conformity pressure is the everyday version: a member stays quiet because nobody else has spoken. Ask people privately, and compare with what was said in the room.
Quick Check
A Merged ICU Team Arguing Again
Quick check. An ICU night team ran smoothly for two years. Then two units merge, four nurses join, and arguments break out over routines. The manager calls it a performance problem. What's the best reading? Pause, and decide. It has returned to storming. Stages aren't strictly one-way: a change of members, leader, or task can send a performing team back. Groupthink is tempting because there's pressure. But groupthink silences dissent, and this team is arguing openly. A manager who assumes progress never reverses misreads it as decline. One more caution. A team that never storms usually isn't agreeing. It's suppressing, and that surfaces later as passive resistance.
Case Resolution
One Number No Profession Moves Alone
Back to Farah's question about the old committee. It wasn't a team. It had a topic, and nothing anyone did depended on anyone else. A team-building day wouldn't have changed that. What changed it was one shared number that no profession could move alone. Farah warned the group the first two months would be harder, not easier. They were. Then injury falls on 4 South began to fall.
Key Takeaways
Teams, Stages and Traps
To recap. A team needs a shared goal, interdependent work, and mutual accountability. Otherwise it's a working group, and that can be fine. Emergency teams can't develop, so they get their structure in advance. Stages run from forming to adjourning, with a task for the manager at each, and teams can slide back. Name the maintenance roles, and keep decision teams small. And watch for social loafing, groupthink, and conformity pressure.
About Healthcare Organization and Management at UPI Study
Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.
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