TEAM BUILDING RESOURCE GUIDE FOR ONTARIO
PRIMARY HEALTH CARE TEAMS
January 2009
Module 9: Leadership
& Decision Making
Amended December 2010
Revised December 2012
Revised December 2012
1
Purpose of the Guide
This guide is designed to help you and your team better understand your processes and to help
you find ways of strengthening team-based care in your primary health care (PHC)
organization.
The guide is divided into ten standalone modules. Each module contains background
information and theory related to the topic (Part A). Some modules (i.e., 3, 4, 7, and 10) also
contain companion tools and resources to address the topic (Part B).
The modules are not sequential. Choose the module that addresses a specific challenge you
have identified and use the tools that are most applicable to your situation.
The Introduction module contains background information about interdisciplinary teams,
interprofessional care and other types of teams. The Introduction module also includes
acknowledgements and key references.
It is recommended that before beginning any of the suggested activities, both the facilitator or
group leader and the participants take the time to review the whole module. This will help to
ensure that the facilitator and all participants have the information necessary to fully engage in
all discussions.
Each PHC organization should decide who will be responsible for overseeing team development
and addressing any problems that arise. This usually falls to the existing leadership or a newlyestablished quality improvement team/leadership team. From time to time you may also involve
an external consultant to facilitate team building activities, although external facilitation is not
required to use these modules.
Visit our website at http://www.hqontario.ca/quality-improvement/primary-care/tools-resources
for the complete set of modules including:

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



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Introduction
Module 1: What Is an Effective Team?
Module 2: Building a Team
Module 3: Clarifying Roles and Expectations
Module 4: Making the Most of Meetings
Module 5: Evaluating Team Performance
Module 6: Understanding Change
Module 7: Enhancing Collaboration
Module 8: Improving Communication
Module 9: Leadership and Decision-Making
Module 10: Conflict Management

“Primary health care (PHC) organization” refers to a group of providers, allied health professionals and other staff,
etc. within a FHT, CHC, NPLC or other practice model with multiple providers. A number of teams may function within
one organization. In the case of solo-provider practice models, “organization” may refer to an individual provider and
staff.
2
Leadership and Decision-Making
Part A
Leadership Roles in Teams
Effective leaders are credible and communicate regularly and clearly with team members. They
are able to involve all team members in their decisions and plans, and encourage them to
develop their own skills and potential. They are able to effectively change and help others
embrace change. They ensure team members are accountable and complete their assigned
tasks. Leadership can be shared in teams that have been together for some time, with team
members taking responsibility for tasks according to the skills and competencies they possess.
In a team, part of the role of the leader is that of facilitator. As a facilitator, the team leader
guides the team toward goal attainment but does not try to single-handedly direct the team.
Effective leadership focuses both task completion and relationship/process development.
While people often think that leadership is a formally appointed position, leaders can sometimes
emerge in teams. In teams in which no formal leader has been named, leadership tends to
emerge organically when a team member takes on leadership responsibilities or when they
have the subject matter expertise that the team needs. However, even when they have been
appointed, effective leaders share leadership by encouraging team members to take on
leadership roles or formally recognizing those with special subject matter expertise.
It is important to remember that a leader is both the leader of the team, as well as a team
member. In many primary health care teams there is a requirement for equal participation and
responsibility from all team members, and leadership shifts depending on the nature of the
problem to be solved. Although one or more individuals may formally be the group leader, all
team members need to share responsibility for informal and formal leadership. In highlyeffective interprofessional teams, the functions of leadership and membership are viewed as
synonymous. Because all team members are invested in seeing the team achieve its goals and
objectives, each member has the responsibility to help the team progress.
Functions of Leadership
Effective leaders help a team:

Decide on its purpose and goals

Establish effective work processes so the team does not become trapped by inefficient
methods of problem solving and decision-making

Develop an awareness of its own resources and how to use them best

Evaluate its progress and development

Be open to new and different ideas while avoiding conflict

Learn from its failures and frustrations as well as from its success
3
Activities of the Leader
The table below outlines some important, leader-specific, activities.
Activity
Description
Effective team leaders guide a team in the completion of its tasks.
Leadership activities that fall into the category of task facilitation include:


Task Facilitation






Information-seeking
Information-sharing
Explaining
Coordinating
Monitoring
Process-analyzing
Summarizing
Resource acquisition
The team leader also must facilitate the development of positive
relationships between team members. Leadership activities that fall into
the category of relationship development include:
Relationship/process
Development







Supporting
Harmonizing
Tension-relieving
Energizing
Developing
Facilitating
Processing
Team leaders must also be aware behaviours that may hinder the development of an effective
team. These ineffective (or blocking) behaviours include:

Overanalyzing

Generalizing

Fault-finding

Premature decision-making

Presenting opinions as facts

Rejecting the ideas of others

Pulling rank

Dominating

Stalling
4
Decision-Making
A successful interprofessional ensures that all team members are involved in critical decisions.
This does not mean that all team members must reach a consensus. Occasionally there will be
some decisions that are influenced by external factors and are not open for discussion. In some
situations, team members are given a few options, while at others they may be invited to invent
the options themselves. However, in some cases they may simply given information about why
a decision has been made. Make it clear whether an issue is being brought to the team in order
to make a decision, for consultation, simply for information. Teamwork is enhanced when the
criteria and process for making decisions is explicit and transparent. When everyone in a team
shares a vision and goals and is involved in the decision making process, the team will be more
supportive of one another and work more efficiently together.
However, it can be complicated at times to involve everyone in all decisions. It is important to
consider not only the role of each individual in the team, but also their culture and gender as
both have an effect on how people engage in decision-making. Being aware of these
differences when making decisions can help ensure the full and equal participation of everyone
on the team.
Guidelines for Effective Decisions
Effective Decision Making Process for Teams
Teams are particularly effective at problem solving because they are composed of people with
complementary and varying skills. These skills allow team members to examine issues from
various angles and see the implications of their decisions from a variety of perspectives. Teams
make decisions using problem-solving techniques. This section addresses processes that can
help teams solve problems and make “good” decisions.
To effectively come to a team decision, the following step-by-step approach can be used.1
1. Recognize the Problem - Teams must see and recognize that a problem exists and that a
decision needs to be made to remedy the problem. While this step appears to be
elementary, sometimes teams do not recognize that there is an issue that needs to be
addressed because of groupthink.
2. Define the Problem - In this stage, teams must map out the issue at hand. Teams should:

State how, when and where members became aware of the problem

Explore different ways of viewing the problem – doing so can lead to an improved
understanding of the “core” problem

Challenge any assumptions that are made about the problem to ensure that the team
fully sees the “real” issue at hand

Establish deadlines
3. Gather Information. Once the problem has been defined, teams need to gather information
relevant to the problem. This is in order to 1) to verify that the problem was defined correctly
in Step 2; and 2) aid in the development alternative solutions.
1
Lafferty, J.T. (1988). Subarctic survival situation: Leader’s guide. Plymouth, MI: Human Synergistics.
5
4. Develop Alternative Solutions - While it can be easy for teams to “jump on” and accept the
first solution that is proposed, teams that are effective problem solvers take the time to
explore several potential solutions. Some ways to generate alternative solutions include:
a. Brainstorming - Teams come up with as many ways as possible to solve the problem
at hand. While brainstorming can help generate creative solutions to problems, there
a few guidelines that can help make it effective:

No criticism of any ideas during the brainstorming phase

All ideas, no matter how silly, get recorded

Get past the sillies – sometimes very creative, viable solutions come after
people have made what appear to be “silly” suggestions.
b. Ask Questions - Network with both internal and external colleagues to get their ideas
and suggestions.
c. Explore - Read journals and books, go to networking functions and attend
conferences that cover similar issues. Be prepared to go outside of the health care
sector. Other industries may have faced similar issues and their solutions can
provide valuable insight.
5. Select the Best Alternative - Once all potential solutions have been considered, the team
needs to determine the solution that best addresses the problem. For this to be effective,
both rational and human elements, as well as the implications for the team need to be
considered.
a. Determine the Desired End State - Teams need to clearly define what success looks
like.
b. Evaluate Alternatives against the Desired State - Here, teams discuss the merits of
each alternative solution and the extent to which each of these alternatives can move
the team toward the desired end state. Some teams find it helpful to rate each
alternative on a scale of 1 to 5 where 1 is low and 5 is high.
c. Discuss Potential Adverse Consequences of Each Alternative - Here, teams need to
discuss the potential downsides of each option. To facilitate an objective examination
of adverse consequences, some teams use a mathematical formula. Specifically,
they assess the severity of adverse consequences in terms of the formula:
Adverse Consequences = Likelihood x Severity
Likelihood = the likelihood of the adverse consequence occurring (using a 5-point
scale where 5 is high). Severity = severity if the consequence does occur (using a 5point scale where 5 is high).
6
Personal Skills & Team Decision-Making
It is important to consider personal skills that may affect decision-making. These personal skills
are described in the table below.
Skill
Description
Actively requires team members to:

Active Listening



Pay attention to team discussion and anticipate where the
conversation is going
Objectively weigh what’s been said
Try to understand what the other person is saying
Review and summarize what has been said
People tend to focus on what they perceive to be right and wrong. Being
supportive requires that you:
Supporting Each
Other’s Ideas




Comfort when
Presenting
Differing Views
Participation
Implementing the
Best Alternative
Evaluating the
Outcome
Assume that others have valid points
Point out the useful aspects of what has been said
Build on these useful points
Avoid unnecessary criticism
Groupthink is a significant concern for teams. To effectively present
differing views and avoid groupthink make sure that you:



Clearly state differing views when they are valid
Focus on the reasons for the differences
Treat differences as a source of ideas rather than a source of
interpersonal conflict
To take advantage of the complementary skills in a team, all team
members must participate. Sometimes, one or two people dominate team
decision-making processes because of their interpersonal style (i.e.,
extraverted vs. introverted) or their status/position. This can have a
negative effect when a team is trying to make group decisions.
Once a solution to the problem at hand has been chosen, the team
needs to implement its decision. This requires planning effectively and
communicating the decision to all stakeholders that may be affected by
the decision.
Remember that team building is a learning process. It is critical that the
team examine whether their plans were executed in an effective way and
resulted in positive outcomes.
7
Strategies for Reaching a Decision
Decisions can be reached by teams in a number of ways.2 Eight effective strategies are
described below.
1. Command Decisions - The team lead or expert makes the decision. This is most effective
when a quick decision needs to be made, in which case it is critical that the leader share the
decision and the rationale with the rest of the team. The downside of this strategy is that it
may not lead to the “best” decision, as it was not the result of a consensus.
2. Individual Consultation - The team lead makes a decision after consulting with a team
member. The advantage of this strategy is the minimal time required, since only one person
on the team is consulted. The disadvantages are that there is no opportunity for group
brainstorming and the lack of buy-in from team members who were not consulted can be a
problem. The leader should explain how the decision was reached and how the team as a
whole is affected. If possible, the leader should ask the individual that they consult with to
meet with the larger team before their consultation so that there is a degree of consensus on
the issue.
3. Team Consultation - Team lead makes the decision only after the entire group has been
consulted. This technique can requires group input, buy-in and commitment. However, this
process will take more time and team members can become frustrated if they were
consulted and the final decision appears to contradict the views expressed during the
consultation process. It is important for the team lead to explain need for the decision, the
type of feedback sought, how this information will be used, and the fact the leader will make
the ultimate decision. Should the leader’s decision appear to contradict the views expressed
by the team, they should go back to the team and express the rationale for the decision.
4. Compromise - A negotiated approach when there are two or more distinct options and
members are strongly polarized. A compromise is reached that incorporates ideas from both
sides. Everyone wins a few of their favourite points, but also loses a few items they liked.
The outcome is something that no one is totally satisfied with. In compromises, no one feels
that they got what they wanted, so the emotional reaction is often, “it’s not really what I
wanted but I am going to have to live with it.”
5. Multi-Voting - This is a priority-setting tool that is useful in making decisions when the group
has a range of options before them and they rank the options based on a set of preestablished criteria.
6. Majority Rule - This is a decision-making process where all team members, including the
leader, have an equal say in the final decision. It involves a vote where the option that gets
the most votes is implemented. An advantage of this technique is that it is quick and easily
understood. The disadvantage is that people’s rationales may not be heard if the vote is not
accompanied by a full discussion. The key here is to ensure that all team members
understand the rules of voting and the alternatives being voted on.
7. 100% Agreement (Unanimous Agreement) - All team members have equal say in the
decision. In this case, all must agree on the final decision. Disadvantages include the time
needed to make the decision and the fact that it may not be possible to ensure all members
2
Association of Ontario Health Centres (2007). Building Better Teams: A Toolkit for Strengthening Teamwork in
Community Health Centres Association of Ontario Health Centres Toronto.
8
completely agree with one option. As such, this technique should only be used on rare
occasions.
8. Consensus - All team members have equal say in the final decision. This does not mean
that the final decision is each team member’s first choice; rather, they need to be able to
support the decision and live with it. Advantages of this technique are that it often ensures
commitment and a higher-quality decision that all members can support. Thus, this is often
the preferred problem-solving/decision-making technique for teams. The downside is the
time needed to make the decision.
Methods for Building Consensus
We will now examine three elements of the various methods for building consensus: guidelines
that can be used during the decision-making process; signs that can be used to recognize when
the team may have reached a consensus; and methods of testing for consensus.
Consensus Guidelines
The following guidelines can be used by teams and team leaders to help reach a consensus:3
1. Contribute to the discussion rather than defend your position
2. Seek out “win-win” solutions that satisfy the needs/concerns of all team members
3. Use active listening skills and summarize what others are saying
4. Seek the rationale for a person’s opinion
5. Avoid voting or averaging to get an answer
6. Don’t be afraid to disagree - address your differences in terms of the idea being
presented, not the person.
Signs of Consensus
During team discussions it can be tough to see if the team is at consensus. If you can answer
“yes” to the following questions, your team may have reached a consensus.
1. Has each person been honestly listened to?
2. Have team members listened and understood the views of others?
3. Can each person summarize each option?
4. Do team members seem supportive of the option being discussed?
5. Has it been a while since any new opinions/views were presented?
3
Biech E. (Ed) (2001). The Pfeiffer Book of Successful Team-Building Tools: Best of the Annuals, JosseyBass/Pfeiffer, San Francisco.
9
Testing for Consensus
Once you sense that the team is at consensus, you need to test for it. Two different tests are
described in the table below.
Test Types
Description
The following five “L” words are placed on a flipchart. Each team member
uses a marker to place an “X” under the “L” word that best represents how
they feel about the option being discussed.

The Five “L”
Straw Pole




Loathe
Lament
Live
Like
Love
Note: if any team members indicate loathe or lament, the team does not have
consensus. If all team members indicate live, like or love, you have
consensus.
This visual technique consists of people using one of the following gestures
when the question “Do we have consensus” is called:
Thumbs Up
a. Thumbs Up - This “hitch-hiking” sign is used when the team member
is in full agreement with the alternative – it is their preferred choice.
b. Thumbs Neutral. -This sign is when the hand is in the same “hitchhiker” shape but the thumb points to the left. This means that the
person can support and live with the alternative, but it is not their
preferred choice.
c. Thumbs down. Here the thumb is pointed to the ground to show that
the person can neither live with nor support the alternative.
Note: any “thumbs down” means that there is no consensus. If all parties have
“thumbs up” or “thumbs neutral” – you have consensus.
There may be times when you are near consensus and only a few people are not yet in
agreement. While these people should not be made to feel bad or forced into consensus, the
following questions may help the team reach consensus:
1. There seems to be a number of people who support this option. What would it take for
everyone to support it?
2. It is important that we hear from all team members on this option. For those that do not
support this option, what would you need for this option to be acceptable to you?
10
Decision-Making Checklist
There are a number of behaviours that can act as barriers to effective decision-making. For
example, people may put less effort into the group process if responsibility for the work is
shared. Also, teams can make poor decisions through habitual processes and pressures to
conform.
Use this checklist to help overcome these barriers to effective team decision-making.
Team Culture:





Have we created a safe atmosphere so team members feel able to contribute?
Do we need to work in subgroups to overcome groupthink?
Do we have a culture of listening?
Does the team have a strong group identity?
Is the task meaningful to the group?
After a decision has been made:














Have we generated a sufficient quantity and range of ideas?
Did we take sufficient time to explore options?
Have we gathered everyone’s thoughts and suggestions?
Have we discussed any doubts?
Have we fully considered all new information?
Are there any sources of new information we have not yet considered?
Have we asked for information from others outside the team?
Do we need expert opinion?
Have we reappraised our original objectives?
Have we fully considered the consequences of our decision?
Do we have contingency plans?
Have we identified the weaknesses in our decision?
Is there individual accountability for the work to be done?
Is there equality in the workload of each team member?
Part B of this module contains the following exercises and activities,
which address the themes we have already discussed.
9.1 - Potential for Team Leadership
9.2 - Deciding How to Decide
9.3 - Making Decisions
9.4 - Brainstorming: The Paperclip Exercise
11
Part B
Leadership and Decision-Making
Activity 9.1 - Potential for Team Leadership
Preparation:

Review Part A, Module 9
Time Required:

15 minutes
Materials:

Handouts

Pens
This activity requires the following handout for participants:
 Leadership Confidence Survey
Steps:

Ask each individual to complete the Leadership Confidence Survey to help each
team member identify where they may be able to play a leadership role within the
team.
12
Activity 9.1 - Potential for Team Leadership
Leadership Confidence Survey
The following statements describe abilities related to team building. How confident are you
in your ability in these areas? Please rate your confidence in these areas on a scale of 1
(Low) to 5 (High).
Confidence
Ability
Low
High
1. Leading an interprofessional team in a
primary health care setting.
1
2
3
4
5
2. Identifying the key characteristics of effective
interprofessional teamwork in a primary health
care setting.
1
2
3
4
5
3. Recognizing the factors that can enable or
inhibit interprofessional teamwork in a primary
health care setting.
1
2
3
4
5
4. Identifying potential overlap in roles, skills and
expertise between professions.
1
2
3
4
5
5. Determining the contributions that other
health care professions can make to
interprofessional patient/client care.
1
2
3
4
5
6. Engaging in shared leadership and decisionmaking as a member an interprofessional
team in a primary health care setting
1
2
3
4
5
7. Formulating an interprofessional care plan in
collaboration with other health care
professionals.
1
2
3
4
5
8. Conducting an effective interprofessional
team meeting.
1
2
3
4
5
9. Leading a consensus-building process with
other health professionals.
1
2
3
4
5
10. Identifying means for managing change in an
interprofessional teamwork environment.
1
2
3
4
5
Are there other leadership abilities which you would like to enhance or develop?
13
Activity 9.2 - Deciding How to Decide
Preparation:

Review Part A, Module 9
Time Required:

30-35 minutes
Materials:

Handouts

Pens
This activity requires the following handouts for participants:



Participant Worksheet
Effective Team Decision-Making
Strategies for Reaching a Decision
Steps:
1. Ask the team members to recall a decision-making process that they were unhappy
with (the example can be drawn from a current or a previous work situation, or from a
personal experience).
2. Ask for a few volunteers to share their example and discuss with the group.
3. Review the way the decision was made in relation to the information presented in
Effective Team Decision-Making handout. Ask the team:
• What were the elements of the process that made it unsatisfactory?
4. Review the Strategies for Reaching a Decision handout. Ask team members to come
up with answers to the following questions regarding each of the options for the
same decision discussed above.
•
What might be the pros and cons of each method?
•
When would you use each method?
•
How would power imbalances within a team affect this type of decisionmaking?
•
If possible, provide examples based on your teamwork and/or recent
decisions.
14
Activity 9.2 - Deciding How to Decide
Participant Worksheet
Step 1: Identify a decision-making process (personal or professional) from the past with which
you were unhappy. Describe this situation:
Step 2: Read Effective Team Decision-Making handout.
o
How do these suggested decision-making processes differ from the way the decision
was made in your situation?
o
What were the elements of the process that made it unsatisfactory?
Step 3: Review the Strategies for Reaching a Decision handout. Consider how the strategies
from this handout would have influenced the situation you described above:
o
What might be the pros and cons of each method?
o
When would you use each method?
o
How would power imbalances within a team affect this type of decision- making?
o
If possible, provide examples based on your teamwork and/or recent decisions.
15
Activity 9.2 - Deciding How to Decide
Effective Team Decision-Making
Teams are particularly effective at problem solving because they are composed of people with
complementary and varying skills. These skills allow team members to examine issues from
various angles and see the implications of their decisions from a variety of perspectives. Teams
make decisions using problem-solving techniques. This section addresses processes that can
help teams solve problems and make “good” decisions.
To effectively come to a team decision, the following step-by-step approach can be used.4
1. Recognize the Problem - Teams must see and recognize that a problem exists and that a
decision needs to be made to remedy the problem. While this step appears to be
elementary, sometimes teams do not recognize that there is an issue that needs to be
addressed because of groupthink.
2. Define the Problem - In this stage, teams must map out the issue at hand. Teams should:

State how, when and where members became aware of the problem

Explore different ways of viewing the problem – doing so can lead to an improved
understanding of the “core” problem

Challenge any assumptions that are made about the problem to ensure that the team
fully sees the “real” issue at hand

Establish deadlines
3. Gather Information. Once the problem has been defined, teams need to gather information
relevant to the problem. This is in order to 1) to verify that the problem was defined correctly
in Step 2; and 2) aid in the development alternative solutions.
4. Develop Alternative Solutions - While it can be easy for teams to “jump on” and accept the
first solution that is proposed, teams that are effective problem solvers take the time to
explore several potential solutions. Some ways to generate alternative solutions include:
a. Brainstorming - Teams come up with as many ways as possible to solve the problem
at hand. While brainstorming can help generate creative solutions to problems, there
a few guidelines that can help make it effective:
a. No criticism of any ideas during the brainstorming phase
b. All ideas, no matter how silly, get recorded
c. Get past the sillies – sometimes very creative, viable solutions come after
people have made what appear to be “silly” suggestions.
b. Ask Questions - Network with both internal and external colleagues to get their ideas
and suggestions.
c. Explore - Read journals and books, go to networking functions and attend
conferences that cover similar issues. Be prepared to go outside of the health care
sector. Other industries may have faced similar issues and their solutions can
provide valuable insight.
4
Lafferty, J.T. (1988). Subarctic survival situation: Leader’s guide. Plymouth, MI: Human Synergistics.
16
5. Select the Best Alternative - Once all potential solutions have been considered, the team
needs to determine the solution that best addresses the problem. For this to be effective,
both rational and human elements, as well as the implications for the team need to be
considered.
a. Determine the Desired End State - Teams need to clearly define what success looks
like.
b. Evaluate Alternatives against the Desired State - Here, teams discuss the merits of
each alternative solution and the extent to which each of these alternatives can move
the team toward the desired end state. Some teams find it helpful to rate each
alternative on a scale of 1 to 5 where 1 is low and 5 is high.
c. Discuss Potential Adverse Consequences of Each Alternative - Here, teams need to
discuss the potential downsides of each option. To facilitate an objective examination
of adverse consequences, some teams use a mathematical formula. Specifically,
they assess the severity of adverse consequences in terms of the formula:
Adverse Consequences = Likelihood x Severity
Likelihood = the likelihood of the adverse consequence occurring (using a 5-point scale
where 5 is high). Severity = severity if the consequence does occur (using a 5-point
scale where 5 is high).
Personal Skills & Team Decision-Making
It is important to consider personal skills that may affect decision-making. These personal skills
are described in the table below.
Skill
Description
Actively requires team members to:

Active Listening



Pay attention to team discussion and anticipate where the
conversation is going
Objectively weigh what’s been said
Try to understand what the other person is saying
Review and summarize what has been said
People tend to focus on what they perceive to be right and wrong. Being
supportive requires that you:
Supporting Each
Other’s Ideas




Comfort when
Presenting
Differing Views
Assume that others have valid points
Point out the useful aspects of what has been said
Build on these useful points
Avoid unnecessary criticism
Groupthink is a significant concern for teams. To effectively present
differing views and avoid groupthink make sure that you:


Clearly state differing views when they are valid
Focus on the reasons for the differences
17
Skill
Description

Participation
Implementing the
Best Alternative
Evaluating the
Outcome
Treat differences as a source of ideas rather than a source of
interpersonal conflict
To take advantage of the complementary skills in a team, all team
members must participate. Sometimes, one or two people dominate team
decision-making processes because of their interpersonal style (i.e.,
extraverted vs. introverted) or their status/position. This can have a
negative effect when a team is trying to make group decisions.
Once a solution to the problem at hand has been chosen, the team
needs to implement its decision. This requires planning effectively and
communicating the decision to all stakeholders that may be affected by
the decision.
Remember that team building is a learning process. It is critical that the
team examine whether their plans were executed in an effective way and
resulted in positive outcomes.
18
Activity 9.2: Deciding How to Decide
Strategies for Reaching a Decision
Decisions can be reached by teams in a number of ways.5 Eight effective strategies are
described below.
1. Command Decisions - The team lead or expert makes the decision. This is most
effective when a quick decision needs to be made, in which case it is critical that the
leader share the decision and the rationale with the rest of the team. The downside of
this strategy is that it may not lead to the “best” decision, as it was not the result of a
consensus.
2. Individual Consultation - The team lead makes a decision after consulting with a team
member. The advantage of this strategy is the minimal time required, since only one
person on the team is consulted. The disadvantages are that there is no opportunity for
group brainstorming and the lack of buy-in from team members who were not consulted
can be a problem. The leader should explain how the decision was reached and how the
team as a whole is affected. If possible, the leader should ask the individual that they
consult with to meet with the larger team before their consultation so that there is a
degree of consensus on the issue.
3. Team Consultation - Team lead makes the decision only after the entire group has
been consulted. This technique can requires group input, buy-in and commitment.
However, this process will take more time and team members can become frustrated if
they were consulted and the final decision appears to contradict the views expressed
during the consultation process. It is important for the team lead to explain need for the
decision, the type of feedback sought, how this information will be used, and the fact the
leader will make the ultimate decision. Should the leader’s decision appear to contradict
the views expressed by the team, they should go back to the team and express the
rationale for the decision.
4. Compromise - A negotiated approach when there are two or more distinct options and
members are strongly polarized. A compromise is reached that incorporates ideas from
both sides. Everyone wins a few of their favourite points, but also loses a few items they
liked. The outcome is something that no one is totally satisfied with. In compromises, no
one feels that they got what they wanted, so the emotional reaction is often, “it’s not
really what I wanted but I am going to have to live with it.”
5. Multi-Voting - This is a priority-setting tool that is useful in making decisions when the
group has a range of options before them and they rank the options based on a set of
pre-established criteria.
6. Majority Rule - This is a decision-making process where all team members, including
the leader, have an equal say in the final decision. It involves a vote where the option
that gets the most votes is implemented. An advantage of this technique is that it is quick
and easily understood. The disadvantage is that people’s rationales may not be heard if
5
Association of Ontario Health Centres (2007). Building Better Teams: A Toolkit for Strengthening Teamwork in
Community Health Centres Association of Ontario Health Centres Toronto.
19
the vote is not accompanied by a full discussion. The key here is to ensure that all team
members understand the rules of voting and the alternatives being voted on.
7. 100% Agreement (Unanimous Agreement) - All team members have equal say in the
decision. In this case, all must agree on the final decision. Disadvantages include the
time needed to make the decision and the fact that it may not be possible to ensure all
members completely agree with one option. As such, this technique should only be used
on rare occasions.
8. Consensus - All team members have equal say in the final decision. This does not
mean that the final decision is each team member’s first choice; rather, they need to be
able to support the decision and live with it. Advantages of this technique are that it often
ensures commitment and a higher-quality decision that all members can support. Thus,
this is often the preferred problem-solving/decision-making technique for teams. The
downside is the time needed to make the decision.
20
Activity 9.3 - Making Decisions
Preparation:

Review Part A, Module 9
Time Required:

30-35 minutes
Materials:

Handouts

Pens
This activity requires the following handouts for participants:
 Participant Worksheet
 Effective Team Decision-Making Process
 Strategies for Reaching a Decision
 Methods for Reaching Consensus
Steps:
1. If necessary, divide the larger group so that there are groups of five to six people.
Identify two “observers” to be part of each group.
2. After reviewing the three handouts listed above, ask the teams if there are others
things they would like to add, based on their experiences.
3. Provide each decision-making group with a scenario they are likely to encounter or a
decision that is commonly made in your office environment. Set a time limit, so that it
mirrors your actual experience.
4. At the end of the allotted time:
o
Ask the participants to comment on the group’s processes.
o
Ask observers to give feedback to the group and to individual members on
what they observed. This exercise can be replicated with another problem
with the observers and participants switching roles.
5. Facilitate a closing discussion that generates a list of the changes that you could now
use in decision-making.
21
Activity 9.3 - Making Decisions
Participant Worksheet
Step 1: Review the following handouts with your team members:
 Effective Team Decision-Making Process
 Strategies for Reaching a Decision
 Methods for Reaching Consensus
Based on your experiences, are there others things you would add to any of them?
Step 2: With your team, discuss the decision-making scenario provided by your facilitator.
Step 3: Comment on the decision-making processes of your group. Do you have any feedback
to give to your group or individual members of your group about the process that you used to
reach a decision?
Step 4: Generate a list of the changes that you could now use in your decision-making
processes.
22
Activity 9.3 - Making Decisions
Effective Team Decision-Making
Teams are particularly effective at problem solving because they are composed of people with
complementary and varying skills. These skills allow team members to examine issues from
various angles and see the implications of their decisions from a variety of perspectives. Teams
make decisions using problem-solving techniques. This section addresses processes that can
help teams solve problems and make “good” decisions.
To effectively come to a team decision, the following step-by-step approach can be used.6
1. Recognize the Problem - Teams must see and recognize that a problem exists and that a
decision needs to be made to remedy the problem. While this step appears to be
elementary, sometimes teams do not recognize that there is an issue that needs to be
addressed because of groupthink.
2. Define the Problem - In this stage, teams must map out the issue at hand. Teams should:

State how, when and where members became aware of the problem

Explore different ways of viewing the problem – doing so can lead to an improved
understanding of the “core” problem

Challenge any assumptions that are made about the problem to ensure that the team
fully sees the “real” issue at hand

Establish deadlines
3. Gather Information. Once the problem has been defined, teams need to gather information
relevant to the problem. This is in order to 1) to verify that the problem was defined correctly
in Step 2; and 2) aid in the development alternative solutions.
4. Develop Alternative Solutions - While it can be easy for teams to “jump on” and accept the
first solution that is proposed, teams that are effective problem solvers take the time to
explore several potential solutions. Some ways to generate alternative solutions include:
a. Brainstorming - Teams come up with as many ways as possible to solve the problem
at hand. While brainstorming can help generate creative solutions to problems, there
a few guidelines that can help make it effective:
a. No criticism of any ideas during the brainstorming phase
b. All ideas, no matter how silly, get recorded
c. Get past the sillies – sometimes very creative, viable solutions come after
people have made what appear to be “silly” suggestions.
b. Ask Questions - Network with both internal and external colleagues to get their ideas
and suggestions.
c. Explore - Read journals and books, go to networking functions and attend
conferences that cover similar issues. Be prepared to go outside of the health care
sector. Other industries may have faced similar issues and their solutions can
provide valuable insight.
6
Lafferty, J.T. (1988). Subarctic survival situation: Leader’s guide. Plymouth, MI: Human Synergistics.
23
5. Select the Best Alternative - Once all potential solutions have been considered, the team
needs to determine the solution that best addresses the problem. For this to be effective,
both rational and human elements, as well as the implications for the team need to be
considered.
a. Determine the Desired End State - Teams need to clearly define what success looks
like.
b. Evaluate Alternatives against the Desired State - Here, teams discuss the merits of
each alternative solution and the extent to which each of these alternatives can move
the team toward the desired end state. Some teams find it helpful to rate each
alternative on a scale of 1 to 5 where 1 is low and 5 is high.
c. Discuss Potential Adverse Consequences of Each Alternative - Here, teams need to
discuss the potential downsides of each option. To facilitate an objective examination
of adverse consequences, some teams use a mathematical formula. Specifically,
they assess the severity of adverse consequences in terms of the formula:
Adverse Consequences = Likelihood x Severity
Likelihood = the likelihood of the adverse consequence occurring (using a 5-point
scale where 5 is high). Severity = severity if the consequence does occur (using a 5point scale where 5 is high).
Personal Skills & Team Decision-Making
It is important to consider personal skills that may affect decision-making. These personal skills
are described in the table below.
Skill
Description
Actively requires team members to:

Active Listening



Pay attention to team discussion and anticipate where the
conversation is going
Objectively weigh what’s been said
Try to understand what the other person is saying
Review and summarize what has been said
People tend to focus on what they perceive to be right and wrong. Being
supportive requires that you:
Supporting Each
Other’s Ideas




Comfort when
Presenting
Differing Views
Assume that others have valid points
Point out the useful aspects of what has been said
Build on these useful points
Avoid unnecessary criticism
Groupthink is a significant concern for teams. To effectively present
differing views and avoid groupthink make sure that you:

Clearly state differing views when they are valid
24
Skill
Description


Participation
Implementing the
Best Alternative
Evaluating the
Outcome
Focus on the reasons for the differences
Treat differences as a source of ideas rather than a source of
interpersonal conflict
To take advantage of the complementary skills in a team, all team
members must participate. Sometimes, one or two people dominate team
decision-making processes because of their interpersonal style (i.e.,
extraverted vs. introverted) or their status/position. This can have a
negative effect when a team is trying to make group decisions.
Once a solution to the problem at hand has been chosen, the team
needs to implement its decision. This requires planning effectively and
communicating the decision to all stakeholders that may be affected by
the decision.
Remember that team building is a learning process. It is critical that the
team examine whether their plans were executed in an effective way and
resulted in positive outcomes.
25
Activity 9.3 - Making Decisions
Strategies for Reaching a Decision
Decisions can be reached by teams in a number of ways.7 Eight effective strategies are
described below.
1. Command Decisions - The team lead or expert makes the decision. This is most effective
when a quick decision needs to be made, in which case it is critical that the leader share the
decision and the rationale with the rest of the team. The downside of this strategy is that it
may not lead to the “best” decision, as it was not the result of a consensus.
2. Individual Consultation - The team lead makes a decision after consulting with a team
member. The advantage of this strategy is the minimal time required, since only one person
on the team is consulted. The disadvantages are that there is no opportunity for group
brainstorming and the lack of buy-in from team members who were not consulted can be a
problem. The leader should explain how the decision was reached and how the team as a
whole is affected. If possible, the leader should ask the individual that they consult with to
meet with the larger team before their consultation so that there is a degree of consensus on
the issue.
3. Team Consultation - Team lead makes the decision only after the entire group has been
consulted. This technique can requires group input, buy-in and commitment. However, this
process will take more time and team members can become frustrated if they were
consulted and the final decision appears to contradict the views expressed during the
consultation process. It is important for the team lead to explain need for the decision, the
type of feedback sought, how this information will be used, and the fact the leader will make
the ultimate decision. Should the leader’s decision appear to contradict the views expressed
by the team, they should go back to the team and express the rationale for the decision.
4. Compromise - A negotiated approach when there are two or more distinct options and
members are strongly polarized. A compromise is reached that incorporates ideas from both
sides. Everyone wins a few of their favourite points, but also loses a few items they liked.
The outcome is something that no one is totally satisfied with. In compromises, no one feels
that they got what they wanted, so the emotional reaction is often, “it’s not really what I
wanted but I am going to have to live with it.”
5. Multi-Voting - This is a priority-setting tool that is useful in making decisions when the group
has a range of options before them and they rank the options based on a set of preestablished criteria.
6. Majority Rule - This is a decision-making process where all team members, including the
leader, have an equal say in the final decision. It involves a vote where the option that gets
the most votes is implemented. An advantage of this technique is that it is quick and easily
understood. The disadvantage is that people’s rationales may not be heard if the vote is not
accompanied by a full discussion. The key here is to ensure that all team members
understand the rules of voting and the alternatives being voted on.
7
Association of Ontario Health Centres (2007). Building Better Teams: A Toolkit for Strengthening Teamwork in
Community Health Centres Association of Ontario Health Centres Toronto.
26
7. 100% Agreement (Unanimous Agreement) - All team members have equal say in the
decision. In this case, all must agree on the final decision. Disadvantages include the time
needed to make the decision and the fact that it may not be possible to ensure all members
completely agree with one option. As such, this technique should only be used on rare
occasions.
8. Consensus - All team members have equal say in the final decision. This does not mean
that the final decision is each team member’s first choice; rather, they need to be able to
support the decision and live with it. Advantages of this technique are that it often ensures
commitment and a higher-quality decision that all members can support. Thus, this is often
the preferred problem-solving/decision-making technique for teams. The downside is the
time needed to make the decision.
27
Activity 9.3 - Making Decisions
Methods of Building Consensus
We will now examine three elements of the various methods for building consensus:
guidelines that can be used during the decision-making process; signs that can be used to
recognize when the team may have reached a consensus; and methods of testing for
consensus.
Consensus Guidelines
The following guidelines can be used by teams and team leaders to help reach a
consensus:8
1. Contribute to the discussion rather than defend your position
2. Seek out “win-win” solutions that satisfy the needs/concerns of all team members
3. Use active listening skills and summarize what others are saying
4. Seek the rationale for a person’s opinion
5. Avoid voting or averaging to get an answer
6. Don’t be afraid to disagree - address your differences in terms of the idea being
presented, not the person.
Signs of Consensus
During team discussions it can be tough to see if the team is at consensus. If you can
answer “yes” to the following questions, your team may have reached a consensus.
1. Has each person been honestly listened to?
2. Have team members listened and understood the views of others?
3. Can each person summarize each option?
4. Do team members seem supportive of the option being discussed?
5. Has it been a while since any new opinions/views were presented?
8
Biech E. (Ed) (2001). The Pfeiffer Book of Successful Team-Building Tools: Best of the Annuals, JosseyBass/Pfeiffer, San Francisco.
28
Activity 9.4 - Brainstorming: The Paperclip Exercise
Preparation:

Review Part A, Module 9
Time Required:

20-30 minutes
Materials:

Handouts

Pens

Flipchart and markers
This activity requires the following handouts for participants:

Participant Worksheet

Effective Team Decision-Making Process
Description:
Teams often have to come up with innovative solutions to workplace issues. Over the next
20 to 30 minutes, you will use the “brainstorming technique” to examine a problem.
Step 1:

Divide participants into sub-groups

Give the group five minutes to come up with as many uses as they can think of for a
paper clip. Have them record their ideas on a flipchart

Also point out that they should:
o
o
o
Record every idea (no matter how silly)
Not criticize any ideas
Ask questions if an idea is unclear
Step 2:

Ask the groups to identify their most creative use of the paper clip

They could use some of the techniques described in the Effective Team DecisionMaking Process to do so (approximately 15 to 20 minutes)
29
Activity 9.4 – Brainstorming: The Paperclip Exercise
Participant Worksheet
Teams often have to come up with innovative solutions to workplace issues. Over the next 20 to
30 minutes, you will use the “brainstorming technique” to examine a problem. A few important
points to remember for effective brainstorming:
o Record every idea (no matter how silly)
o No criticism of ideas
o Ask questions if an idea is unclear
Step 1: Your group has five minutes to come up with as many uses for a paper clip as you
can. Record all the ideas on a flipchart.
Step 2: Use some of the techniques described in Effective Team Decision-Making to identify
your most creative use of a paper clip (approximately 15 to 20 minutes).
30
Activity 9.4 – Brainstorming: The Paperclip Exercise
Effective Team Decision-Making
Teams are particularly effective at problem solving because they are composed of people with
complementary and varying skills. These skills allow team members to examine issues from
various angles and see the implications of their decisions from a variety of perspectives. Teams
make decisions using problem-solving techniques. This section addresses processes that can
help teams solve problems and make “good” decisions.
To effectively come to a team decision, the following step-by-step approach can be used.9
1. Recognize the Problem - Teams must see and recognize that a problem exists and that a
decision needs to be made to remedy the problem. While this step appears to be
elementary, sometimes teams do not recognize that there is an issue that needs to be
addressed because of groupthink.
2. Define the Problem - In this stage, teams must map out the issue at hand. Teams should:

State how, when and where members became aware of the problem

Explore different ways of viewing the problem – doing so can lead to an improved
understanding of the “core” problem

Challenge any assumptions that are made about the problem to ensure that the team
fully sees the “real” issue at hand

Establish deadlines
3. Gather Information. Once the problem has been defined, teams need to gather information
relevant to the problem. This is in order to 1) to verify that the problem was defined correctly
in Step 2; and 2) aid in the development alternative solutions.
4. Develop Alternative Solutions - While it can be easy for teams to “jump on” and accept the
first solution that is proposed, teams that are effective problem solvers take the time to
explore several potential solutions. Some ways to generate alternative solutions include:
a. Brainstorming - Teams come up with as many ways as possible to solve the problem
at hand. While brainstorming can help generate creative solutions to problems, there
a few guidelines that can help make it effective:
a. No criticism of any ideas during the brainstorming phase
b. All ideas, no matter how silly, get recorded
c. Get past the sillies – sometimes very creative, viable solutions come after
people have made what appear to be “silly” suggestions.
b. Ask Questions - Network with both internal and external colleagues to get their ideas
and suggestions.
c. Explore - Read journals and books, go to networking functions and attend
conferences that cover similar issues. Be prepared to go outside of the health care
sector. Other industries may have faced similar issues and their solutions can
provide valuable insight.
9
Lafferty, J.T. (1988). Subarctic survival situation: Leader’s guide. Plymouth, MI: Human Synergistics.
31
5. Select the Best Alternative - Once all potential solutions have been considered, the team
needs to determine the solution that best addresses the problem. For this to be effective,
both rational and human elements, as well as the implications for the team need to be
considered.
a. Determine the Desired End State - Teams need to clearly define what success looks
like.
b. Evaluate Alternatives against the Desired State - Here, teams discuss the merits of
each alternative solution and the extent to which each of these alternatives can move
the team toward the desired end state. Some teams find it helpful to rate each
alternative on a scale of 1 to 5 where 1 is low and 5 is high.
c. Discuss Potential Adverse Consequences of Each Alternative - Here, teams need to
discuss the potential downsides of each option. To facilitate an objective examination
of adverse consequences, some teams use a mathematical formula. Specifically,
they assess the severity of adverse consequences in terms of the formula:
Adverse Consequences = Likelihood x Severity
Likelihood = the likelihood of the adverse consequence occurring (using a 5-point scale
where 5 is high). Severity = severity if the consequence does occur (using a 5-point
scale where 5 is high).
Personal Skills & Team Decision-Making
It is important to consider personal skills that may affect decision-making. These personal skills
are described in the table below.
Skill
Description
Actively requires team members to:

Active Listening



Pay attention to team discussion and anticipate where the
conversation is going
Objectively weigh what’s been said
Try to understand what the other person is saying
Review and summarize what has been said
People tend to focus on what they perceive to be right and wrong. Being
supportive requires that you:
Supporting Each
Other’s Ideas




Comfort when
Presenting
Differing Views
Assume that others have valid points
Point out the useful aspects of what has been said
Build on these useful points
Avoid unnecessary criticism
Groupthink is a significant concern for teams. To effectively present
differing views and avoid groupthink make sure that you:

Clearly state differing views when they are valid
32
Skill
Description


Participation
Implementing the
Best Alternative
Evaluating the
Outcome
Focus on the reasons for the differences
Treat differences as a source of ideas rather than a source of
interpersonal conflict
To take advantage of the complementary skills in a team, all team
members must participate. Sometimes, one or two people dominate team
decision-making processes because of their interpersonal style (i.e.,
extraverted vs. introverted) or their status/position. This can have a
negative effect when a team is trying to make group decisions.
Once a solution to the problem at hand has been chosen, the team
needs to implement its decision. This requires planning effectively and
communicating the decision to all stakeholders that may be affected by
the decision.
Remember that team building is a learning process. It is critical that the
team examine whether their plans were executed in an effective way and
resulted in positive outcomes.
33
References
Association of Ontario Health Centres (2007). Building Better Teams: A Toolkit for
Strengthening Teamwork in Community Health Centres Association of Ontario Health
Centres Toronto.
Biech E. (Ed) (2001). The Pfeiffer Book of Successful Team-Building Tools: Best of the Annuals,
Jossey-Bass/Pfeiffer, San Francisco.
Lafferty, J.T. (1988). Subarctic survival situation: Leader’s guide. Plymouth, MI: Human
Synergistics.
34
www.hqontario.ca