Conversion of an existing organization to a team system can be a rocky road in the beginning. Many managers and staff members are at a peak of frustration because of the uncertainty of how to get ready or how to react to a change. Yet the conversion to a team system yields obvious rewards. Staff members gain status and empowerment.

Despite initial difficulties in seeing benefits, managers also gain through greater productivity, better quality and generally reduced tension and conflict in the work setting itself. Thus, both managers and staff members can benefit significantly and experience an increase in their own ability to influence the organization and its performance.

            The building of teams in the early implementation phase requires putting into place well thought out structures for guiding and designing the change or implementation effort. Often a steering committee, task force or design team can be appointed. Having realistic expectations about the amount of time and energy required as well as having patience with the results is always a good start!

An important criterion for creating a team in the early implementation phase is to determine its objective. With this in mind, a manger can determine which staff members or groups should be part of the process. The selection of team members may be selected by the available time commitment, the knowledge, skills and level of authority to implement changes.

Team member selection could be similar to the interview process for hiring a new staff member. The staff member must want the job or be committed to the objective of the team to be considered.

The manager or designated individual must be able to clearly describe the expectations and responsibilities of the new role as a team member. He or she must also articulate the level of authority and accountability within the team. The staff member should have the necessary interpersonal skills to collaborate and not be rigid or posturing.

Some staff members should be on the team because of their knowledge, even though they may lack the necessary skills to be an effective member. In this case, the manager or designee must determine how he or she can help the team member. Staff members should also take some responsibility for helping other team members develop team skills.

According to Peter Scholtes, teams will go through four stages of growth, forming, storming, norming, and performing. Forming is described as when staff members cautiously explore the boundaries of acceptable group behavior. They may be trying to figure out “who” is involved and “what” is going on. This can be considered a stage of transition from individual to member status and of testing the manager’s guidance.

Often, there are numerous requests for direction and clarification.  In some organizations team members direct most of their comments to the leader and the status of team members may be based on their status in the organization. During the forming stage, staff members may have the following concerns:  

What’s my role?  

Will I be accepted in the team?  

How much time will the team take?  

What are we supposed to do?  

Who will help us?  

What resources do we have available?  

Who will be the leader?  

Will the leader be competent?  

Will my input be valued?  

 Storming  is the most difficult stage because staff members are usually impatient about the lack of progress, but still too inexperienced to know much about decision making. Conflict and resistance can characterize this stage. Subgroups and cliques may even form. Some members may try and gain influence over other members and even consider challenging the leader.

They often try to rely solely on their personal and professional experience, resisting the need for collaborating and communicating with other team members. Avoidance of tasks can become a daily occurrence. If proposals are made, some team members may judge them harshly or try and make other suggestions without discussion or consensus. During the storming stage the staff members may have the following concerns:  

How will my input influence the new team?  

Will I have support?  

What will be my place in the pecking order?  

Will I be liked?  

Will the team be able to get the job done?  

Will minority or new staff members voices be heard?  

Will conflicts interfere with commitment, progress and the goals of the unit?  

During the norming  process, staff members reconcile competing loyalties and responsibilities. They are beginning to accept the team, the ground rules or norms, their roles in the team and the individuality of each team member. Some may even seem to be getting along, laugh or truly enjoy their work.

Guidelines for behavior and operations are formed. A sense of “group” is evidenced by attention to the group’s norms and members tend to challenge one another less frequently. Information is shared openly and trust develops.

 During this stage emotional conflict is reduced, as previously competitive relationships become more cooperative. In other words, as team members realize they are not going to drown, they start helping each other stay afloat. Even though they begin to think like a team they may still have a few of the following concerns:  

Will we continue to make progress?  

Will the team stay focused?  

Will emphasis on process get in the way of progress?  

How do we compare with other groups?  

How well are we really relating to one another?  

 At the performing  stage, the team has settled its relationships and expectations. They can begin performing, diagnosing and solving problems and choosing and implementing changes. Actual production will take place. Tasks are tackled and results are emphasized with creative problem solving taking place and members seeking feedback from one another.

There is a reward system in place and successes are celebrated. At last, team members have discovered and accepted each other’s strengths and weaknesses and learned what their roles are. Throughout this last stage, the manager or designee plays a significant role in providing education and opportunities for the team member. While success is sweet, some concerns may still surface:  

Will the team continue to be successful?  

Are we acknowledging our successes?  

Are we getting recognition?  

Are the members still motivated and challenged?  

Is it time to change our goals or expected outcomes?  

Will the team be able to meat current standards?  

[Peter Scholtes. The Team Handbook  (Madison, Wisconsin: Joiner and Associates, Inc., 1988), 5-31].

The stage model of team development may be generalized and not an exact picture of your particular team development. In the real world, teams develop in a lot of different ways and at different paces.

 Some teams for example, may progress through developmental stages in different order, and get stuck in a stage, or even return to a previous stage. Anyone working with teams could look for dominant themes that reflect the stages of development. Once the stages are identified, you can assess team needs and offer help.  

Roller Coaster Cycles 

          In addition to stages of development, teams go through cycles of highs and lows. The pattern of highs and lows is different for every team, but the inevitability of highs and lows exists for all teams. Here is an example of a typical teal roller coaster.

·        High (first few weeks)  
The team usually begins on a high note of optimism and excitement. Initially, the team members feel satisfied and pleased.

·        Setback  
Team members become impatient, even bored if they have to wait for the project or process to get underway. As the project is defined and planned, team members become overwhelmed or discouraged by the amount of work that lies ahead.

·        Encouraged
The team begins to gather data and feel encouraged by the process. Communication is at a high level and there is excitement within the group.

·        Discouraged
The team comes face to face with obstacles. For example, mistakes are uncovered or a reviewer challenges procedures.

·        Breakthrough
The team tries again and is very successful. The team is praised for its work and progress.

The best way to deal with cycles is to learn ways to prevent as many problems as possible. Another option is to deal with problems effectively when they do occur. 

Common Themes of Teams 

          What do teams have in common? The answer is broad but some common themes that are dominant in teams are described below. Teams in an organization:  

·        Share a common goal  

·        Have members from diverse backgrounds  

·        Face ambiguous situations  

·        Must choose from various options to achieve common goals  

·        Must cooperate to be successful  

·        Must have ongoing communication  

·        Must perform a complex task that requires interdependence of all active members  

·        Needs the highest level of performance to achieve its goals  

·        Must be able to solve problems and make decisions  

Team Challenges 

                A great deal more has been written and is know about the benefits and advantages of teams, than about the problems and challenges that arise, especially during the implementation phase. Often, staff members think they don’t have any more problems since they converted to teams! Typical teams can face the following challenges:  

·        Organizations tend to expect too much, too soon.

·        Things often get worse before they get better.

·        Manager’ or supervisors’ sense of control and power is threatened.

·        Some high-status staff members may initially feel like losers.

·        Staff members need expanded on technical and behavioral skills.

·        Building and implementing teams requires planning and organization.

·        Good communication efforts need to be in place for teams to be infused into the organization.

Teams are a demanding and challenging implementation effort. Even when a team implementation is successful, it is not done without considerable patience, dedication, and allocation of resources.

Despite the difficulties, the real question is whether teams are worth doing. The answer is yes! Provided it’s done intelligently and effectively.

The evidence in health care is becoming clearer that teams can provide better productivity, higher quality and a better quality of life for staff members. Teams may not always be the complete answer to the competitiveness challenge but they can become a critical element.

Teams enable the staff member to participate in life at work in a meaningful and dignified way. Teams are not always paradise at work, yet staff members who work in teams generally are more satisfied and for the most part, people like teams! Team members should be encouraged to become heroes, where diversity and differences should be valued. Success and rewards belong to the team.

Teamwork Practices 

            Thomas Kayser describes seven team work practices that link values and behavior in the implementation phase. He describes them as: 

·        Goals  

·        Handling differences  

·        Meeting effectiveness  

·        Making decisions  

·        Continuous improvement  

·        Customer focus  

·        Coordination  

Goals set the short and long-term direction for the team. Depending on the value system of the members and the unit or department, the goals may be defined specifically with exact timelines, outcomes or even cost containment efforts.

Handling differences describes how conflict is dealt with in the team and the organization itself. For instance, some individuals value open discussion and confrontation of differences as a creative tool for problem solving. Others tend to cut off conflict because they do not wish to hear disagreement with their own point of view and see conflict as a threat to imposing their solution on the team.

Meeting effectiveness describes ways that meetings are used by the team to achieve its specific goals. For some, meeting effectiveness means a social get-together where staff members can build teamwork through an informal “touch base” approach. Others see meetings as briefing sessions where assignments are made, roles may change, problems are solved and plans are made. The important aspect is that meeting are timely, have agendas, minutes and measurable outcomes.

Making decisions may be handled in a variety of ways in the team or clinical setting. Depending on the belief system of the team members, decisions may reflect the “politically correct” decision of the unit, department or organization or they may go in the direction of the most creative and optimal use of resources available. Decisions can be made be handled by getting a majority view, or by letting the group come up with something that is pleasing or agreeable to each person.

Continuous improvement describes changes and progress made through examining past experiences and planning for different actions. Feedback, critique, and discussing better ways of doing things are part of the continuous improvement process.

However, these can be implemented very differently by numerous individuals. Some may see continuous improvement as a mechanical set of procedures handed down by the organization or as one-way feedback from boss to staff member. It may be utilized as a communication tool for all involved in going beyond previous achievements or benchmarks.

 Continuous improvement is the constant process of looking objectively at what is being done and defining ways to improve the quality of products or services. Although many people talk the language of continuous improvement, the way it is implemented can differ greatly according to the values and assumptions of the staff members doing the improving.

Customer focus describes the amount and kinds of attention focused on meeting the needs of the customer. Internal customers are those in the same organization to whom your product or service is delivered. Examples could include, the patient, physicians, colleagues or support staff. External customers could include the patients’ family members, third party payors or other organizations.

Coordination describes the way that team members can communicate with one another to align their tasks with team goals and how the team communicates with other teams or departments within the organization. Based on the thoroughness and attention paid to coordination issues, staff members can dramatically increase or decrease effective use of resources.

[Thomas Kayser. Building Team Power  (New York: Irwin Professional Publishers, 1994), 97].