Simple tasks, like stocking supply closets in the therapy gyms, requires the processing of limited amounts of information and can be most efficiently carried out in a centralized network like the wheel. A supervisor (hub of the wheel) might send out a directive to the therapy aides. More complex tasks, like developing a comprehensive patient discharge plan, requires the processing of large amounts of complex information and might be most efficiently handled by decentralized networks of communication between the physician, nurse, therapists, and social worker.
Systematic observation of communication and attraction patterns provides insight into morale and levels of satisfaction flow of information, power and influence, cohesiveness, and effectiveness within teams. Communication patterns tend to parallel role, status, and attraction patterns with higher interaction rates being associated with higher status individuals. Lower status individuals are less likely to express their thoughts and feelings in groups with people of higher status. According to the Institutes of Medicine (2003), hierarchical communication patterns are partially responsible for many medical errors. Additional challenges to communication may exist along gender and generational lines (Spector, 2010). However, in teams that continually employ collaborative processes characterized by directness, mutual understanding, and parity of participation, a climate of psychological safety is created along with an effective and efficient exchange of information among all members of the team (Meads & Ashcroft, 2005; Nembhard & Edmondson, 2006.
Healthcare organizations are composed of a diverse network of health professionals, patients, and caregivers who must leverage each other’s expertise by coordinating the exchange and flow of highly complex data. High-quality feedback among interdependent team members yields high levels of cohesion, satisfaction, and performance in teams (Garman, 2010; Gittell, 2009; Goleman, Boyatzis & McKee, 2002). To this end, conscious effort must be applied to developing information exchange strategies that distribute leadership and facilitate accountability and engagement of every member of the team (Gray, 2008; Hammick, Freeth, Copperman, & Goodsman, 2009). Attention to the analysis of social networks and information exchange is crucial to understanding the interpersonal aspects of collaboration around a task, goal, or function (Gray, 2008). Social and interpersonal processes, including team members’ collaborative styles, communication networks, and conflict management and negotiation strategies that emphasize excellence and convey clear goals and expectations are hallmarks of high-functioning teams (Stokols, Hall, Tylor, & Moser, 2008).
The fast-paced healthcare environment places time at a premium. Managers and practitioners find it difficult to justify taking time away from direct patient care in order to attend meetings. However, recent healthcare reforms have linked reimbursement to patient outcomes such as length of stay, readmission rates, and patient satisfaction rather than the number of procedures and services provided. High-functioning healthcare teams have been associated with positive patient outcomes and high retention rates for health professionals. While one could argue that the time spent in meetings is not reimbursable, it would be hard to deny that the improvements in team communication and performance positively affect team sustainability and patient outcomes. Institutions that invest in the development of relationships through formal structures that support frequent and consistent time allocation for team interaction—face-to-face and electronic—will find that gains in patient outcomes will mirror gains in social capital (Drinka & Clark, 2000; Ghaye, 2005; Gittell, 2009; IOM, 2003; Lawrence, 2002; Ratcheva, 2009).
CASE STORY: Check Your Ego at the Door
Any complicated problem lends itself to an interprofessional approach. When we have to do any project we have groups where there are 12 people in different areas on the team (eg: graphics, engineering, administration, nursing) and they talk about the project. Then we break the team into smaller groups of 3 and they all have to come back with their proposed designs and talk about the process of coming to that conclusion. The group, as a whole, reviews all the alternative proposals and pulls them together for their final decision. No one person has the final say—it is not hierarchical. This fosters the idea that everyone has something to contribute. Everyone understands that you have to check your ego at the door. It is not about you. The final decision reflects the goals of the program, not individual goals.
This approach is neither intuitive or the individualistic “American way.” There should be some kind of training so that people learn how to separate their work performance from their own personal needs and work as a team.
—Karen J. Nichols, Chief Medical Officer, University of Pennsylvania LIFE (Living Independently for Elders) Program
REFLECTION: Recognizing and Respecting Diversity
How do you demonstrate respect of diversity in the healthcare team?
How might you use conflict as a path to creative problem solving in the healthcare team?
How do you find shared ground?
How do you influence others on your team?
How do they influence you?
Collaborative, participative environments engender increased knowledge and respect of the health team members for each other. Increased awareness of the expertise available to the team will facilitate the team’s ability to distribute leadership based on the nature of the challenge, or problem and disciplinary boundaries can become points of connection and innovation rather than points of contention (Drinka & Clark, 2000; Gray, 2008; Meads & Ashcroft, 2005; Wheatley, 2006). Leaders, who are willing to trust in the diverse wisdom and singular intent of the collective, actively encourage, and seek participation from all members of the team. Consequently, communication disparities are mitigated and psychologically safe team environments are created. All members are encouraged to contribute, exercise leadership, and be personally engaged and accountable for the team outcomes. (Nembhard & Edmondson, 2006; Wheatley, 2006).