WORKING IN TEAM By Dr Fadel Naim Consultant

WORKING IN TEAM By: Dr Fadel Naim Consultant Orthopedic Surgeon

Teamwork n n Quality health care depends on every health care worker doing his/her part. Well coordinated teamwork across the health professions can provide effective and cost-effective patient care.

Teamwork n Professionals with different: ¡ ¡ ¡ Backgrounds Education Ideas Responsibilities Interests n All work together to provide appropriate quality care.

Teamwork n n The team concept was created to provide quality holistic health care to every patient. It is essential to learn to become a “team player” and learn to work well with others.

Groups and Teams n Group ¡ n Two or more persons who are interacting in such a way that each person influences and is influenced by each other person. Team ¡ A group of people committed to a common purpose, set of performance goals, and approach for which the team members hold themselves mutually accountable. 5

What is a Team? n A group of people, with complementary skills who are committed to a common approach for which they hold themselves mutually accountable, working together to achieve a common goal

Healthcare Teams n n n Individuals from different healthcare disciplines come together to provide patient care. No single professional can deliver a complete plan of care to meet patient needs. The leader of the healthcare team may vary depending on the task.

Example: Surgical Team 1. 2. 3. 4. 5. 6. 7. Admitting clerk (admission information) Insurance representative (approval for surgery) Nurses or patient care technicians (prep pt) Surgeons, one or more Anesthesiologist Operating room nurses Surgical technicians 8. 9. 10. 11. 12. 13. 14. 15. Housekeepers (clean and sanitize OR after procedure) Sterile supply techs (clean instruments) Recovery room personnel Dietitian Social worker Physical therapist Occupational therapist Home health personnel

Why is Teamwork Important in Healthcare? n Promoting teamwork and good communication among health professionals can dramatically improve healthcare delivery, resulting in much better outcomes for patients.

Advantages of Teamwork n For Patients: ¡ ¡ ¡ Improves care by increasing coordination of services, especially for complex problems. Empowers patients as active partners in care. Uses time more efficiently.

Advantages of Teamwork n For Health Care Professionals: ¡ ¡ Increases professional satisfaction. Enables the practitioner to learn new skills and approaches. Encourages innovation. Allows provider to focus on individual areas of expertise.

Advantages of Teamwork n For the Health Care Delivery System: ¡ ¡ ¡ Holds potential for more efficient delivery of care. Maximizes resources and facilities. Decreases burden on acute care facilities as a result of increased preventive care.

None of us is as smart as all of us

Interdisciplinary Teams n In almost any health career, doctors will be a part of an interdisciplinary health care team ¡ ¡ Practitioners from different professions Share a common patient population Share common patient care goals Share responsibility for complementary tasks.

Interdisciplinary Teams n In contrast to: ¡ Disciplinary or independent medical management approach n in which a practitioner works autonomously with limited input from other practitioners. ¡ Multidisciplinary approach n ¡ which involves various health care professionals working independently - - not collaboratively - - with each responsible for a different patient need Consultative approach n in which one practitioner retains central responsibility and consults with others as needed.

Patient Care Conferences n Most teams have frequent patient care conferences, and, in some instances, the patient is an active participant. ¡ ¡ n Opinions are shared Options are discussed Decisions are made Goals are established. During the conference, each team member must: ¡ ¡ Listen Be honest Express his/her own opinion Be willing to try different solutions.

Interpersonal Relationships n n Good interpersonal relationships are essential and can improve the quality of care. Poor interpersonal relationships among team members can harm the quality of care and prevent the team from meeting its goals

Ways to Develop Good Interpersonal Relationships n n n Have a positive attitude & learn to laugh at yourself. Be friendly & cooperative. Assist others when you see that they need help. Listen carefully to others. Respect opinions of others even if you don’t agree. Be open-minded & willing to compromise.

Ways to Develop Good Interpersonal Relationships n n n Avoid criticizing others. Learn good communication skills. Support and encourage other team members. Perform your duties to the best of your ability be dependable.

Characteristics of High-performing Work Teams May 9, 2006 LIS 580 - Spring 2006 20

Collaboration n n Joint communication and decision-making process with the goal of satisfying the health care needs of a target population. Belief that quality patient care is achieved by the contribution of all care providers. A true collaborative system has no hierarchy. The contribution of each health care worker is based on knowledge and expertise.

Collaboration n Members of a team will have different: ¡ ¡ ¡ ¡ n cultural backgrounds Genders Ages socioeconomic statuses lifestyle preferences Beliefs levels of education. Each team member must understand that these differences affect the way a person thinks and acts.

Collaboration n Each person must be sensitive to the: ¡ ¡ ¡ n Hopes of other team members. Feelings of other team members. needs of other team members. Treat others as you would want to be treated!

Conflict n n Conflict among individuals with different personalities is a problem that can occur when a group of people is working as a team. When conflict occurs, it is essential for each person to deal with the conflict in a positive way. ¡ If a team is to meet its goals, conflict must be resolved.

Symptoms of Group Dysfunction n One member dominates others ¡ n n n Poor idea development will occur Disagreements do not lead to productivity Members do not attend meetings or disrupt when they do attend Silence is the norm You wish you were in another team No one acknowledges that the team has a problem

Conflict n Conflict may encourage innovation and creative problem -solving. ¡ n Successful resolution of differences may foster: ¡ ¡ n We need to manage conflict, not eliminate it. increased trust understanding among team members. Failure to deal effectively with conflict, however, may lead to ¡ ¡ ¡ low morale Withdrawal Condescension anger, burn-out.

Interpersonal Conflict n Teams with minimal interpersonal conflict had the same 6 strategies. ¡ Team members: 1. Work with more information, and debated facts 2. Develop multiple alternatives to enrich the level of debate; 3. Share commonly agreed upon goals 4. Inject humor into the decision process; 5. Maintain a balanced power structure; and resolved issues without forcing consensus. ” 6. Keep the focus on the facts and not on personalities, 27 and communicating in an open, honest, and safe forum

Causes of conflict n n Conflict of aims- different goals Conflict of ideas- different interpretations Conflict of attitudes - different opinions Conflict of behavior- different behaviors are unacceptable

Outcomes of Conflict n n n Avoidance ¡ conflicting members avoid each other or conflicting issues are avoided in team discussions; leads to stagnation. Capitulation/domination ¡ leaves “winners and losers”; divisive for team. Compromise ¡ each party gives up something important.

Outcomes of Conflict n Collaborative problem-solving ¡ each party states clear, observable terms ¡ solutions are sought that maximize net gains for all parties ¡ members feel positively about a solution that is of greatest benefit to the team.

Resolving Conflict 1. 2. 3. 4. Separate people from the problem – diffuse the emotional component of the conflict. Clarify the conflict & recognize the problem. Involved parties need to agree to work towards a solution. Deal with one problem at a time, beginning with the easier issues.

Resolving Conflict 5. 6. 7. 8. 9. 10. Brainstorm about possible solutions. Focus on common interests, not positions. Use objective criteria when possible. Invent new solutions where both parties gain. Implement the plan. Evaluate and review the problem-solving process after implementation.

CUDSA model n n n 1. Confront the conflict 2. Understand the other’s position 3. Define the problem(s) 4. Search for and evaluate Alternative solutions 5. Agree upon, implement and evaluate the Best solution

People Play “Roles” in Teams n Innovator: ¡ n Worker: ¡ n generate ideas and concepts; often impractical but stimulating practical; buckles down to get the job done but may lack vision Monitor/evaluator: ¡ analyzes ideas and feasibility, can process complex data but may dominate too much with practicalities

People Play “Roles” in Teams n Resource investigator: ¡ n Completer: ¡ n explores resources and ideas outside the group; may overextend and increase complexity but improves external contacts concerned about keeping on schedule and completing details; often anxious but controlled and will work hard to meet goals Free rider: ¡ see if others will pick up the slack

People Play “Roles” in Teams

Leaders n n A leader is an important part of any team. Leadership: ¡ n the ability or skill to encourage people to work together and do their best to achieve common goals. A leader: ¡ an individual who leads or guides others, or who is in charge or in command of others.

What is leadership? Leading people Influencing people Commanding people Guiding people

Managers vs. Leaders Managers Leaders

Managers vs. Leaders Managers Leaders n Focus on things n Focus on people n Do things right n Do the right things n Plan n Inspire n Organize n Influence n Direct n Motivate n Control n Build n Follows the rules n Shape entities

Leader in health care group n Historically the leader and primary decisionmaker has been a physician – but now that role is shared. n The leadership in the group passes from person to person as each individual contributes to the achievement of the groups’ goals.

Common Characteristics Of Leaders 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Respect rights, dignity, opinions, & abilities of others. Understands principles of democracy. Works with group & guides them towards a goal. Understands own strengths & weaknesses. Displays self-confidence & willingness to take a stand. Communicate effectively. Show self-initiative, willingness to work, & completes tasks. Shows optimism, is open-minded, & can compromise. Praises others & gives credit to others. Dedicated to meeting high standards.

Types of Leaders n n n Leader by the position achieved Leader by personality, charisma Leader by moral example Leader by power held Intellectual leader Leader because of ability to accomplish things

Types of Leadership n Democratic Leader:

Types of Leadership n Democratic Leader: ¡ ¡ ¡ Encourages the participation of all individuals in decisions that have to be made or problems that have to be solved. Listens to the opinions of others and then bases decisions on what is best for the group as a whole. Allows the group to take responsibility for the decision.

Types of Leadership n Laissez-faire Leader:

Types of Leadership n Laissez-faire Leader: ¡ ¡ More of an informal type of leader. Believes in non-interference in the affairs of others. (“Hands-off” policy) Strive for only minimal rules or regulations and allows the individuals to function in an independent manner with little or no direction. Usually avoids making decisions until forced by circumstances to do so.

Types of Leadership n Autocratic Leader:

Types of Leadership n Autocratic Leader: ¡ ¡ “Dictator”. This individual maintains total rule, makes all of the decisions and has difficulty delegating or sharing duties. Seldom asks for the opinions of others, emphasizes discipline, and expects others to follow directions at all times. Individuals might follow this type of leader because of a fear of punishment or because of extreme loyalty.

Types of Leadership n n All types of leadership have advantages and disadvantages. The democratic leader is the most effective for group interactions. ¡ By allowing a group to share in deciding what, when, and how something is to be done, members of the group will usually do what has to be done because they want to do it.

Legal Responsibilities n n n Each member of a team must be aware of the legal limitations on duties that can be performed. All members must function within legal boundaries. No team member should ever attempt to solve a problem or perform a duty that is beyond the range of duties legally permitted.