Team Building Blocks: Norms, Goals, Roles, Communication, Leaders, and Members

Learning Objectives

1.  Analyze how personal values and other motivating forces influence group process and development.

2.  Differentiate personal and group needs.

3.  Analyze the relationship between role assumption, group needs, and goal attainment.

4.  Understand the relationship between communication and learning styles.

5.  Match communication style to the needs of the listener.

6.  Give and receive feedback.

Norms

Group norms are agreed-upon standards of behavior. Norms are the shared explicit or implicit rules that a group uses to identify standards of performance and distinguish appropriate from inappropriate behavior. When group norms are explicit or made explicit, they are commonly referred to as ground rules, agreements, group charters, conditions, or guidelines. However, not all norms are explicit, and the perceptions and concomitant behavior of individuals in groups is profoundly—and often unconsciously—affected by social influence (Sherif, 1936).

FIGURE 3-1

In many progressive organizations, errors are routinely considered teaching moments that can provide opportunities for open discussion, team-based problem solving and continuous organizational improvement. While similar normative responses to errors would elicit the same type of team and organization improvements in health care, the dire consequences of medical mistakes tend to discourage the very discussions that are necessary to prevent their occurrence (O’Daniel & Rosenstein, 2008). This tendency, in combination with differing professional identities, cultures, skills, domains of concern, differences in power, capacity, resources, goals, and accountability actually requires that more attention be paid to constructing organization-wide standards that encourage and reward interaction. In groups where intraprofessional and interprofessional conflict avoidance is the normative behavior, the ensuing misunderstandings and related mistrust tend to limit collaborative or cooperative behavior. Sustainable collaborative environments for interprofessional healthcare teams require a collectively constructed core of prescriptive (do’s) and proscriptive (don’ts) norms or ground rules that inform interaction at intrapersonal, interpersonal, and systems levels (Nash, 2008). Using normative structures that highlight the commonality of patient-centered care while acknowledging the existence of divergent organizational and personal priorities will help team members to understand that personal goals and wishes will often be subordinate to the goals of the group. The acceptance of professional differences and the proactive examination of errors help to create opportunities for increased communication, understanding, and trust and pave the way for collaborative endeavors between disciplines (Doucet, Larouche, & Melchin, 2001).

REFLECTION: Explicit and Implicit Norms in a Group

Identify the norms or rules of your work group.

Interview members of your group and ask them to identify the rules of your group.

How does your response differ from your coworkers? How is it the same?

How does the similarity/difference of perception affect the group’s functioning?

As team members come to expect and deliver full participation, and experience consistent adherence to norms associated with role assumption, communication, and authority, accountability is shared. Trust in each other’s expertise engenders a parity of participation and shared ownership of team outcomes (Ratcheva, 2009).

Goals

Group goals, like norms, are both explicit and implicit. Implicit goals address the developmental processes inherent to group maturation. Focusing on, defining, and committing to the explicit work-related goals of a group is a major key to success. Commonly held goals and the collective efficacy that the achievements of these goals engender are key contributors to group performance (Silver & Bufanio, 1996). Not surprisingly, the ease of goal attainment is related to the level of goal complexity.

In the current healthcare climate, team goals for professionals are complex and require problem solving using multiple types of data and a convergence of multiple areas of expertise and skill sets. To add to that complexity, interdisciplinary team members bring diverse professional values, individual personal goals, and goals influenced by multiple reporting relationships. It is essential that goals are not only clear but constantly revisited.

Groups that continually communicate and become more explicit with regard to the teams goals are more successful in performance. Regardless of the complexities of the team tasks and team membership, if group members are committed to the group goals, the team can succeed. If the commitment to the goals is low then there is little chance of success (Locke, Latham, & Erez, 1988).

Roles

The inherent diversity of teams makes team members’ interaction and relationships key factors in team effectiveness. Researchers have studied groups of people who have a variety of styles in order to ascertain whether a particular complement of individual member styles has any impact on group effectiveness, outcomes, and development. Lewin (1943) observed that behavior is a function of the person and the environment or B = ƒ (P, E). Role assumption in groups is a function of an individual’s preferred style or personality in the context of the complex system of group dynamics that comprises team behavior and effectiveness. Subsequent research examined functional roles in groups. These roles are not necessarily attached to any individual but affect the group’s developmental progress and productivity.

Wheelan (2005) identifies three primary roles that group members assume regardless of their personality types. Task roles are needed to facilitate a project from inception to completion. Socioemotional or maintenance roles contribute to positive atmosphere of the group and foster cohesion. Organizational roles like the leader, recorder or project manager keep the group organized. According to Benne & Sheats (1948), individual roles tend to disrupt group progress and weaken cohesion. Table 3-1 provides examples of each role.

TABLE 3-1 Benne & Sheats’s Group Member Roles

Data from: Benne, K. & Sheats, P. (1948). Functional roles of group members. Journal of Social Issues, 4(2), 41–49.

Belbin (2010) studied teamwork and observed that people in teams tend to assume various team roles, which alternate in their dominance depending upon the developmental stage of the group’s activities. The nine roles where categorized into the following three groups: Action oriented, people oriented, and thought oriented. The action-oriented group includes shaper (SH), implementer (IMP), and completer-finisher (CF) roles. The people-oriented group includes coordinator (CO), team worker (TW), and resource investigator (RI) roles. The thought-oriented group includes plant (PL), monitor-evaluator (ME), and specialist (SP) roles. Each team role is associated with typical behavioral and interpersonal strengths. Belbin also defined characteristic weaknesses that tend to accompany each team role. He called these the allowable weaknesses—areas to be aware of and potentially improve upon (see Table 3-2 ).

A group that is composed of members who assume only those roles related to job completion while ignoring the roles that engage and facilitate member participation runs the risk of diminished cohesion, unmanaged conflict, and apathy. All of these negatively affect the sustainability of good performance and successful outcomes. However, groups that are stymied in a quagmire of conflicting emotions or that are burdened with members who are myopically focused on their personal agenda will never get any work done. These scenarios can negatively impact healthcare teams who routinely deal with issues related to complex medical decision-making and the resultant interventions that will impact a patient’s lifestyle and quality of life. Throughout the life of every group of health professionals, leaders and members must be alert enough to recognize what roles need to be assumed and be flexible enough to assume the roles that will sustain optimum group functioning and consistently positive patient outcomes.

TABLE 3-2 Belbin’s Team Roles

Reproduced with permission from: of Belbin Associates, www.belbin.com.

The attempt to carry out functional group roles, as described, is further complicated by the many other personal and professional roles that are held by members of healthcare teams. While a primary challenge for all team members is to separate personal needs and roles from the team needs and roles, healthcare professionals must also juggle team and discipline-related roles that often conflict at the intraprofessional and interprofessional levels. Perceived roles and responsibilities may diverge based on variations in professional socialization, experience, and organizational expectations. Some professionals—often from the same discipline—may see themselves as primarily responsible for the physiology of care while others believe they need to incorporate the contextual aspects of the illness experience in their treatment planning (Doucet et al., 2001). When faced with budget restrictions in a rehabilitation department, does the physical therapist on the team focus her energy on advocating for the physical therapy equipment budget or facilitating a group discussion regarding prioritizing the needs of the department? The answer depends on how group, member, and contextual issues are negotiated. Each member of the healthcare team is faced with similar decisions about role choices. These choices will affect the culture, development, and performance of the team and ultimately determine the nature of patient outcomes (Freshman, Rubino, & Chassiakos, 2010).

Communication Patterns

In spite of the role differentiation that exists among the disciplines, holistic approaches to health care can engender role overlap, ambiguity, and boundary management challenges (Gray, 2008; Klein, 2010; Nash, 2008). Teams that leverage common ground as well as disciplinary differences through well-constructed and maintained communication strategies are likely to demonstrate sustained high performance and achieve positive patient outcomes (Drinka & Clark, 2000; Gittel, 2009).

The first step in productive communication is to get the attention of the person with whom one is trying to communicate. Team members who understand that communication styles often reflect learning styles and professional orientation will be most successful if they take the time to adjust their communication style to complement the styles of the people with whom they are communicating. People who are action oriented are interested and tend to talk about objectives, results, performance, and productivity. Strategies, organization, and facts tend to pique the attention of those who are process oriented. People who are idea oriented are interested in concept development and innovation, while those with a people orientation focus their communication on values, beliefs, and relationship building (Youker, 1996).

While the previous examples give an indication of how communication is carried out and received, the following model provides some insight into what is communicated. Conscious attention to how and what is communicated allows for more mindful, strategic, and effective communication in teams.

CASE STUDY: Communication Style Match

Members of the interprofessional team on a geriatric unit (physician, nurse, physical therapist, occupational therapist, and social worker) are meeting to discuss patient safety on the unit. During the previous quarter, falls increased by 10%. Analysis of the incident reports indicates that an examination of the fall prevention program that is offered jointly by nursing, physical therapy, and occupational therapy is indicated. The team is meeting with the goal of designing a revised fall prevention program for the unit. The proposed program will need to be based in the most current evidence, ensure the safety of the patients, and be cost effective. All four styles of communication noted previously in this chapter—action oriented (physician and physical therapist), process oriented (occupational therapist), people oriented (social worker), and idea oriented (nurse)—are represented. The leader (in this case, it is the physical therapist) is an identified action-oriented communicator. In preparation for the first meeting, she reviews strategies for adjusting her communication style to the team members and prepares her opening remarks. Her remarks might vary depending on how she perceives the other members of the group. She lists pointers for addressing the others based on their communication styles, along with alternate statements for each type.