Chapter 18 Notes: Work Teams and Team Building — Comprehensive Study Notes
Overview
Learning outcomes for Chapter 18: Work Teams and Team Building
Difference between stable teams and teaming
Various types of teams
Differences between a virtual team and conventional teams
Approaches for building team performance
Organizational barriers to effective team building
Common characteristics of successful teams
Key opening idea: not all groups are teams. A team is a special kind of group with highly defined tasks and roles and a high level of mutual commitment (Katzenbach & Smith, 1993).
Teams are increasingly common in organizations. Lawler (1999) notes that almost every organization uses problem-solving teams, with self-managing work teams being particularly prevalent in Fortune 1000 companies. As teams become the norm, managers must understand work design, member composition, and factors enabling high performance and effectiveness.
Practical implication: healthcare environments often assemble and disband teams rapidly, requiring a nuanced understanding of when to rely on stable teams versus teaming (teamwork on the fly).
Case Study 18-1 Halloween in the Trauma Unit
Scenario: Dr. Andrea Martinelli, a trauma surgeon, faces Halloween night shifts with chaotic, high-stakes cases and an unfamiliar team configuration.
Environment: The trauma unit is frenetically busy; staffing consists of nurses, residents, a fellow, nursing students, a scrub tech, an anesthesiologist, and a nurse anesthetist. The exact team composition changes frequently due to shifts and turnover.
Lesson: in high-pressure settings, teams may not be stable; rapid coordination and clear leadership are critical even when people do not know each other well.
Case Study 18-2 Kaiser Permanente Facilities Use TeamSTEPPS to Improve Obstetrics and Other Patient Care
Context: Kaiser Permanente in Northern California implemented TeamSTEPPS to standardize teamwork and reduce variation in care delivery.
Program: TeamSTEPPS is an evidence-based, customizable program to optimize performance among health care teams. It was developed by AHRQ in collaboration with the Department of Defense and launched in 2006.
Implementation results:
45 Kaiser teams completed TeamSTEPPS train-the-trainer programs since 2014.
Training covered a wide range of units: ED, ICU, CCU, cardiac catheterization labs, NICU, medical/surgical/telemetry units, interventional radiology, environmental services, perioperative, perinatal, and skilled nursing.
Common TeamSTEPPS strategies used by perinatal teams:
Huddle: Ad hoc daily planning session to reinforce plans; includes multidisciplinary obstetricians, CNMs, residents, RNs, anesthesiologists, and pediatric specialists.
Debrief: After-action review to improve performance; identifies concerns and coordinates additional staff support when needed.
SBAR: Situation, Background, Assessment, and Recommendation; facilitates clear communication; a “baby SBAR” supports obstetrician-neonatal team coordination for delivery planning and resuscitation needs.
Reported outcomes and insights:
Huddles improved workflows and situational awareness during high-volume periods.
Debriefs contributed to improvements in hemorrhage team response and C-section decision-to-incision times.
Source context: Kaiser materials on TeamSTEPPS and patient care improvements.
Teams and Teaming: Definitions and Concepts
Team: a small group committed to a common purpose, with complementary skills, and mutually accountable performance goals (Katzenbach & Smith, 1993).
Characteristics of a team (as per definition): small size (often 5–7, preferably odd to encourage consensus), specific goals, and mutual accountability with interdependence and collaboration.
Not all healthcare groups fit neatly as either a group or a team; some are rapidly assembled for a specific purpose and disband shortly after, which challenges traditional definitions of a group.
Amy Edmondson (2012) introduces and advocates for "teaming" — teamwork on the fly — when tasks are complex and uncertain and require rapid assembly of diverse experts.
Contrast: stable teams (with long-standing membership) can be highly effective for routine tasks, but teaming is valuable for dynamic, complex challenges.
In healthcare, teaming is increasingly common due to evolving technologies, patient needs, and system pressures.
Types of Teams (Cohen & Bailey, 1997)
Four categories of teams:
1) Work teams: continuing work units responsible for producing goods or providing services. Traditionally directed by managers who decide what is done, how, and by whom; newer forms include self-managing/empowered work teams where employees decide how to carry out tasks, allocate work, and make decisions. Examples: primary care teams, surgical teams, emergency department teams.
2) Parallel teams: drawn from different work units to perform functions outside the regular organization’s normal scope; exist in parallel with formal structure; limited authority; can only make recommendations upward. Used for problem solving and improvement activities (e.g., quality improvement teams, quality circles, patient satisfaction task forces).
3) Project teams: time-limited, produce one-time outputs; high knowledge/skill requirements; may be cross-functional; members return to functional units after project completion. Example: new electronic health record implementation team, new facility design team.
4) Management teams: coordinate and direct subunits, integrating interdependent processes across subunits; responsible for overall performance of a business unit; composed of subunit managers; top management teams set organizational strategy.Cross-functional project teams tend to improve success by handling multiple activities simultaneously, saving time; especially relevant for rapid development of new services/products.
The use of top management teams responds to turbulence and complexity in healthcare environments by leveraging collective expertise and shared responsibility.
Virtual Teams
Definition: teams that work across space, time, and organizational boundaries using technology to collaborate.
Key distinction: distance is the defining factor separating virtual teams from conventional teams (Roebuck & Britt, 2002).
Characteristics:
Members may be located anywhere in the world; rarely meet face to face; rely on communication technology.
Often configured as temporary structures for a specific task or as more permanent teams addressing ongoing issues.
Trends and stats:
As of 2018, approximately 70\% of workers globally work remotely at least one day per week.
Benefits for organizations:
Access to previously unavailable expertise and enhanced cross-functional interaction.
Ability to place the right person on a task regardless of location.
Challenges and management considerations:
Social isolation risk: in-person social interaction is a common source of social capital; a 2019 survey found that 30\% of millennials report feeling lonely, and 22\% report having no friends, highlighting the wellbeing risks for virtual team members.
Strategies to mitigate isolation include deliberate social and collaborative practices and supportive leadership.
Health care example: Rush University Medical Center piloted Virtual Integrated Practice, coordinating offsite interdisciplinary teams (social workers, dietitians, pharmacists, etc.) to manage geriatric chronic disease care virtually; reported reductions in ED visits, improved patient understanding and satisfaction, increased physician knowledge, and more referrals to interdisciplinary team members.
Building Team Performance
In health care, teamwork is not always intuitive due to cultures that emphasize autonomy and professional boundaries; strong teamwork and communication are critical in high-risk areas (ED, ICU, L&D, OR).
A highly cohesive team tends to be more cooperative and effective; cohesion relates to focus on process, mutual respect, commitment to decisions, and accountability across team members.
The Team Performance Curve (Katzenbach & Smith, 1993): small groups can develop into high-performing teams; unlike working groups, teams commit to joint work products and mutual accountability, tolerating conflict and shared risk to achieve a common purpose. Pseudoteams are those that call themselves teams but do not take these risks.
Eight approaches to building team performance (applied to stable or semistable teams): 1) Establish Urgency and Direction: teams must believe in an urgent, worthwhile purpose; clear performance expectations with flexibility for the team to shape purpose, goals, and approach. 2) Select Members on the Basis of Skills and Skill Potential, Not Personality: balance between current skills (technical/functional, problem-solving, interpersonal) and potential for growth. Margerison & McCann (1989) developed the Team Management Wheel to balance roles and linking skills.
Skills categories:
Technical/functional
Problem-solving
Interpersonal
Team roles example (from Team Management Wheel): Adviser, Explorer, Promoter, Assessor, Organizer, Producer, Inspector, Maintainer; plus the Linker role is central to leadership.
3) Pay Attention to First Meetings and Actions: initial impressions are pivotal; teams assess signals about others to confirm or challenge assumptions; early signals shape trust and collaboration.
4) Set Some Clear Rules of Behavior: establish norms such as attendance, discussion norms, confidentiality, analytic approach, end-product orientation, constructive confrontation, and meaningful contributions.
5) Set and Seize upon a Few Immediate Performance-Oriented Tasks and Goals: establish challenging yet achievable goals early to create cohesion.
6) Challenge the Group Regularly with Fresh Facts and Information: new information reshapes shared understanding and clarifies purpose/goals.
7) Spend Lots of Time Together: both scheduled and unscheduled time; in-person is not always necessary, but interaction is essential for bonding and insight.
8) Exploit the Power of Positive Feedback, Recognition, and Reward: positive reinforcement supports team motivation; recognition can take many forms beyond direct compensation.
Note: teaming often involves brief, goal-directed collaboration that disbands; thus some steps may not fully apply in a teaming context. Edmondson (2012) identifies behaviors necessary for successful teaming (see Table 18-1).
The Team Management Wheel and Linking Skills
The Margerison-McCann Team Management Wheel defines eight team roles and emphasizes balance among roles and skills:
Roles: Reporter-Advisors, Creator-Inventors, Explorer-Promoters, Assessor-Developers, Thruster-Organizers, Concluder-Producers, Controller-Inspectors, Upholder-Maintainers
The hub is the Linker, typically the team leader, but all members contribute to linking activities.
Three levels of Linking (Practice levels):
People Linking Skills (outer ring): create a positive team atmosphere by promoting harmony and trust. Examples include Active Listening, Communication, Team Relationships, Problem Solving and Counseling, Participative Decision Making, Interface Management.
Task Linking Skills (inner ring, around the core): form the foundation for work; include Work Allocation, Team Development, Delegation, Objective Setting, Quality Standards.
Leadership Linking Skills (core): Motivation and Strategy; used by leaders with organizational responsibility to implement strategic direction and align people with the team’s goals.
Leader role: The Linker Leader combines People, Task, and Leadership Linking Skills to drive effective teaming and organizational performance.
Visuals referenced: Exhibit 18-1 (Team Management Wheel) and Exhibit 18-2 (Linking Skills Wheel, including the hub Linker and the three levels of linking).
Common Characteristics of Successful Teams
Hackman (2011) identified six enabling conditions for team effectiveness:
Real: the team exists as a functioning unit with clear boundaries and membership.
Compelling purpose: a strong, shared reason for the team’s existence.
Right members: appropriate mix of skills and personalities.
Clear norms of conduct: agreed-upon rules guiding behavior.
Work in a highly supportive context: supportive organizational environment and resources.
Well-timed team coaching: access to coaching that helps the team improve.
Elaine Biech (cited by Gordon, 2002) lists ten common characteristics of successful teams:
Clear Goals: everyone understands the function and purpose.
Defined Roles: clarity on why team members are on the team and each person’s responsibilities.
These characteristics align with practical guidance for building effective teams, though real-world teaming may require adaptation.
Behaviors of Successful Teaming (Table 18-1)
Key behaviors and how they translate into health-care practice:
Emphasizing purpose: Define project/task purpose and align with shared values.
Building psychological safety: Create an environment where people can speak up and disagree without punishment; encourage curiosity and situational humility (acknowledging complexity and unknowns).
Embracing failure: Normalize and learn from failures; view them as opportunities for improvement and learning.
Open and clear communication: Effective communication hinges on active listening; ensure messages are understood and miscommunication is minimized.
Effective decision making: Consensus-based decisions; ensure the team agrees and that decisions reflect shared input.
Balanced participation: Engage all members; leadership should foster inclusion and avoid domination by a few voices.
Valuing diversity: Recognize the knowledge, skills, perspectives, and abilities each member brings; diversity goes beyond demographics.
Managed conflict: Encourage curiosity and inquiry; use conflict as a productive force for idea evaluation and goal alignment.
Open/shared governance: In health care, shared governance distributes decision-making responsibility among team members.
Open and constructive feedback loops: Use mortality and morbidity conferences and other feedback mechanisms to discuss errors and improve safety.
Health care examples emphasize collaboration among doctors, nurses, and other professionals to reduce clashes and improve patient outcomes.
Barriers to Effective Teamwork (Table 18-2)
Four broad barrier categories identified: 1) Management barriers
Lack of sufficient support and commitment from senior management
Pressure for short-term results
Political meddling and power politics
2) Leadership barriersLack of trust among team members and with leadership (communication is closed; risk-taking is not encouraged or rewarded)
Lack of clear vision, goals, and objectives
Unwillingness to grant autonomy and decision-making powers
Poor communication and interpersonal skills
Lack of recognition and reward for group efforts
3) Resources barriersInsufficient release time from other duties for team members
Inadequate training and skills development
Lack of project management skills
4) Training barriersInadequate training resources and opportunities
Impact: When these barriers are present, teams struggle to develop into high-performing units.
Conclusion and Practical Guidance for Building Effective Teams
Dunphy (1996) supports that teams contribute to productivity, efficiency, quality, safety, and satisfaction in healthcare; however, team-building requires time and resources and needs management investment.
Messmer (2004) provides a practical checklist for managers (Exhibit 18-2): Building Effective Teams
1) Start with an action plan detailing mission, required expertise, and collaboration approach; address questions such as duration, project components and deadlines, autonomy vs. overlap with full-time staff.
2) Demonstrate project impact to the department/company at the first team meeting; prepare supporting materials (timeline, handouts).
3) When selecting team members, assess interpersonal and communication skills in addition to technical expertise; ensure ability to present analyses clearly to non-specialists.
4) Seek recommendations from others and confirm with each member’s manager that they can commit time.
5) Consider appointing a coordinator to collect and distribute status reports.
6) Have an initial meeting to review the action plan; encourage feedback and establish protocols for conflict resolution and expense approvals; share revised guidelines.
7) Leaders should balance coaching with avoiding micromanagement; encourage problem-solving and risk-taking; exceptional difficulties can spur transferable innovations.
8) Periodically evaluate progress and adjust membership if workload conflicts arise; ensure inclusive participation by soliciting input from quieter members.
9) Maintain motivation with regular momentum: start meetings with a recap of accomplishments and celebrate milestones to sustain productivity.
10) Leaders play a pivotal role in guiding collaboration and ensuring the right participants and direction to maximize the team’s organizational contribution.
Messmer’s guidance emphasizes a structured, proactive approach to forming, guiding, and sustaining teams.
Discussion Questions and Exercises (for study prompts)
Discussion questions:
1) Explain why teams and groups are not the same.
2) Describe the various types of teams used in today’s organizations.
3) Explain the difference between a traditional work team and a self-managing work team; discuss pros and cons of virtual versus conventional teams.
4) Explain the difference between a working group and a high-performing team.
5) Explain the approaches managers can use to build team performance.
6) Discuss organizational barriers to team effectiveness.
7) Are there additional characteristics of successful teams beyond Biech’s list?Exercises:
Exercise 18-1: List and describe the types of teams most commonly found in your organization; state their purposes.
Exercise 18-2: List teams you are a member of; analyze one for high performance and identify changes needed to become high-performing.
Exercise 18-3: Use recent news headlines to describe an example of teaming where a group came together briefly to solve a complex problem.
References (selected)
Ballard, J. (2019); Bartunek, J. M. (2011); Browne, R. (2018); Cohen, S. G., & Bailey, D. E. (1997); Daft, R., & Marcic, D. (2009); Edmondson, A. C. (2012); Katzenbach, J. R., & Smith, D. K. (1993); Lipnack, J., & Stamps, J. (1997); Lurey, J. (1998); Margerison, C., & McCann, D. (1989); Margerison-McCann Team Management Wheel (Exhibit 18-1, 18-2); Messmer, M. (2004); Roebuck, D. B., & Britt, A. C. (2002); Rothschild, S. K., & Lapidos, S. (2009); Taplin, S. H., et al. (2013).
Additional readings and resources cited throughout the chapter provide deeper context on team dynamics, TeamSTEPPS, and health-care teamwork practices.