Creating High Performance Health Care Organizations
Through Building Effective Teams
April 2014
Phil Hassen
International Society for Quality in Health Care
Philip Hassen MPH, FCCHSE
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Past President, International Society for Quality in Health Care
President, Canadian Network for International Surgery (2010-2012)
CEO, Canadian Patient Safety Institute (2005-2010)
Deputy Minister of Health, Ontario (2002-2004)
President and CEO, Vancouver Coastal Health Authority (2000-2002)
President and CEO, Providence Health Care (1997-2000)
President and CEO, St. Joseph’s Health Care Centre (1988-1997)
Other Senior Hospital Positions in Calgary and Toronto
Session Purpose
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Increase your knowledge about team building and stages
of team development
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Build your understanding about the constructs of teams
and the challenges in making them effective
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Recognize that effective teams are essential for
 improving quality and service
 providing better care to patients and families
What is Team Building?
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Is a philosophy of job design in which
staff members are viewed as
interdependent members of a team
rather than as individuals who perform
jobs/work
Is built upon a culture which weighs
more heavily on achieving team goals
rather than individual ones
“The whole is
greater than
the sum of
its parts.”
(Aristotle)
1+1 = 3
Team Building
What are the Goals?
Develop both the individual and team
 Increase team members understanding of:
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How the team currently works
How to improve the way the team can work together in the future
How to achieve better results
Improve the team’s ability to collaborate,
communicate, problem solve and plan together
 Increase quality, safety and efficiency in order to
achieve intended team/organizational objectives
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Building Effective Teams
What are some of the challenges?
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Relationships of trust
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Culture of "blame”
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Ineffective leadership
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Members agree on everything too quickly
Building Effective Teams
What are some of the challenges?

Building teams within and
across disciplines
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Increasing complexity of
care delivery
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Lack of common goals
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Competing agendas
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Power struggles/conflicts
What is Team Work?
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Achieving a
common purpose
through
collaboration with
others
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Using the talents of
all members
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Individuals working
together for a
common purpose
create a force
All individuals
contribute
knowledge and
expertise
What are the Characteristics of
Effective Teams?
Work together with specific objectives in mind
 Members place the best interests of the team
above individual interests
 Each team member has an important role and
contributes uniquely to the work
 Use agreed-upon principles and processes such
as decision-making and communication
processes
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What are the Benefits of
Effective Teamwork?
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Aids in decision making
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Improves communication
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Ensures that the work is
accomplished efficiently and
effectively
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Commits to the results
Teamwork
is the best countermeasure for fatigue
11
Common Team Building
Exercises : Objectives
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Build healthy relationships and encourage team
members to get to know each other both
personally and professionally
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Increase Problem-solving Skills
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Strengthen Communications
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Build Trust
What are some examples of
Team Building Exercises?
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Through organized time away from daily work, teams
can focus on the following exercises:
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Building Relationships - Use a sequence of questions and
share in pairs or small groups. For example: share hopes &
fears; share something personal such as a “little known fact” or
“two facts (truths) about themselves and a lie”. Members
introduce themselves to the rest of the group with three "facts"
and others guess which one is a lie.
Problem Solving Simulations – For example, Human
Synergistics, a Canadian company provides a variety of
simulations intended to demonstrate the importance of working
together. In the “Desert Survival Simulation” there is a plane
crash and team members must work together to survive the
elements and make high quality decisions.
What are some examples of
Team Building Exercises?
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Through organized time away from daily work, teams can focus on the
following exercises:
 Self Assessments – For example, use a well regarded
assessment tool such as Myers Briggs Type Indicator (MBTI) to
strengthen relationships and communication. With the information
from the self-assessment team members gain more understanding
about themselves and appreciate differences between people. All
four MBTI types are equal; there is no best “Type” --Introversion/Extroversion; Sensing/Intuition; Thinking/Feeling;
Judging/Perceiving.
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Group Dynamics Observations – To build trust, team members
discuss how they interact with each other. For example, ask
members to observe and record speaking patterns and track who
speaks to whom and observe the flow of information and general
communication patterns.
Team Building Exercises
Risks
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Team members may become cynical of the
leader and/or organization if there are no
meaningful changes or improvements after a
team building exercise
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Events may be viewed as a waste of time and
lead to decreased motivation and productivity if
there is no lasting impact
Fundamentals to Team Success
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Team leadership
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Team members
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Team relationships
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Organizational Culture
Team Leadership
Start with the Fundamentals
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Use Best Leadership Practices described by authors
& researchers Kouzes & Posner
1. Model the Way
2. Inspire Shared Vision
3. Challenge the Process
4. Enable Others to Act
5. Encourage the Heart
Team Leadership
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Assemble competent team
members
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Match the talents of the members
with the work that needs to be done
Establish clear and inspiring team
goals
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Know what the team needs to
accomplish
Believe in the team
Team Leadership
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Encourage standards of excellence
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Develop work approaches, procedures and processes
to ensure work is accomplished efficiently and
effectively
Invest in learning and development and be prepared
to devout time and resources
Build trust and member responsibility and
accountability
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Coach individuals & the team
Give feedback on team & individual performance
Team Leadership
Give Constructive Feedback
Tips
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Be descriptive and specific
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 Avoid generalizations
Focus on behavior and state the
facts
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Avoid exaggerations
Give regular feedback and “catch”
team members doing things right
 Be respectful & not
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threatening
Use active listening
 Check for understanding & be
prepared to discuss options
Examples
Positive Feedback : “I noticed that
you finished the project two days
ahead of schedule and so we have
some flexibility and can catch our
breath. I wonder if you would be
willing to share your approach to
project management with others?”
Critical Feedback: “I noticed that
you were 30 minutes late for clinic
and we are delayed in seeing some
people who were scheduled. We will
not be able to get to the meeting at
the end of the day.” What do you
suggest we do now?
Team Leadership
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Leaders recognize that approaches
need to be flexible and appropriate to
the team’s stage of development
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As we next review the stages of
team development, consider the
implications to the delivery of the
quality and safety of care and service
Stages of Team Development
Overview
Forming
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Storming
Norming
Performing
Stages of Team Development (Tuckman, 1970)
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Describes characteristics and practical approaches for
each stage of development
Stages of Team Development
Forming
Forming
Storming
Norming
Characteristics
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Hesitant participation
Roles and responsibilities are unclear
Exchange of functional information
High dependence on leader for direction
Performing
Team Formation
What is
my role?
How can I
make a unique
contribution?
What are
the goals?
Stages of Team Development
Forming
Forming
Storming
Norming
Performing
Practical Approaches
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Clarify roles & goals
Get acquainted and orient members to the task & people
Establish group agreements
Identify information and resources
Stages of Team Development
Storming
Forming
Storming
Norming
Performing
Characteristics
 Resistance to the task as members realize it is more
difficult than imagined
 Formation of conflicting factions
 Polarization of issues and lack of unity
 Leader may be challenged by team members
Stages of Team Development
Storming
Forming
Storming
Norming
Performing
Practical Approaches
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Use active listening
Be flexible & open-minded
Clarify the issues, share views & feelings respectfully
Apply understanding of different approaches to conflict
Stages of Team Development
Norming
Forming
Storming
Norming
Performing
Characteristics
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Development of cohesive team
Engage in brief fun & playfulness
Co-operation & commitment is high
Acceptance of others & respect for individual
differences
Stages of Team Development
Norming
Forming
Storming
Norming
Performing
Practical Approaches
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Give & receive constructive feedback
Seek & give opinions & perspectives
Focus on problems/issues (not the person)
Leader coaches and enables action
Stages of Group/Team Development
Performing
Forming
Storming
Norming
Characteristics
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Shared vision & values
Strong interdependence of task & relationships
Able to resolve disagreements positively
Act on opportunities for change & improvement
Team has a high degree of autonomy
Performing
Stages of Group/Team Development
Performing
Forming
Storming
Norming
Practical Skills
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Use participative decision making
Apply problem solving approaches
Stay open to new ideas
Delegate, support & encourage
Performing
Summary
Stages of Team Development
Forming
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Clarify roles & goals
Establish team agreements/expectations
Storming
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Address differences & face challenges
Use active listening
Norming
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Give & receive constructive feedback
Focus on problems & issues
Performing
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Use participative decision-making approaches
Support and encourage the team
“Coming together is a beginning.
Keeping together is progress.
Working together…
achieving results
… is success.”
Henry Ford
Cross Functional & Interdisciplinary
Teams
“Interdisciplinary collaboration is
considered key to the visionary
21st century health care paradigm
where teams function effectively
to optimize safety and deliver
high quality care.”
(Institute of Medicine, 2001)
Summary : Capabilities of
Effective Teams
Clarity of Outcomes
 Commitment
 Competence
 Collaboration
 Communication
 Coordination
 Change Oriented
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Cross Functional & Interdisciplinary Teams
Necessary for Large Scale Change
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Usually used for large & complex tasks
 Teams are usually more diverse
 More connected via technology
 Typically composed of more highly educated people
Harder to manage
Often more diversity of views; thus more prone to
disagreement and deadlock
Used selectively, for leading edge and innovative
creative-type changes
Role of leader is more dynamic and thus requires a very
skilled leader
Some Examples
My Experience with Team Building
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Developing senior staff through modified responsibilities to
achieve common mission, vision, values and principles of
operation AND becoming effective team members/leaders
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Improving patient/family care processes by teams
collaborating to reduce steps and hand-offs to enhance
surgical care resulting in improved quality and efficiency
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Addressing major care problems in a complex
community/multi-hospital organization by understanding roles
and enabling team members to gain new perspectives to
improve across the continuum for patient/client care
Cross Functional Teams
Hospital
Community
(Physicians &
Homecare)
The overwhelming majority of untoward events
involve communication failure
 Somebody knows there’s a problem but can’t get
everyone “in the same movie”
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Communication
Patient Safety Practices
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In 2008 Accreditation Canada established Patient Safety
areas and Required Organizational Practices (R.O.P.’s)
as a mandatory element of all accreditation surveys
 R.O.P.: Employ effective mechanisms for transfer of
information at interface points, including shift
changes, discharge, and patient/client movement
between health care services and sectors, and
implement improvements.
 Evidence: Mechanisms for transfer of information are
consistently used (For example: checklists, transfer
forms, huddles).
Do Effective Teams Make a Difference?
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Better communication
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Improved co-ordination and
collaboration
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Increased capability to achieve
goals and make change
Quality and Safety Improve
Final Thoughts: The Road Ahead
“We are on a journey−a journey
that will take enormous efforts to
change. It is clear that
improvement in patient safety and
quality will take time, but the time
for change is now. Our patients,
residents, families and
communities depend on
providers to work as teams to
achieve improved care and
services.”
- Hassen & Dingwall 2008
Selected Resources
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Teamwork and Team Building. Corporate Training Materials.
corporatetrainingmaterials.com
Effective Teamwork in Healthcare: Research & Reality. D. Clements,
M. Dault & A. Priest. Heathcare Papers. Vol. 7. Special Issue
The Wisdom of Teams: Creating the High-Performance Organization.
J.R .Katzenbach & D.K .Smith. (1993)
The Team Handbook. 3rd Edition. P. Schultz, B. Joiner & B. Streibel.
(2003)
The Leadership Challenge. 4th Edition. J. Kouzes & B. Posner (2007)
When Teams Work Best. F. LaFasto & C. Larson. (2001)
Rx for Hospitals. Philip Hassen. (1993)
Creating High Performance
Health Care Organizations
Through Building Effective Teams
~Your Question & Comments Please ~
Thank you!