Chapter 10: Collaboration And Team Development

Chapter 10collaboration And Team Developmentcopyright 2015 Fa

Effective teamwork in healthcare is an essential component of a healthy organizational culture. Patients receive the best care at the hands of a team of professionals and paraprofessionals who offer different strengths and areas of expertise. Team development is unique and challenging in healthcare settings. Hierarchy poses a challenge to the collaboration and communication necessary for optimal teamwork.

In healthcare, there are many teams working to provide patient care. Teams are characterized by their goals, norms, membership roles, expertise, and explicit and implicit rules. Various experts on a healthcare team must follow their scope of practice, licensing requirements, and individual job descriptions. Hierarchical order introduces power gradients into relationships and provides a structured framework for activities.

Members come from diverse educational backgrounds, possess varied knowledge and experience levels, and are responsible for urgent and specialized tasks. Organizational tensions, such as budget concerns, and various goals, like bed occupancy, can create conflicts among team members. Clinical disagreements, such as when to provide comfort measures versus aggressive treatment, are also common in healthcare teams.

Team membership varies based on staffing patterns including shifts, weekends, and on-call duties. Teams typically comprise 6 to 24 members, though sizes can vary. Some teams are transient, like first responders, while others, such as hospital management teams, are more permanent. Factors influencing team dynamics include diversity, fatigue, emotional intelligence, training, experience, and relationship quality.

Stages of Team Development

Understanding the five stages of team development is critical to effective teamwork. Neglecting these stages can lead to problematic dynamics. The stages may occur over different timeframes.

The first stage, forming, involves initial team coming together. Members seek to understand goals, expectations, opportunities, and challenges. Leaders should establish clear objectives, facilitate introductions, and remain accessible and visible.

The second stage, storming, occurs when team members scrutinize the objectives, challenge each other's perspectives, and question leadership. Leaders should stay visible and accessible to manage conflicts.

Norming, the third stage, involves team members identifying as part of the group. They agree on goals and accept challenges, moving past conflicts. Leaders should adopt a collaborative approach to foster cohesion.

The fourth stage, performing, is characterized by high productivity and creativity. Ideas flow freely, and collaboration enhances innovative thinking. Leaders should encourage experimentation and innovative problem-solving.

The final stage, adjourning, focuses on completing tasks and celebrating accomplishments. Leaders facilitate closure and reflect on successes, helping members transition out of the team environment.

Challenges in Team Development

In real-world nursing, team development faces obstacles such as emergent urgent tasks and constant change. Priorities often overshadow comprehensive team-building efforts, though such work is vital for safety and effective collaboration. Time constraints and skill development challenges can impede progress through developmental stages.

Team-Building Strategies

Basic team-building may include informal gatherings and social activities, while more advanced interventions involve assessments, strategic recommendations, and targeted training. Formal strategies include leadership meetings, facilitated feedback sessions, retreats, and customized training programs. The goal is to foster effective collaboration essential for high-quality, safe patient care.

Crews Resource Management (CRM)

Originating in aviation, CRM emphasizes safety, team dynamics, leadership, and communication. It is based on four principles: communication, workload management, teamwork, and technical proficiency, fostering psychological safety where staff feel empowered to voice concerns.

TeamSTEPPS

Developed specifically for healthcare, TeamSTEPPS extends CRM principles through a standardized curriculum delivered via a national program encompassing six regional centers in the U.S. It highlights six core competencies—leadership, situational monitoring, mutual support, and communication—in a structured, three-phase process aimed to improve team performance and patient safety.

Hierarchy and Teamwork in Healthcare

Traditional hierarchy in healthcare reflects a command-and-control model, historically favoring decision-making authority based on gender and status, with communication flowing from top to bottom. Although gender roles are evolving, this model persists. To improve patient safety and team function, there is a pressing need for a healthier hierarchy that promotes sharing authority, responsibility, and decision-making based on expertise and knowledge.

Healthcare professionals increasingly are encouraged to develop leadership skills that foster collaboration and empower team members. When hierarchical boundaries are softened and shared decision-making is embraced, patient outcomes improve, and team cohesion is strengthened. Nonetheless, the delicate balance of authority remains essential for maintaining accountability and clarity in clinical situations.

Leadership and Cultural Change in Healthcare Hierarchies

Developing a collaborative leadership approach requires a shift from authoritarian models to participative leadership styles. Healthcare organizations should foster environments that support mutual respect, open communication, and shared accountability. Such cultural change promotes innovation, staff satisfaction, and resilience in high-pressure environments.

Empowering team members also involves patient engagement, encouraging patients to participate actively in their care and decision-making processes. This empowerment aligns with contemporary models of patient-centered care, ensuring that patients' preferences and values are incorporated into treatment plans.

Conclusion

Effective teamwork and collaboration in healthcare are vital for delivering high-quality patient care. Recognizing the stages of team development, implementing formal and informal team-building strategies, and fostering a culture of shared leadership and respect can overcome barriers posed by hierarchy and organizational challenges. Promoting psychological safety, open communication, and mutual support enhances team cohesion and ultimately improves patient outcomes. As healthcare continues to evolve, embracing flexible, inclusive leadership models and collaborative practices will remain essential for advancing safety and quality of care.

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