Teamwork in the Health Care Environment

iNancy Elder Care with Nancy Karen Culp RN.  As a Registered Nurse with almost 38 years of nursing experience I bring to you a series of articles & guides to help navigate thru the workplace setting. Over the years I have been thru the School of Hard Knocks so to speak and I’m still learning!  Experiencing a wide range of work settings, situations and challenges along the way has allowed me to share what I have learned or that which those around me have learned.  This information is presented to give you support and advice. Here is my unique perspective of the experiences I have had along the way for your benefit!

An effective teambuilding program is designed to be a give and take situation… to allow for participants to give feedback on what their strengths and weaknesses lie and then make their contribution to the team.  In a health care environment, where Quality of Care and Quality of Life are at stake, it is vital all staff to work together to get the hundreds of tasks done in a timely and efficient manner. 

Long Term Care (LTC) like most work environments, undergoes changes that impact how the unit or interdisciplinary team work together. One example of this was back in the 90’s when most facilities added subacute or rehab units to their services, they dramatically increased the number of admissions and discharges.  Staff needed to work more closely than ever as a TEAM to accomplish this monumental task.

WHY IS WORKING AS A TEAM SO IMPORTANT?

TEAMBUILDING creates a working environment that:

• Fosters TEAM spirit.  It is a way to formalize the power of COLLABORATION. By definition – collaboration is a way to blend the talents, skills & creativity of a diverse group of people.  By collaborating, a work group leverages its skills, time, and resources for their own benefit and that of the organization. 
• Allows for us to better understand ourselves and others thereby creating a diverse and creative and enjoyable working environment…In order to accomplish what we want, we need to START with the END in mind.  Wouldn’t it be great to look forward to work every day?  To thoroughly enjoy what we do?  We must first decide what that would be like.  “If a person does not know what harbor he is seeking, no light will be enough to guide him”  

Trainers know that it is important to get the objectives out of the way early on, otherwise participants spend valuable time thinking about them and miss the learning at hand.  One way to do this is to tell the staff that I have a magic wand which allows them to change anything they want in their work environment.  I pass around an actual toy “magic wand”  and I ask them to answer the following questions:

Question #1 – If you could change anything about others at work, what would it be?

Question #2 – You have just become “the boss” if you could change anything about your working environment, what would it be?

These two questions open the door for participants to verbalize their thoughts and feelings about their vision for what a cohesive work environment should be… it is very insightful to say the least about the picture they paint of the challenges they are currently working with!

TELL THEM THEY ARE IMPORTANT!

The next critical point to be made helps each individual employee to recognize the importance as part of the teams they work with… I explain that the culture of the facility is to recognize that THEY are important and that NO ONE in this organization is insignificant.  I cover this in orientation as well.  “Every single employee is equally important, no one is more or less important than another!”  I reiterate that this means that for example, the housekeeper and the director of nursing for example are equally important   Responsibility and knowledge base varies but importance does not.  Each of us has specific talents, skills, knowledge and responsibilities that make our organization complete as illustrated in the following story;

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions until I read the last one: “What is the first name of the woman who cleans the school?”   Surely this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50s, but how would I know her name?  I handed in my paper, leaving the last question blank. Just before class ended, one student asked if the last question would count toward our quiz grade.  “Absolutely,” said the professor. “In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say ‘hello’.”  I’ve never forgotten that lesson. I also learned her name was Dorothy. Everyone is important…

PRODUCTIVITY & JOB SATISFACTION:

Next, teamwork boosts productivity and job satisfaction… TEAMBUILDING helps people to understand that they are greater collectively than individually.  It is bringing people to a place where there is an honest appreciation of each other.  When you respected as an individual and FEEL that you are important… you become comfortable with CONTRIBUTING your thoughts and ideas and are able to appreciate, trust and depend on your fellow teammates… Then and only then will Productivity and Job Satisfaction be significantly increased.

IDENTIFY THE VARIOUS “TEAMS” THEY ARE PART OF:

Before we get into TEAMBUILDING itself, you need to identify for your staff what “TEAMS” currently exist in your facility. You may write these on a whiteboard or flipchart.  It brings into reality how teambuilding affects and applies to all that they do:

IDENTIFY FACILITY TEAMS:

• Care planning team members
• Unit caregiver teams
• Quality improvement committees
• Shift to shift or morning report teams
• Individual departmental teams
• JCAHO or DOH compliance teams
• CPR response team
• Etc. etc. etc…

This also reinforces the fact they may be members of several teams which broadens their understanding of their involvement as a team player.

TEAMBUILDING STAGES:

There are four stages of team development.  It is important to understand that teambuilding is not a one time experience but an ongoing one that is affected each time a new member is added to the team!  If for example, a new unit manager is hired, the following team building stages will start all over again incorporating the new staff member into the mix.  It helps when staff understand this and know that disruption is expected but that it will pass when the team ultimately settles into a cohesive team.  If not, they may get stuck in the disruption and not progress as they should! Team Development:

Stage 1 – FORMING: Team members define & clarify the team’s purpose, goals and working approach.  May lead to uncertainty and redefinition of roles.

Stage 2 – STORMING:  Work thru conflicts about who’s in charge and who does what. this is the most disruptive stage of teambuilding and they may need to be reminded that the “storming” stage is to be expected and will eventually pass. Team members ultimately develop a climate of trust and confidence in each other.

Stage 3 – NORMING:  Here the team develops a sense of identity and cohesiveness.  There is a sense of mutual accountability.

Stage 4 – PERFORMING:  Finally, the team enters the stage at which time they become far more effective than the sum of their individual efforts.

It is helpful to incorporate a teambuilding role play into the training session if time allows such as the Stranded on the Moon Survival Exercise (a Google search for teambuilding exercises will help you find an exercise that allows for the timeframe and relatable learning exercise that meets your need)..

TAKING TIME TO BUILD STAFF SELF-ESTEEM:

The team’s ultimate strength lies in the strength/skills of each individual.  Each of us must not only have a good understanding and belief in our own strengths and skills – but it is to our benefit to understand others as well.  In order to help us with this (understanding of ourselves and others) you may choose to have staff take a personality test or simply have staff list their strengths, accomplishments and goals… let them know that this information won’t be shared with the group unless they choose to do so.  This gives them the freedom to be honest and the effects of such an exercise are inspiring and beneficial. 

ADDRESS THE BIGGEST ROADBLOCK TO TEAM BUILDING

The biggest roadblock to working as a team is dealing with difficult personalities.  Everyone is not always on the same page and having the skills to work thru this issue is critical to team success.  Here are a few suggestions but you know your staff best and you will need to choose what to address and expand on this list as needed:

COMPLAINERS What you can do:

• Listen Attentively
• If the complainer goes on and on and begins repeating themselves, be prepared to interrupt – politely i.e. (when they take a breath) “Wait a minute, Let’s see if I can understand what you are saying”
• Acknowledge that you understand and take them seriously.
• Avoid accusation (the complainers favorite way out is to blame others), resist getting defensive – the complainer will use words like “always”, “never”, “it took forever”
• Work towards getting their focus off the complaint by: Asking specific/factual questions “When does this happen?”, ” Who are the people involved?”, “Exactly how long did it take?”  Write down the facts. (this shows that you value what they are saying and also helps you remember the details when you pass the information on)

• Avoid “Why” questions, this only gets them off in a direction other than problem solving.
• Assign a task to collect information: “Would you keep track of how long it takes….”
• Repeat the “problem” back to the person to assure that you have a clear understanding of the issue. “Let me see if I understand what you are saying…..” or “What I hear you saying is …, is that correct?”
• Bring the issue to closure for the time being by specifying exactly what you are going to do, then follow-up accordingly.
• Sincerity is the key to reaching the complainer.  They will lose respect for you if they believe you are not really interested in their problem or helping them solve it.  Good listening skills convey a message of sincerity.

THE STALLER:  Slow to act.  Fence sitters!  Can hold the team back if they don’t act quickly enough.  Puts off making decisions, indecisive.  Favorite phrase “let me think about it and I’ll get back to you”. This can be a significant issue if the staller is in a position of authority and will need to be dealt with assertively. What you can do:

• Find out why they are stalling.  To make it easy say something like “Even a good plan has some things about it that aren’t quite perfect.  I’d welcome your comments on even the small things that could use improvement.” Or “What seems to be the conflict? I want your honest feedback” or “Feel free to talk about what’s on your mind”.
• Ask for a complete description of the problem with details and ask them for possible solutions.
• Give your support after the staller makes a decision: Start by saying “Just wanted to know if you are having any second thoughts?” and end by saying “In my opinion you have made the right decision”  or “I can count on you because I am personally committed and I have complete confidence in your decision-making ability”
• Know when not to push, if forced to change or make a decision before they are ready, they will withdraw or not follow-up on required changes.

THE TANK:  They make themselves look strong by making others look weak.  That is why their view has to be always right and why they can’t accept feedback.  Their favorite saying is “My way or the highway”.  What you can do:

• Avoid confrontation over who is right.  They will win the fight, they are experts at it!  Being defeated leaves tanks seething and plotting so you need to let then save face.
• Stand up for yourself by doing the following: 
• • Don’t be afraid, stand up for yourself
  • Let them wind down.  Maintain eye contact and hold your ground mentally and physically (unless you are in danger)
• Don’t worry about being polite, just jump in. Call out their name to get their attention. If you are talking and they interrupt you say firmly “You interrupted me”.
• Get them to sit down “Look, if we’re going to continue this discussion, we might as well be comfortable”.  If they continue to stand however, you continue to stand.
• Speak from your own point of view, use words that project self-assertion “In my opinion…” “I disagree with you”, “I can see that you… but my experience is different” Use these words to express your point of view, not saying that the tank is wrong – that only makes them feel like they are being attacked. “I’m not trying to attack you; I’m trying to get you to see another point of view”.
• Use the following formula:  “I” (the impact is on you, not them) “feel angry” (or frustrated, or feel betrayed) “when you” (describe the behavior specifically, not them the person) “use that tone of voice (specify behavior)” .  “I would prefer that you…….(or come to me when a problem first arises so you won’t get so frustrated)”  “If you do this, I will….. (state the positive outcome).
• If they are beyond control, “I feel frustrated when you use that tone of voice. I’ll come back and talk with you about it when you are less angry so we can talk about it in a more productive way.”
• If your boss is a tank “It is not my intention of making you think that I don’t believe you’re in charge, you are the boss whatever you decide, I’ll do what I can to make it happen.  But I do have some ideas on how to …..”
• To make them think and raise the level of positive expectation, try this one “____, this is so unlike you to act this way, yelling and carrying on.  Usually you handle this situation calmly and sensibly.”

Last but not least, remember these important “facts” about dealing with people:

1. Most people are not intentionally difficult or malicious.  People truly believe that they are right and that they are trying to help.  If you remember this fact, you will have a better understanding of others and be able to deal with them more successfully.
2. There is no way to re-create YOU!  You are valuable and offer a unique set of skills, experiences and creative ideas to the teams you are a part of.  You are important.
3. Intelligence, good looks or any other personal preferences or characteristics have nothing to do with being SUCCESSFUL.  Characteristics of success are things like persistence, goal-setting, positive expectation, faith, willingness to take a risk or to change  etc. etc. etc.  Traits we all inherently have already to all different degrees = diversity strengthens our team!
4. Use common courtesies and remember to say “Thank-you”.  Appreciation and recognition must be personal and timely.

 TEAMWORK PRINCIPALS & REQUIREMENTS:

Review of the following teamwork principals and requirements helps determine where you may need to concentrate your efforts and follow-up accordingly. If these items are not in place, working as a cohesive team will be difficult to say the least.  Reinforcement can come in the form is signs, memo’s, verbalization at meetings etc.

•  Teams must have a clearly stated objective; established goals and the strategies to reach their goals.  This unifies the team and holds them together thru thick and thin…. Diverse objectives must be linked by a common purpose. Teams must find common goals that benefit all members. On a unit for example, what are the common objectives that meet the needs of the entire work team? Define them and post them for all to see!
• When the team faces adversity or challenges, cooperation needs to be reinforced and encouragement given. Remind them that what they are going thru is just temporary – this too shall pass!
• Mutual support is one of the key factors to successful teams and continued successes reinforce commitment to each other as well as the team’s ultimate goal… Successful teams are mutually supportive.  Team members need to understand that if they bring someone else down they actually hurt the team and in the long run… themselves.
• Create a work environment that encourages openness & honesty.  On successful teams, members look to one another to point out flaws no one else will…from such openness and honesty comes mutual respect and trust…
• Team members need to realize that adversity strengthens the bonds of the team and sharpens our skills.  During these trails, the bonds of the team are ever fortified.  It is when the team faces the challenge of a task together, that it becomes most cohesive. 
• Two critical teambuilding skills are planning & creativity.  This may take place at formal or impromptu meetings.  This will only happen when a culture of equal importance for all team members had been established so all team members feel free to contribute their thoughts and ideas.  Individuals need to trust the goodness with-in themselves as well as their own unique strengths and abilities.

IN SUMMARY: 

• BUILD AND RELY ON TEAMS
• DELEGATE AND EMPOWER
• TAP INDIVIDUAL INNER RESOURCES
• POOL SKILLS AND ABILITIES
• USE IMAGINATION AND CREATIVITY TO TAKE RISKS

Realize that people don’t just work for the tangible rewards but for those of the spirit and the heart.  The journey into teambuilding will bring out aspects of individual team players they never though possible.  They will empower themselves along the way.  The self confidence that results from this process makes them able to tackle future projects and achieve future goals. Success is a journey, not a destination.

“Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” Andrew Carnegie