Group Work and High Performing Teams

Overview
This Tool Kit item focuses on three key areas for maintaining high performance on interprofessional teams: balancing task and process, understanding team dynamics, and team cohesiveness.

Balancing Task and Process
In order to produce optimal patient outcomes, it is critical that interprofessional health care teams attend to the task at hand, as well as the processes needed to complete the task. High-performing teams create an appropriate balance between task and process.

Definitions
Task: “A usually assigned piece of work often to be finished within a certain time” (Merriam-Webster, 2014)
Process: “A series of actions or operations conducing to an end” (Merriam-Webster, 2014)

Dangers and Pitfalls
Results of the group’s work may be poor if the team emphasizes either task or process at the expense of the other. An appropriate balance between task and process is important in making decisions, based on available information. The dangers involved in focusing too heavily on either the task or the process are described below:

Too Task Oriented:
The process of considering alternative causes and interventions may be cut short, resulting in less than the best decision
Participation in the team process may be discouraged, leading some to be unsupportive of the decision
The team may believe it is being efficient when it may not be, particularly if decisions and results need to be revisited and reworked

Too Process Oriented:
The team can lose sight of the task and begin to consider the discussion the product, leading to failure to complete the task
The team can run out of time, forcing a decision to be made that may be less than the best
Decisions may simply not be made, leading to potential failure of the team
Some team members may become frustrated with the lack of closure and stop their participation and support

Tools to Balance Task and Process
There are several approaches that can be taken to ensure that the team does not become too immersed in the process, or too focused on completing the task, at the expense of being diligent in their work. Suggestions for accomplishing this include the following:
Focusing on the task:

  • Clarity is key – identify and agree upon a purpose or product—write it down, memorize it
  • Determine clear responsibility and accountability for each member and for the team itself
  • Set realistic deadlines and enforce them
  • Make the task guide the group’s work; refocus on it if the team appears to be straying
  • Embrace the expertise and diversity of each group member in relation to the task

Focusing on the Process:

  • Assure that all team members understand the process the team will use
  • Understand causes of process variation and identify processes that need improvement
  • Select a process improvement method in advance and always use it and include frequent tests of the impact of change (Central State Hospital, n.d.)
  • Use benchmarking, to help make sure the team is adopting best practices
  • Empower team members to innovate (Johnson, n.d.)

Team Dynamics
Definition: “Team dynamics are the unconscious, psychological forces that influence the direction of a team’s behavior and performance. Team dynamics are created by the nature of the team’s work, the personalities within the team, their working relationships with other people, and the environment in which the team works” (Myers, 2013).
This is the “here-and-now” experience of the team—how the team is functioning, the quality of the team members’ relationships, and the team and members’ apprehensions and aspirations
Team dynamics are affected by the following:

  • Overt factors, such as the space that the team meets in, the patient population and their conditions, each member’s professional background, and experience. The effect of each of these may be different for each team member. Some may be challenged by unmotivated patients, while others may be frustrated. Some may be eager to learn from those with more experience while others may be intimidated. Team members are collectively responsible for being aware of such disparate reactions and acting to make them positive contributions to the team’s performance.
  • Covert factors, such as each team member’s personal background, prior experience with teams, and relationship with administration. Team members may not be aware of these factors, potentially leading to inaccurate assumptions and reactions about and to each other. A team should take time during its formation to learn as much about each other and how that may affect their performance on the team.
  • The efforts to balance task with process (see: previous section)
  • How each team member communicates with each other, both verbally and non-verbally. Cultural and experiential differences may also mean differences in communication style and methods. Awareness of these differences during the forming stage can minimize the magnitude and duration of the storming stage.
  • The norms and ethics that have been accepted by the group. It is best if the team has a common set of norms and ethics. This should be tested early in team formation. Significant differences in expectations or in underlying ethics bodes poorly for team success.

Cohesiveness
Team cohesiveness is critical to team success. It is vital that all team members share the same values, ethics, and goals when providing care to an individual or a population.

Definition
Cohesiveness: “The extent to which team members stick together and remain united in the pursuit of a common goal…a team is said to be in a state of cohesion when its members possess bonds linking them to one another and to the team as a whole” (Molnau, 2013).

Organizational Justice
The concept of organizational justice can be a helpful guide when attempting to start a high functioning team or when diagnosing and correcting problematic team performance.
Definition: Organizational justice is “the extent to which employees perceive workplace procedures, interactions and outcomes to be fair in nature. These perceptions can influence attitudes and behavior for good or ill, in turn having a positive or negative impact on employee performance and the organization’s success” (Baldwin, 2006)
Organizational Justice is strongly correlated with the well-being of team members. It is characterized by decision-making fairness, transparency, and relational processes of respect, mutuality, and decency. Team members subconsciously ask themselves, “Is being in this team good for my self-esteem?”

Factors Affecting Cohesiveness

  • Several internal and external factors affect a team’s cohesiveness. While performing on a team, it is critical that each team member is aware of factors that could inhibit their ability to collectively pursue a common goal.
  • Team members are affected by their own values and biases, resulting from personal, educational, and professional experiences—it is critical that each member accept this, and understand that each member brings their own experiences to the team
  • The culture at the organization—surrounding the team—has the potential to interrupt team cohesiveness through changes in policies, procedures, and focus areas
  • Factors outside of the organization can disrupt team cohesiveness, through changes in population, payment systems, and professional regulations

Methods and Tools to Promote Cohesion
The following steps can be taken to promote group cohesion:

  • Take time to recognize the individual
  • Each member’s behavior affects the team function—each individual has the capacity to affect the team’s effectiveness through how they have accepted their role as a team member; team functioning could suffer if a team member feels that they do not have to contribute, or if they are simply going through the motions
  • Each member has a role in attending to the team function—each team member is responsible for monitoring how the team is functioning and performing; each team member should be alert when the team goes off-task, and is responsible for bringing this to the attention of the rest of the team; everybody on the team is responsible for everything, and each team member is responsible for the work of the team
  • Each member builds relationships with others—positive and reciprocal personal relationships among all team members are ideal

Communicating the “we” work and accomplishments results in a more cohesive team

According to Yukelson (n.d.):

  • Develop a shared vision and unity of purpose
  • Develop pride in group membership and identity as a team
  • Develop a meaningful and inspiring mission for the team
  • Develop complementary roles and synergistic teamwork
  • Reinforce individual and mutual accountability
  • Promote positive team culture and cohesive group atmosphere
  • Require ongoing communication about progress
  • Ensure open communication at all levels

References
Myers, S.P. (2013). Definition of team dynamics. Team Technology. Retrieved fromhttp://www.teamtechnology.co.uk/team/dynamics/definition/
Molnau, D.C. (2013). High-performance teams: understanding team cohesiveness. Six Sigma. Retrieved fromhttp://www.isixsigma.com/implementation/teams/high-performance-teams-und…
Baldwin, S. (2006). Organisational Justice. Brighton, UK: Institute for Employment Studies. Retrieved from http://www.employment-studies.co.uk/pdflibrary/mp73.pdf
Task. (2014). In Merriam-Webster.com. Retrieved from http://www.merriam-webster.com/dictionary/task
Process. (2014). In Merriam-Webster.com. Retrieved from http://www.merriam-webster.com/dictionary/process
Merrit, B.O., Morrison, L., Satterwhite, M.W., Smith, A., Thomason, G., & Thompson, J. (eds.) (n.d.). The focus-PDCA strategy. Central State Hospital. Retrieved fromhttp://www.centralstatehospital.org/policy/plan8.10A.pdf
Johnson, J.K. (2009). The health care interdisciplinary context: a focus on the microsystem context. Collaboration Across the Disciplines in Health Care. Freshman, B., Rubino, L.G., & Chassiakos, Y.R. (eds). Sudbury, MA: Jones & Bartlett Learning. Retrieved fromhttp://samples.jbpub.com/9780763755584/55584_CH02_5284.pdf
Yukelson, D. (n.d.). Group cohesion and team building. Pennsylvania State University. Retrieved from http://www.mascsa.psu.edu/dave/Group-Cohesion-and-Team-Building.pdf