Groups-Teams-Systems

Learning Objectives

1.  Understand groups as complex, open systems.

2.  Apply the concept of open systems to healthcare teams.

3.  Differentiate groups and teams.

4.  Describe levels of systems and how they relate to healthcare teams.

5.  Understand how the diversity inherent to interprofessional healthcare teams contributes to their adaptability and sustainability.

Why Groups?

Humans are wired to be interdependent. We bond together in families, in friendship groups, in sports, neighborhoods, in work groups, and recently in electronic social networks like Facebook. The world has become more complex, and the exponential growth of information that is required to solve problems is not the purview of a single person or a single profession. By recognizing our need to join with others to meet these challenges, we have the opportunity for collective wisdom to emerge. Facilitate the creation of new connections and innovative strategies to ensure the health and stability of the world that we share (Briskin, Erickson, Ott, & Callanan, 2009). Groups that we often refer to as teams have been and will continue to be an essential part of our daily lives. Nowhere is the need for teamwork more relevant than in the healthcare arena.

Diagnosis and intervention require the efforts of a cadre of physician specialists, nurses, therapists, pharmacists, social services personnel, laboratory personnel, information managers, dietitians, transportation workers, home health aides, family caregivers, and patients. Quality health care that is accessible and cost effective requires that the boundaries between these stakeholders are made permeable through consistent collaboration (Grant & Finocchio, 1995). Skills in team building, team membership, and the understanding of group dynamics are foundational and indispensable for the next generation of healthcare leaders. Well-functioning healthcare teams are linked to good morale, reduced staff turnover, and positive patient outcomes (Gittell, 2009; Lawrence, 2002; Torrens, 2010; Woltmann et al., 2008).

CASE STORY: The Importance of Interprofessional Teams

Here, everything is a committee decision. You can have input from multiple perspectives such as nursing, social work, occupational therapy, physical therapy, dietary. Elder problems are highly complicated. Getting other perspectives is helpful. For example, let’s say you can’t transport Mrs. X into the center because she keeps hitting people and is not putting her seatbelt on. What do you do? You need to get different perspectives in order to make a decision. It is like that example of the blind men and the elephant. No single perspective will describe the elephant and there probably is not one single resolution. This requires that team members are confident in what they know, amenable to listen to someone else’s ideas and willing to offer their own ideas.

— Karen J. Nichols, MD, Chief Medical Officer, LIFE (Living Independently for Elders) Practice, School of Nursing, University of Pennsylvania.

What Distinguishes a Group from a Random Collection of People?

There is a unique designation for each of the myriad groupings in the animal kingdom such as school (fish), troop (baboons), murder (crows), gam (whales), and group (humans). No matter what the species, the critical element that is common to all the groupings is that the individual members are interdependent. In the case of humans, “members are linked together in a web of interpersonal relationships. Thus, a group is defined as two or more individuals who are connected to one another by social relationships” (Forsyth, 2006, pp. 2–3). Alderfer (1977) expanded the definition of human groups to include how they are distinguished from and perceived by nonmembers and how they relate to other groups. For the purposes of this text, in order for a group to be distinguished from a random collection of people, its members must have common interests and goals and regular patterns of interaction, exert influence among the members, and work interdependently to achieve goals (Cartright & Zander, 1968; Lewin, 1948; Smith, 2008; Wheelan, 2004).

What Is the Difference Between a Team and a Group?

Team and group are often used interchangeably. However, making the distinction between these two terms can offer valuable insight into how groups work and can facilitate leadership and full participation in productive teams. The term group comes from the French word groupe and from the Italian gruppo, which was borrowed originally from prehistoric Germanic kruppaz, which is translated into a “round mass, lump” (http://www.wordorigins.org/word-origins.com). This is hardly what we think of when we talk about work teams today. The term group is defined by Merriam Webster (2011, group entry) as “A number of individuals assembled together or having some unifying relationship.” The origin of team is defined as a group that engages in more focused intentional action. The word derives from the Middle English term teme and the Old English ton which is to draw or pull (Merriam Webster, 2011). Katzenbach and Smith (1993) describe a team as “a small number of people with complementary skills who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable” (pp. 112).

REFLECTION: Identification of Groups

Rank in order the 10 descriptions below with No. 1 being the most grouplike and No. 10 the least grouplike. Give reasons for your rankings.

The difference between a group and a team can be described on a continuum ( Figure 1-1 ). At one end, group refers to people with something in common and at the other end of the spectrum team refers to people who must work together to get to a common agreed-upon goal or outcome. In this text, the term group will be used in discussions regarding the dynamics, processes, and patterns found in human collectives. Health professionals who are working together to achieve positive patient outcomes will be designated as teams.